Phakic IOL (ICL) for Keratoconus
The Visian ICL is an artificial lens that is implanted into your eye to correct high degrees of nearsightedness. It is a type of implant known as a phakic intraocular lens (IOL). Although it is often called the Implantable Contact Lens, ICL officially stands for Implantable Collamer Lens.
Good candidates for the ICL procedure are between the ages of 21 and 45 and are highly nearsighted. Often, phakic intraocular lenses are suggested when LASIK or PRK are not appropriate options because of severe myopia, a thin cornea, or if you have keratoconus.
The ICL can correct high degrees of nearsightedness associated with keratoconus. Sometimes, if there is also astigmatism and corneal irregularity, we will suggest Intacs, topography-guided PRK, or CK to further improve vision correction after the ICL procedure.
The ICL Procedure
The implantation procedure for the Visian ICL involves a procedure similar to that of cataract surgery.
The main difference is that, unlike cataract surgery, the ICL procedure does not require the removal of the eye’s natural crystalline lens. Unlike LASIK or PRK in which the cornea is reshaped by a laser to improve vision, the ICL procedure does not involve the cornea; rather, it involves the placement of a permanent lens within the eye.
About one to two weeks prior to the insertion of the ICL, a YAG laser iridotomy will be performed by our doctors. During this procedure, a YAG laser is used to make one or two small openings near the edge of your iris, which is the colored part of the eye. These openings serve as outlets that will allow the fluid in your eye to circulate around the lens.
The actual ICL procedure will take about 30-60 minutes. ICL implantations are done under topical anesthesia with eye drops to minimize discomfort. Often, a mild sedative is given to make you more relaxed.
Once you are comfortable, the procedure is started by creating two small openings at the edge of your cornea that will be used to position the lens. Next, a gel-like substance is placed inside your eye to protect the natural lens during ICL placement. After placement of the gel, a small opening will be made, through which the lens will be inserted.
Before the Visian ICL procedure, the proper power and size of your implant were selected based on your examination measurements. The proper ICL is then inserted into your eye using a small cartridge that is placed through the incision.
As the lens is inserted, it will gently unfold in your eye. Once it has fully unfolded, the four corners of the lens will be placed behind your iris. This makes the lens invisible to both you and others. Because the incision made during surgery is so small, sutures are typically not needed following ICL surgery, but one or two small sutures may be placed.
After your procedure, eye drops will be administered to help prevent infection and inflammation. You will continue to use these drops for a week or two after your procedure.
You should not drive immediately after ICL surgery, so it is important that you arrange for transportation home. You will return to our office after your ICL surgery in order for our doctors to assess corneal pressure and check that you are doing well.
Vision starts to return the day after the procedure. We will see you for an examination the day after your surgery. It is important to follow your postoperative instructions, especially regarding the needed use of antibiotics and anti-inflammatory medications during the week following the procedure. You should contact us if you experience severe eye pain or a sudden decrease in vision.
After your procedure, you may need adjustments to your specialty contact lenses and/or glasses prescription. Due to the healing involved, we recommend waiting at least one month before you are refit for contact lenses or update your glasses.
ICL combined with Topography Guided PRK
Because the ICL does not correct the corneal irregularity and visual static of keratoconus, sometimes it is suggested that we perform topography-guided PRK before the ICL procedure.
The goal of this is too smooth the corneal optics to improve the ultimate vision after ICL implantation. The following is a report of a patient who received TG-PRK and corneal crosslinking followed by ICL surgery.
For some patients with keratoconus, a stepwise surgical strategy aimed at different components of the disorder – in this case, high myopia, astigmatism, topography irregularity, and prevention of disease progression – may be rewarded by improved visual function.
In assessing patients for adjunctive procedures, it is important to ascertain the patient’s candidacy for all of the procedures that will be undertaken. For example, the patient must have adequate corneal thickness for both TG-PRK and CXL and also have an adequate anterior chamber depth for ICL insertion.
In addition, the patient must also be educated and prepared for at least 3 months of blurry vision because of the period of stabilization required between TG-PRK/CXL and ICL insertion.
For an individual with high myopia, moderate astigmatism, and keratoconus, preparatory TG-PRK/CXL for ultimate phakic IOL insertion may improve uncorrected visual function substantially.
This patient achieved 20/20 acuity in both eyes. However, it is important to have a full discussion with potential candidates about the expected outcomes in their particular case.