Refractive surgery remains one of the most popular elective surgeries completed throughout the world and laser vision correction continues to be an effective option. One alternative to consider, especially for those who are not ideal candidates for laser vision correction, is the Visian ICL. The following highlights it’s use in one of our refractive surgery patients.
S.T. presented for consultation on laser vision correction in August of 2015. She was deemed a non-ideal candidate for both LASIK and PRK. While her prescription (-8.75 -0.75 x 019 OD, -9.25 -0.75 x 151 OS) was within the range of what is correctable with laser vision correction, her pachymetry was borderline for such a high correction and the ICL has been shown to give better vision quality at high levels1. Incidentally, S.T. also had a small retinal hole in her right eye.
She was referred for consultation with Dr. Abraham for focal laser treatment and consultation with Dr. Spencer for the ICL procedure. She underwent focal laser treatment in her right eye to reduce the risk of retinal detachment. Approximately one month later she had the ICL placed in her right eye, with the left eye receiving the ICL the following week. Vision at her one-week post-op measured 20/20 in the right eye and 20/25 in the left eye. S.T. was happy with the results and reported “seeing great!” Post-op refraction measured +0.50 -0.50 x 017 in the right eye and +0.50 -0.50 x 002 in the left eye.
Dr. Spencer has been utilizing the ICL for eight years. The surgery process is very similar to intraocular lens placement in cataract surgery. The ICL is designed to be positioned directly behind the iris in phakic patients. It is made from a proprietary polymer similar to collagen known as Collamer. This material is flexible, biocompatible and provides 100% UV A & B protection2. It is FDA approved for those with between -3 and -20 diopters of myopia for patients 21 to 45 years of age. Patients need an anterior chamber depth of at least 3.0 mm, normal endothelial cell count and a stable refractive error.
The ICL does not correct astigmatism. Limbal relaxing incisions can be performed at the same time as implantation for low levels of astigmatism (generally 1.5 diopters or less) or PRK can be performed approximately 6 weeks post-implantation for higher degrees of astigmatism. The toric ICL is
available outside of the United States, but timing on FDA approval is unknown and speculative. Laser peripheral iridotomy (LPI) is completed prior to implantation to reduce the risk of glaucoma from pupillary block. Cataract formation appears to be the highest risk in those receiving the ICL. Changes in lens design have helped to reduce this risk3. In our practice, we will complete laser vision correction in those with up to -10.00 diopters of myopia, but those above -8.00 are counseled that the ICL may give them the best chance for best vision. Please do not hesitate to contact us if you have any questions.
Steve Khachikian, M.D. Scott Schirber, O.D. Terry Spencer, M.D.
- Sanders DR, Vukich JA. Comparison of implantable contact lens and laser assisted in situ keratomileusis. Cornea. 2003; 22(4): 324-31.
- Data on file: STAAR Surgical Company. ©2008 STAAR® Surgical Company 10-0004-35
- Fernandes P, Gonzalez- Meijome JM, et al. Implantable collamer posterior chamber intraocular lenses: a review of potential complications. J Refract Surg. https://repositorium.sdum.uminho.pt/bitstream/1822/13782/1/5.5.62.%2520FERNANDES_11_JRS%2520(Review%2520on%2520ICL%2520Safety).pdf Posted online: June 2011, accessed December 2016.