What if you find you are not a candidate for LASIK or PRK? Do you feel like your prescription is too high? What if you still want to be glasses free and see the world clearly? Is there any other options? The answer is YES! You may be a candidate for phakic intraocular lenses, another type of refractive surgery.
What are Phakic Intraocular Lenses (Phakic IOL)?
Phakic intraocular lens is a special type of lens designed to correct vision in the same way as contact lenses except they are placed permanently in the eye. The term phakic means that the natural lens in the eye is not removed. Some people get the term phakic confused with aphakic lens. Aphakic lens is used in cataract surgery where the natural lens is removed and replaced with a new lens. IOL stands for IntraOcular Lens which are small lens implants. Therefore, the term Phakic IOL means an artificial lens which is implanted inside the eye, leaving the eye's natural lens in place. Phakic IOLs are often used to correct vision in patients unsuitable for LASIK (thin corneas, high refractive errors, etc). There are different types of phakic intraocular lens such as the implantable collamer lens (ICL) and the phakic refractive lens (PRL).
Who are candidates?
Phakic IOLs are indicated for patients not suited for LASIK. The surgeon will consider in the following cases:
High amount of near-sightedness (myopia) or far-sightedness (hyperopia)
High amount of astigmatism
Thin cornea
Severe dry eyes
Patients 21-55 years of age with an anterior chamber depth of 3.00 mm or greater
What are the advantages?
Wide range of treatment
Minimal side effects
Made of biocompatible material which is gentle to the eye
Small and foldable for easy insertion
Small Incision which eliminates need for any sutures
Does not alter the tissue of the cornea
Can be combined with other corrective options
Reversible in effect - lens can be removed or replaced if needed
What steps are involved in the procedure?
Certain eye measurements are taken and evaluated prior to the procedure in order to customize the lens for each individual. The procedure is considered to be out-patient which means that it is not necessary to stay overnight due to minimal risks involved. Implanting the phakic intraocular lens is actually a two-part process.
YAG laser is applied to make two to three small openings in the peripheral iris, the colored portion of the eye. The openings guard against possible elevation of intraocular pressure immediately following the implantation of the new lens. This is done 1 week prior to the implantation.
Insertion of the phakic intraocular lens itself.
Its foldable design makes it easy to insert the lens through a small (3 mm to 3.5mm) incision in the cornea, the outer surface of the eye. The incision is self-sealing so no stitches are required. As the phakic IOL is inserted, it slowly unfolds and is then carefully placed behind the iris and in front of the natural lens. This placement makes the lens invisible to the naked eye.
Patients receive topical or local anesthesia to minimize any discomfort during the procedure. Implanting the phakic IOL is considered an outpatient procedure and takes 30 minutes. However, the whole process takes a few hours due to preparation time, dilation of the eyes, and postoperative monitoring. It is advised for the patient to have someone drive them home after completion of the procedure.
This is a unilateral procedure where one eye is treated and has to recover properly before implanting the lens into the second eye, which normally takes about 1 week.
What are some expectations and chance of success?
After the complete preliminary eye exam, the phakic intraocular lens will be ordered to customize to your eyes. This can take up to three weeks, depending on your prescription. For toric phakic IOL to correct for astigmatism, the lens order may take longer, up to 6 weeks. Therefore, with the one week interim between each operated eye, the whole process could take about five weeks, or eight weeks for astigmatism correction.
If residual refractive errors should occur in the future, a second procedure to adjust or replace the phakic IOL is possible. Otherwise, corneal laser surgery (LASIK or PRK) to correct the vision may be recommended.
Implantation of the phakic intraocular lens does not help with age related far-sightedness (presbyopia). In the natural process of aging, everyone will notice more difficulty reading fine print starting at the age of 40 years old. Therefore, phakic IOL patients will experience this aging change just the same as normal people and reading glasses will be necessary.
Postoperative Care
There is a critical follow up care schedule after each phakic IOL treatment. This is to assure proper healing and provide continued care. The postoperative appointments are at the following time increments, from the day of treatment per eye accordingly:
One day
One week
One month
Three months
One year
Your doctor will adjust medications accordingly, and can request additional follow up appointments if necessary. If the other eye also needs phakic IOL treatment, this can be determined at the one week follow up exam.
There are some guidelines and restrictions following the surgery. A list of instructions will be given. A few of the instructions for the first two weeks include:
No swimming or getting water into the eye
Limit activities that would cause sweating
Limit rigorous activities which could cause strain
Refrain from coughing or sneezing forcefully
Be cautious with head, making sure not to shake it or look down
Be cautious with staircases
Avoid cooking and cleaning
Keep a soft light diet
No eye make-up
Refrain from playing with pets and children
What are possible side effects and complications?
As with any surgeries, there are possible side effects and complications. The risks and success rates will vary depending on which lens your surgeon chooses to implant in your eye. The details will be further discussed on the day of your preliminary exam. Some reported complications include:
Lens repositioning
Lens decentration
Trace of lens opacities
Intraocular pressure spikes
Inflammation/Infection
Some patients may experience dizziness due to the temporary increased eye pressure, but this will gradually disappear in a couple of hours after the treatment.
Your doctor will be giving you additional information on the risks and the benefits prior to having the procedure to help you decide if phakic intraocular lenses are right for you.
