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KAMRA Vision™

KAMRA Vision™ is a revolutionary reading vision procedure that is based upon small aperture optics. It allows patients to read and perform near tasks without the complete dependence upon bifocals or reading glasses. Every patient around 45 years of age will be affected by presbyopia, the natural loss of focusing muscle strength in their eyes making it increasingly difficult to read without glasses. For some patients it may begin even before they reach age 40, for others perhaps age 50 or later, but everyone will eventually notice that they are holding printed material further away and needing more light to read. It is a genuinely frustrating part of the aging process, especially for people who have never depended on glasses or contacts before.

The KAMRA Vision™ reading procedure works by creating a small pocket or corneal flap within the cornea with a Femtosecond laser, the same laser technology used for advanced Custom LASIK. This laser opening allows for the insertion of the KAMRA corneal inlay, a very thin disc shaped implant. It is placed in front of the pupil in the eye within the cornea. The KAMRA corneal inlay is 3.8 mm in diameter with a 1.6mm central opening and is remarkably only 5 microns thick, which is thinner than a red blood cell. Read more... The central opening increases your depth of focus, and allows you to see at both distance and near. It is made of an inert material PolyVinyliDene Fluoride, or PVDF. The KAMRA corneal inlay was developed in 2005 and is now approved in 45 countries worldwide, from Argentina and Chile in South America, to England and France in Europe, to the other side of the globe in Japan and Australia. The KAMRA corneal inlay is approved in Canada and is already more than two years into FDA clinical trials in the USA. What is most remarkable about this procedure is that similar to when LASIK was first introduced in the early 1990′s, ophthalmic surgeons have been amongst the first patients to have the procedure, including Dr. Machat.

Dr. Machat was not only the first surgeon to perform Custom LASIK and Custom All Laser LASIK (Bladeless Custom LASIK) in Canada, he helped popularize these procedures, training and lecturing to surgeons in twenty countries. Traveling to Europe and South America to learn these LASIK techniques and then bringing them back to Canada. To learn the KAMRA Vision™ reading vision procedure, he once again traveled to South America where he performed his first procedures on May 21, 2012. In August 2012, he then travelled to Japan to broaden his clinical experience and have the procedure done himself with Dr. Minoru Tomita, Medical Director of the Shinagawa Clinic. You may view Dr. Machat’s patient journey by clicking here. In September 2012, he travelled to Europe to further his training and understanding, and then completed his Canadian certification that same month.

Dr. Machat has been involved in multiple clinical trials over the past decade to improve reading vision for his patients, ranging from Multifocal laser treatments that place various bifocal type patterns on the eye, to monovision techniques, to scleral implants. He has travelled to Bogota, Columbia and to Germany to investigate an intracorneal Femtosecond laser technique, INTRACOR, and reviewed countless other approaches. However it was not until KAMRA Vision™ that he had found a procedure that possessed the combination of four unique qualities that could benefit not only his patients but also himself:

  1. KAMRA Vision™ provides near vision while preserving distance vision
  2. KAMRA Vision™ provides intermediate vision in addition to near vision
  3. KAMRA Vision™ provides intermediate and near vision that will remain stable for decades
  4. KAMRA Vision™ is a reversible procedure providing greater safety


Comparing KAMRA Vision™ with other Reading Vision Procedures

The most common method of providing patients in their 40′s and 50′s with a continued ability to read following LASIK is to leave one eye a little nearsighted. This technique is known as Monovision or Blended vision. However, Monovision is a compromise, near vision is gained at the expense of distance vision. The better the vision for near, the more blurry the distance vision becomes. Read more... Monovision patients generally notice more night glare and some find themselves feeling off balance. Many patients are corrected with Monovision in their contact lenses, and those that adjust well to Monovision contacts, do well with Monovision LASIK. Like KAMRA Vision™, an advantage that Monovision has over other Multifocal laser treatments is that it is readily reversible by performing additional LASIK surgery. In general, while Monovision is a good solution for some patients experiencing presbyopia, patients must be prepared for a lack of sharpness in their distance vision, and also must realize that the strength of the near vision is limited and diminishes with time.

