Kamra Corneal Inlay

The Kamra corneal inlay is one of the best-known corneal inlays ever developed for presbyopia. It was designed for people who could still see well at distance but needed help reading or doing close work because of age-related loss of near focus. Instead of changing the natural lens inside the eye, the inlay was placed within the cornea.

For many patients, the idea sounded attractive: improve near vision without removing the natural lens and without relying completely on reading glasses. However, as experience grew, doctors also recognized important trade-offs. Some patients were satisfied, while others developed visual symptoms, haze, dry eye, or needed the inlay removed. This is why Kamra is now discussed as both a presbyopia treatment concept and a cautionary lesson in long-term patient selection and follow-up.

What the Kamra Corneal Inlay Is

The Kamra corneal inlay was a very small implant placed within the corneal stroma to improve near vision in presbyopic patients. It was not a lens implant inside the eye and it did not restore the eye’s natural ability to accommodate. Instead, it used a small central opening to increase depth of focus, similar to the way a pinhole can sharpen an image.

This made Kamra different from LASIK, SMILE, cataract surgery, refractive lens exchange, or multifocal intraocular lenses. It did not remove the natural lens and it did not primarily reshape the cornea to create monovision in the usual laser sense. Instead, it altered how light entered one eye.

How the Kamra Inlay Worked

The Kamra inlay used small-aperture optics. In FDA labeling, it was approved to improve near vision by extending depth of focus in the non-dominant eye. The device was implanted intrastromally in a femtosecond-laser-created pocket. In practice, that means the surgeon created a precise pocket within the cornea and inserted the thin inlay at a planned depth and location.

The aim was to improve near and intermediate vision while keeping distance vision as functional as possible. However, because this depended on centering, healing, tear film quality, corneal clarity, and patient adaptation, outcomes were not identical for every patient.

Who It Was Designed For

In its FDA-approved indication, the Kamra Inlay was intended for phakic presbyopic patients between 45 and 60 years old, with a cycloplegic spherical equivalent from +0.50 D to -0.75 D, no more than 0.75 D of refractive cylinder, clear distance vision without glasses or contact lenses, and a reading add between +1.00 D and +2.50 D. In other words, it targeted patients who were close to plano at distance but needed help for near tasks.

This was an important point. Kamra was not designed to solve every refractive problem. It was a presbyopia-specific strategy for a narrow group of patients. It also depended on careful screening of the cornea, ocular surface, and visual expectations.

Potential Advantages of the Kamra Concept

1) It addressed presbyopia without removing the natural lens

Some patients liked the idea of improving near vision without lens replacement surgery. For younger presbyopes, that could feel less invasive than lens-based approaches.

2) It used a reversible concept

The inlay could be removed if necessary. This made it different from some permanent corneal or lens changes. However, “removable” did not always mean “everything returns exactly to baseline.”

3) It could improve useful near and intermediate function

In the right patient, the pinhole principle could improve functional near tasks such as phone use, menus, labels, and computer-range work.

Risks, Downsides, and Why Some Patients Needed Removal

Over time, doctors recognized that the Kamra inlay could also cause important side effects. FDA patient information and AAO education describe problems such as dry eye, glare, halos, blurry vision, reduced night vision, and corneal scarring or haze in some patients. Published explantation studies show that some patients asked to have the inlay removed because of dissatisfaction with visual quality, haze, dim-light complaints, ghosting, glare, or reduced distance clarity.

These are not minor details. Near vision improvement means little if the patient feels that overall vision quality has worsened. Some patients are more bothered by glare, night-vision changes, contrast loss, or fluctuations than others. This is why counseling and realistic expectations were always critical.

Commonly discussed concerns included:

• Dry eye symptoms
• Corneal haze
• Blurred or fluctuating vision
• Glare, halos, streaks, or double vision symptoms
• Reduced quality of vision in dim light
• Need for repositioning or explantation in some cases

What Happened After Explantation?

One of the most important lessons from long-term follow-up is that removal of the inlay did not always reset the eye perfectly to its original state. A published 10-year explantation analysis reported that some patients still had residual corneal haze, hyperopic shift, and reduced uncorrected distance vision after explantation compared with their pre-implant status.

That matters because patients often assume that “reversible” means “no long-term footprint.” In real life, corneal biology can be more complicated. Once tissue has healed around an implant or reacted to it, some changes may persist.

Current Status of the Kamra Inlay

The Kamra Inlay received FDA approval in 2015. However, the FDA PMA database now lists a withdrawal date of February 3, 2022. Published literature has also noted that the product was discontinued in the United States. For patient education, that means Kamra is best understood today as a historically important presbyopia technology rather than a mainstream contemporary option for new treatment planning in the U.S.

This does not mean Kamra patients no longer exist. It means ophthalmologists may still encounter patients who already have the inlay, are considering removal, or want help interpreting symptoms years later.

What Existing Kamra Patients Should Know

If you already have a Kamra inlay and you are comfortable, see clearly enough for your needs, and your surgeon is monitoring the eye, that is one situation. If you have symptoms such as increased dry eye, worsening near or distance blur, glare, halos, night-driving difficulty, or new haze, you should not guess. A proper exam can check the corneal surface, inlay position, corneal clarity, refraction, and whether removal should even be discussed.

Patients should also remember that not every symptom in midlife is caused by the inlay itself. Cataract, ocular surface disease, meibomian gland dysfunction, and other presbyopia-related or age-related eye problems can overlap with Kamra-related complaints. A full evaluation is important.

Why Kamra Still Matters in Refractive Surgery Education

The Kamra story remains important because it teaches several useful refractive surgery lessons:

• Good ideas in optics do not always translate into durable satisfaction for every patient.
• Near-vision gain must always be balanced against overall visual quality.
• “Removable” does not always mean “no long-term consequences.”
• Corneal implants require careful patient selection, counseling, and follow-up.
• Modern presbyopia management must consider safer and more predictable alternatives for the right patient.

Questions Patients Should Ask If They Have a Kamra Inlay

• Is my current blur coming from the inlay, dry eye, cataract, or something else?
• Do I have corneal haze or a refractive shift?
• Is the inlay well centered and stable?
• Would treatment of the ocular surface help before discussing removal?
• What are the realistic pros and cons of explantation in my case?
• What visual changes might remain even if the inlay is removed?

FAQ

1) What was the Kamra corneal inlay used for?

It was used to improve near vision in presbyopia, usually in patients who still had good distance vision and wanted less dependence on reading glasses.

2) How did the Kamra inlay improve near vision?

It used a small-aperture or pinhole effect to increase depth of focus in the implanted eye, usually the non-dominant eye.

3) Was the Kamra inlay implanted inside the eye like a cataract lens?

No. It was not placed inside the eye. It was placed within the cornea, in a stromal pocket created with a femtosecond laser.

4) Can a Kamra inlay be removed?

Yes, it can be explanted. However, removal does not always return the eye exactly to its pre-implant state, and some patients may still have haze, refractive change, or reduced uncorrected distance vision.

5) Why did some patients need Kamra explantation?

Common reasons included dissatisfaction with vision, glare, haze, blurred vision, night-vision symptoms, dim-light complaints, and other quality-of-vision issues.

6) Is the Kamra inlay still a routine modern option?

It is best viewed today as a historically important presbyopia technology. The FDA PMA record lists a withdrawal date in 2022, and current care is more likely to focus on managing existing Kamra patients than implanting new ones in the U.S.

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