. Phakic IOLs (intraocular lenses) are an alternative to LASIK and PRK eye surgery for correcting moderate to severe myopia (nearsightedness), and in some cases produce better and more predictable vision outcomes than laser refractive surgery.
Phakic IOLs are clear implantable lenses that are surgically placed either between the cornea and the iris (the colored portion of your eye) or just behind the iris, without removing your natural lens. Phakic lenses enable light to focus properly on the retina for clearer vision without corrective eyewear.
Implantable lenses function like contact lenses to correct nearsightedness. The difference is that phakic IOLs work from within your eye instead of sitting on the surface of your eye.
. Two FDA-approved phakic IOLs currently are available in the United States. Your eye surgeon will recommend the most appropriate implantable lens for you.
Visian ICL. The Visian ICL (Implantable Collamer Lens) marketed by Staar Surgical is a posterior chamber phakic IOL, meaning it is positioned behind the iris and in front of your natural lens. It received FDA approval in 2005 for correcting nearsightedness ranging from -3.00 to -20.00 D.
Because the Visian ICL is placed behind the iris, it is undetectable to the naked eye and can only be seen through a microscope.
The Visian ICL is made of a soft, biocompatible collagen copolymer. Due to its flexibilty, the lens is able to be folded during implantation, allowing for a much smaller surgical incision.
Verisyse. The Verisyse (Abbott Medical Optics) is an anterior chamber phakic IOL, meaning it is positioned in front of the iris. In 2004, the Verisyse phakic IOL received FDA approval for correcting moderate to severe nearsightedness within the range of -5.00 to -20.00 diopters (D).
The Verisyse lens is made of medical-grade plastic (polymethylmethacrylate, or PMMA) and is rigid in form. In Europe, it is approved and marketed under the trade name Artisan.
Verisyse IOLs typically aren’t noticeable in the eye, though you may see the lens if you look closely in the mirror.
. Are You a Candidate for Phakic IOLs?
Not all patients are candidates for phakic intraocular lens implantation, just like not all patients are candidates for LASIK.
Some questions to help determine whether phakic IOLs are right for you include:
1. Is your myopia within the range for which the phakic IOL has been approved (up to around -20.00 D)?
2. Have you had a comprehensive eye exam to determine that your eye can safely accommodate an implantable lens? Of particular importance is the depth of the anterior chamber of your eye and the health of the corneal endothelium.
3. Are you between the ages of 21 and 40? Even if you are outside this age range, you may still be a candidate for a phakic IOL and should discuss with your eye surgeon. While a phakic IOL does not treat blurry near vision due to presbyopia, a normal age-related condition that generally starts in your early 40s, monovision IOL surgery can help.
4. Has your eyeglass or contact lens prescription changed in the past year? For vision correction surgeries, you must have had stable vision for at least a year.
5. Are your eyes healthy? Conditions such as cataracts, glaucoma and untreated eye infections generally will prevent you from having a phakic IOL.
6. Are you in good health? Certain degenerative or autoimmune diseases such as Sjogren’s syndrome, rheumatoid arthritis, type 1 diabetes, HIV and AIDS, as well as certain medications such as steroids and immunosuppressants may interfere with healing and final outcomes.
7. Will the cost of phakic IOLs — from pre-screening to ongoing regular check-ups — be covered by your vision insurance?
Phakic IOLs: What to Expect
Before. If you wear contact lenses, you should stop wearing them at least one week before your pre-operative eye exam and/or consultation. Contacts can alter the shape of your cornea and therefore make your refractive error reading less accurate.
A week or two before your phakic IOL surgery, your eye surgeon may perform a laser iridotomy on each eye to prepare your eye for lens implantation. An iridotomy creates a small opening at the outer edge of your iris, allowing fluid to circulate and helps to prevent a possible increase of intraocular pressure after phakic IOL surgery.
The iridotomy procedure typically is performed in-office and is relatively quick, taking only a few minutes for each eye. It is important that you follow your surgeon’s instructions after the procedure to minimize any possible complications.
Some surgeons have incorporated the iridotomy procedure on the same day as the phakic IOL surgery.
Insertion of the Verisyse phakic IOL.
During. Numbing eye drops are first applied to your eye to alleviate any discomfort during the procedure. Your doctor may also give you some medication to help you relax.
An instrument called a lid speculum is used to keep your eyelids open and a tiny incision is made in the cornea. The incision length for a Verisyse lens is around 6 mm; the Visian ICL incision is as little as 3.2 mm due to the flexible and foldable material of the lens.
With the Verisyse, the lens is positioned in the anterior eye chamber behind the cornea and attached to the front of the iris. Tiny dissolvable stitches often are used to close the wound and an eye shield is placed over your eye.
The Visian ICL is positioned in the posterior chamber of the eye behind the iris and pupil and in front of your natural lens. Once inserted, the artificial lens unfolds to its full width and typically does not require any stitches. An eye shield is then placed over your eye which needs to be worn for a day or two after the procedure.
The phakic IOL procedure typically takes 10 to 30 minutes and is performed on an outpatient basis, although you will need to organize someone to drive you home after surgery. Your doctor will prescribe antibiotic and anti-inflammatory drops for you to use at home.
After. Most people notice improved vision immediately following the phakic IOL procedure, but vision may be hazy or blurry with an increased sensitivity to light for the first few days. For some people, it can take two to four weeks for their vision to stabilize.
Vision with the Visian ICL tends to stabilize in about 1 to 7 days, which can be quicker than with the Verisyse lens.
There typically is minimal discomfort after phakic IOL surgery but you may have a mild scratching sensation, like something is in your eye. If required, your doctor can prescribe medication to make you more comfortable during the first few days following surgery.
You will need to return for a follow-up visit with your doctor the next day. It’s essential that you follow your eye surgeon’s post-operative instructions carefully and attend frequent check-ups to help avoid any complications.
Refrain from rubbing or squeezing your eye, lifting heavy objects and participating in strenuous activities until your eye has completely healed, which could take several weeks.
Most people can return to work and resume driving within a couple of days, once you are given the okay from your doctor.
Risks and Complications
As with any type of surgical procedure, phakic IOL surgery has certain risks. Fortunately, these risks are low. Possible short-term and long-term complications of phakic IOL surgery include:
- Retinal detachment, a serious and sight-threatening emergency situation.
- Glaucoma, increased eye pressure that can damage the eye’s optic nerve and cause permanent vision loss.
- Loss of cells in the thin layer inside the cornea (endothelium) that could cause corneal edema and progressive clouding of vision (your doctor will measure your endothelial cell count at regular intervals).
- Inflammation or infection of the eye.
- Distorted vision such as halos or glare, especially while driving at night, and blurry vision.
- Cataracts, a clouding of your natural lens which can eventually cause blindness if left untreated.
- Distortion of the pupil, which increases the potential for glare and blurry vision.