Multifocal ablations provide near and distance correction in the same eye, much the way multifocal or progressive bifocals do in glasses and contact lenses. The two biggest limitations with this technique go hand in hand. Not everyone will be able to tolerate or adjust to the quality of vision changes associated with multifocal treatments and if you are unable to, this is a very difficult treatment to reverse. Reversing multifocal ablation patterns is very difficult because of the complex nature of the laser patterns. While patients do feel balanced with multifocal ablations, there still may be an adjustment period because dual images for near and far are presented to each eye simultaneously. In the majority of people, the brain is capable of separating the images and focusing on the image related to the task at hand, while ignoring the other image. In some patients, it can be too challenging and then the lack of reversibility becomes the real issue.

KAMRA Vision™ is able to preserve excellent distance vision, even improving distance focus in many people in sharp contrast to Monovision, which by its nature blurs distance vision in every patient. The small opening in the center of the KAMRA® inlay acts as an F stop of a camera, eliminating extraneous light rays, and helping to focus the central light rays providing a clearer image on the retina for not only reading vision but distance vision as well. The central opening of the KAMRA® inlay preserves the distance vision, and as no laser is applied to the central cornea, it provides far greater safety and even reversibility compared to Multifocal laser treatments. Patients remain balanced because both eyes retain excellent distance vision, even though the KAMRA Vision™ procedure is only performed on one eye, overwhelmingly the non-dominant eye. The dominant eye is the one that is typically used to look through a camera viewfinder, or sight a rifle. Another important differentiating factor in favour of the KAMRA Vision™ Reading vision procedure is that by acting as an F Stop on a camera the depth of focus is significantly increased to about 2.5 diopters of additional add. This increased depth of focus means that KAMRA Vision™ will provide a greater range of focus, with both intermediate and near vision. Furthermore, this reading vision improvement remains stable whether a patient is 50 or 60 or even 70 years of age. Monovision however decreases in its reading power over time and patients will require a increasing need for reading glasses as they age. Hide...

Steps in the KAMRA Vision™ Reading Vision Procedure

The KAMRA Vision™ procedure may be performed on its own, with, or even years after patients have undergone LASIK, PRK and even Cataract surgery, to provide or restore better reading vision without compromising distance. Read more... If patients require distance vision correction or cataract surgery as well, then the steps Custom LASIK, Custom PRK and Premium Cataract Surgery are explained in their respective website section. The KAMRA Vision™ reading vision procedure is a very brief and complementary procedure to other refractive procedures.

In contrast to LASIK and PRK for distance vision correction, only one eye is treated in the KAMRA Vision™ procedure as noted earlier. The first step is to anesthetize the eye to be treated with topical anesthetic eye drops and instill topical antibiotics to help prevent infection. No needles are used. The cornea will be completely numbed through drops alone, and Dr. Machat is very generous with his use of topical anesthetic. The second step is to insert an eyelid holder. Patients are always worried that they will blink but the anesthetic drops eliminate the blink reflex. Next, the suction ring is applied to the eye, holding it in position for the creation of a corneal pocket or corneal flap with the Ziemer Femtosecond laser for the KAMRA® corneal inlay. Once again, patients are always worried about their eye moving but the suction ring holds the eye in perfect position. Minimal pressure is sensed during this step, much like rubbing your eye. The Femtosecond laser is painless and takes about 15 seconds to create the flap or pocket, which is about 4.5 mm wide and 9mm long. Patients will see lights dancing during this step. Once the flap or pocket is created over the pupil, the KAMRA corneal inlay can be inserted and positioned over the visual axis.

The technique and equipment that Dr. Machat has selected is precisely the same equipment that Dr. Tomita utilizes in Japan and was used on his own eye. Dr. Tomita has several different laser systems, but uses this technology for his VIP patients and charges a premium to other patients who select this technology. Previously Dr. Machat had used the Visx and WaveLight excimer laser systems and the Intralase Femtosecond laser but based on his review with other KAMRA Vision™ surgeons globally and Dr. Tomita, he elected to bring the first Schwind AMARIS 750S excimer laser system into Canada and the Ziemer Femtosecond Laser.

Medication Regimen

Topical antibiotics and topical steroid drops are the mainstay of the post-operative care regimen during the first week. Patients are placed on topical antibiotic drops to prevent infection and topical steroid drops to control inflammation and swelling.

After the first week, only topical steroid drops are required to help the healing process, which continues for three to six months. It is also strongly recommended that patients utilize artificial tear supplements to moisturize the eye during the recovery phase. Hide...

