Phakic IOLs (intraocular lenses) are an alternative to LASIK and PRK eye surgery for fixing moderate to severe myopia (nearsightedness), and sometimes produce much better and more foreseeable vision results than laser refractive surgery.
Phakic IOLs are clear implantable lenses that are surgically positioned either in between the cornea and the iris (the colored portion of your eye) or simply behind the iris, without eliminating your natural lens. Phakic lenses allow light to focus correctly on the retina for clearer vision without corrective eyeglasses.
Implantable lenses operate like contact lenses to correct nearsightedness. The difference is that phakic IOLs work from within your eye rather of resting on the surface area of your eye.
Likewise, phakic IOLs offer a permanent correction of myopia, unless the lens is surgically eliminated.
Unlike contact lenses, you can’t feel a phakic intraocular lens in your eye (much like you don’t feel a dental filling for a cavity) and, apart from regular eye exams, phakic IOLs typically do not need any maintenance.
Phakic IOL Types
Two FDA-approved phakic IOLs presently are offered in the United States. Your eye surgeon will suggest the most suitable 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 varying from -3.00 to -20.00 D.
Because the Visian ICL is placed behind the iris, it is undetected 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 flexibility, the lens can be folded during implantation, requiring just a small surgical incision.
- Verisyse. The Verisyse (Abbott Medical Optics) is an anterior chamber phakic IOL, implying it is positioned in front of the iris. In 2004, the Verisyse phakic IOL received FDA approval for remedying moderate to severe nearsightedness within the variety of -5.00 to -20.00 diopters (D).
The Verisyse lens is made of medical-grade plastic (polymethylmethacrylate, or PMMA) and is rigid in kind. In Europe, it is authorized and marketed under the brand name Artisan.
Verisyse IOLs usually aren’t noticeable in the eye, though you may see the lens if you look closely in the mirror.
The Visian ICL and Verisyse phakic IOL are FDA authorized to remedy myopia (nearsightedness) only. Scientific trials for both lenses are continuing for potential FDA approval for treating hyperopia (farsightedness). A toric variation of the Visian ICL is being studied for correcting astigmatism along with nearsightedness.
Phakic IOLs vs. LASIK Eye Surgery
LASIK currently is the most popular kind of refractive surgery in the United States. It is safe and reliable, and technology advances such as custom LASIK and bladeless LASIK have made visual outcomes even better.
But not everyone is a good candidate for LASIK surgery. Prospective reasons for not being a good LASIK prospect consist of: having too much nearsightedness, farsightedness or astigmatism; having an unusually thin or irregularly shaped cornea; and having eye conditions such as keratoconus or dry eye syndrome.
For many people who are outside the treatment series of LASIK, phakic intraocular lenses can produce excellent outcomes.
One recent research study that assessed LASIK versus phakic IOL surgery for the correction of -6.00 to -20.00 D of myopia revealed that the two treatments produced basically equal odds of attaining 20/20 vision without restorative lenses one year after surgery.
The research study likewise discovered that patients who went through phakic IOL implantation had much better contrast sensitivity and were more pleased with their outcome than LASIK patients. Neither strategy triggered considerable complications that permanently affected vision.
“Our findings recommend phakic IOLs are much safer than excimer laser surgery for correcting moderate to high levels of short-sightedness,” said lead author Allon Barsam, MD, of the Moorfields Eye Hospital NHS Foundation Trust in London.
The cost of phakic IOLs likewise ought to be taken into consideration; implantable lenses normally are somewhat higher than the cost of LASIK. If your surgeon suggests a phakic IOL over LASIK, it might be prudent to not let cost cloud your decision to follow your surgeon’s recommendations.
After a comprehensive eye examination and health examination, your eye surgeon will recommend on the best type of surgery for you.
Phakic IOLs: What To Expect
Before. If you wear contact lenses, you need to stop using them a minimum of one week prior to your preoperative eye examination and/or assessment. Contacts can change the shape of your cornea and for that reason make your refractive error reading less accurate.
A week or two before your phakic IOL surgery, your eye surgeon may carry out a laser iridotomy on each eye to prepare your eye for lens implantation. An iridotomy develops a small opening at the external edge of your iris, allowing fluid to distribute and helps to avoid a possible boost of intraocular pressure after phakic IOL surgery.
The iridotomy procedure usually is carried out in-office and is relatively quick, taking just a few minutes for each eye. It is essential that you follow your surgeon’s instructions after the procedure to minimize any possible complications.
Some surgeons have actually included the iridotomy procedure on the very same day as the phakic IOL surgery.
During. Numbing eye drops are first used to your eye to relieve any discomfort during the procedure. Your doctor may also offer you some medication to assist you unwind.
An instrument called a lid speculum is used to keep your eyelids open and a tiny cut 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 versatile and foldable product 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 frequently are used to close the injury and an eye guard is put over your eye.
The Visian ICL is placed in the posterior chamber of the eye behind the iris and pupil and in front of your natural lens. As soon as placed, the artificial lens unfolds to its complete width and normally does not need any stitches. An eye shield is then positioned over your eye and needs to be used for a day or two after the procedure.
How long does phakic IOL procedure last? The phakic IOL procedure generally takes 10 to 30 minutes and is performed on an outpatient basis, although you will have 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. Many people observe improved vision instantly following the phakic IOL procedure, but vision may be hazy or blurred with an increased sensitivity to light for the first couple of days. For some people, it can take two to four weeks for their vision to stabilize.
Vision with the Visian ICL tends to support in about one to seven days, which can be quicker than with the Verisyse lens.
There generally is very little discomfort after phakic IOL surgery however you may have a mild scratching sensation, like something is in your eye. If needed, your doctor can recommend medication to make you more comfortable during the first few days following surgery.
You will have to return for a follow-up see with your doctor the next day. It’s essential that you follow your eye surgeon’s post-operative directions carefully and attend frequent check-ups to assist prevent any complications.
Refrain from rubbing or squeezing your eye, raising heavy items and taking part in strenuous activities up until your eye has actually totally recovered, which might take a number of weeks.
Most people can return to work and resume driving within a couple of days, as soon as you are provided the okay from your doctor.
Phakic IOL Vision Outcomes
In a research study of 3-year outcomes of the FDA scientific trial of the Verisyse lens, 84 percent of patients achieved uncorrected vision of 20/40 or better, which is the legal limitation for owning without prescription glasses in most states. And 31 percent achieved uncorrected vision of 20/20 or much better.
In FDA trials of the posterior chamber Visian ICL, 81 percent of patients achieved uncorrected visual acuity of 20/40 or better.
Forty-one percent achieved uncorrected vision of 20/20 or much better.
Patient fulfillment with the quality of vision with both types of phakic IOLs was usually high.
Some patients, particularly those with extremely severe myopia, elect to go through LASIK as a follow-up to further enhance vision after phakic IOL surgery.
Phakic IOLs are an effective option for people with moderate to severe nearsightedness who fall outside the treatment series of LASIK. When considering implantable lenses– or any refractive surgery – make certain to talk about all the benefits and risks with your eye surgeon.