Risks of the KAMRA Vision™ Reading Procedure

Read more... The most common complication with the KAMRA Vision™ Reading vision procedure is the need to realign the corneal inlay position. This occurs in 1-3% of patients, and varies with the sensitivity of each patient. Pre-operatively an AcuTarget image is acquired that denotes the pupillary center and visual axis, which varies from patient to patient. The AcuTarget image is utilized to determine the ideal alignment of the KAMRA® Corneal Inlay and is used for guidance during the surgical placement of the corneal inlay. If the corneal inlay is misaligned it can produce asymmetrical night glare, ghosting of images, and a lack of visual improvement for reading. In these cases, the AcuTarget measurement is repeated and if misaligned, the corneal inlay is realigned based upon the clinical findings.

The most common symptom with the KAMRA Vision™ procedure is the development or worsening of dry eye symptoms. Many patients have dry eye symptoms pre-operatively but these can be exacerbated by any surgery including the KAMRA Vision™ procedure. For this reason, dissolvable punctual plugs and artificial tears are utilized but if necessary, prescription medication such as Restasis® can be prescribed.

The most common side effect is night glare, which varies highly from patient to patient. The physics of small aperture optics restricts the amount of light entering the eye, like the F stop of a camera controlling the diameter of the iris diaphragm. This principle explains why under low light conditions, the amount of light entering the eye is restricted and reading vision is not as clear as with normal ambient lighting.

When driving at night, the pupil expands as normal, but the KAMRA corneal inlay acts as an artificial pupil. There are 8400 tiny perforations in the corneal inlay allowing the cornea to receive adequate oxygen and nutrients. Thus patients may note more night glare in the corneal inlay eye than their dominant distance eye. However with both eyes open the brain adjusts over several months and the amount of night glare dissipates. It is important to not cover each eye separately and compare eyes as this only serves to dissociate the images and prolong the neural integration and suppression of the night glare.

Dr. Machat spent time with multiple KAMRA Vision™ surgeons, the videos of which can be viewed on this website as well. He attended the Acufocus Surgeon Conference in Japan and spent numerous days at the Shinagawa Clinic, following his training in South America. Dr. Machat then completed further clinical training in Canada when the procedure received Health Canada approval. Hide...

Dr. Machat’s KAMRA Vision™ Story

Dr. Machat was able to see well all his life at a distance and read comfortably up close, but as he approached 50, he began to struggle with his BlackBerry, reading a menu, and with prices and labels. It was when his daughter made fun of the size of his BlackBerry text that he decided he needed to do something about it. Everyone has their own reason, the hassle of their reading glasses, constantly losing them, forgetting them or simply feeling old when wearing readers in public. In today’s world, we all strive to take care of ourselves far better than previous generations. As they say, 50 is the new 40. So in this new world, wearing reading glasses or bifocals visibly makes us stand out and designates us as “older”. Dr. Machat readily admits, he did not want to be seen wearing readers, did not want people to guess his age so easily. He wanted to be without readers longer, he wanted to reclaim his youth. Read more...

During the week prior to Dr. Machat’s procedure, he was interviewed and that interview was also recorded and is available for viewing. Just as his patients had told him for more than two decades, Dr. Machat explains how nervous he was prior to his procedure. More importantly, in his post-procedure interview, Dr. Machat happily admits that it was far easier than he expected, something he had also heard from his patients for the past two decades. The next morning Dr. Machat was able to read the fine print on the shampoo bottle, the ingredients on his sweetener package and the newspaper. Although he realizes that this is not typical, he was deeply satisfied to stop depending upon his readers. The next step for Dr. Machat was to reduce the size of his BlackBerry font. Dr. Machat on his first week check up was measured at 20/25 for distance, one line better than his pre-procedure measurement and 20/20 at near, five lines better than pre-operatively. Over the next few weeks his near vision improved further to better than 20/20.

The typical visual recovery takes one week to one month but some patients will bounce back much more rapidly. Every patient heals at their own rate. In particular, Dr. Machat had excellent distance vision so he only required the KAMRA® Inlay inserted through a laser corneal pocket, whereas most patients require LASIK and the KAMRA® Inlay.

Dr. Machat is the first Toronto patient to have the KAMRA Vision™ Reading Procedure but the third surgeon in Canada. Dr. Machat knew there were no guarantees, but of all the procedures to help reading vision, he was most comfortable with the success and safety profile of the KAMRA Vision™ procedure. Hide...