FAQ: Implantable Contact Lens
Who are the best candidates for the ICL and is the ICL better than Laser Vision Correction (LASIK / PRK)?
Deciding on the vision correction procedure that’s right for you is an important one. The VISIAN ICL/LASIK/PRK COMPARISON – (Printable PDF) provides a general comparison of the major differences between the Visian ICL, LASIK and PRK. It is NOT an exhaustive list, nor is it a substitute for the advice of your doctor. ONLY AN EXTENSIVE EXAMINATION BY YOUR EYE CARE PROFESSIONAL CAN PROVIDE THE INFORMATION NECESSARY TO DETERMINE WHICH PROCEDURE IS UNIQUELY SUITED FOR YOU. To determine if you are a suitable candidate, contact us to schedule a complimentary evaluation.
What are the U.S. FDA indications for the ICL?
The Visian ICL™ was U.S. FDA approved in December 2005. It is intended for use in adults with healthy eyes and stable spectacle and / or contact lens prescriptions. It is designed for:
· The correction of myopia ranging from -3 to -15 diopters (D) with less than or equal to 2.5D of astigmatism at the spectacle plane
· The reduction of myopia ranging from -15D to -20D with less than or equal to 2.5D astigmatism at the spectacle plane
· Adults 21 years of age or older with a stable refractive history within 0.5D for 1 year before implantation
A toric version of the Visian ICL™ for patients with myopia and astigmatism has completed US FDA trials and is under review; results are very promising!
The Visian ICL™ is not approved for patients with hyperopia in the U.S.
What will it accomplish?
The Visian ICL™ may reduce or eliminate your dependence on glasses or contact lenses. In a clinical study of 294 patients implanted with the Visian ICL™, 95 percent had 20/40 or better vision (considered standard vision necessary to obtain a driver’s license), and 59 percent had 20/20 or better after three years.
What preparation is required?
A tiny hole in the iris is made with a laser prior to the ICL procedure to prevent a serious form of intraocular pressure increase or Glaucoma from developing. Drs. Erdey and Kaswinkel prefer to make this iris hole surgically at the same time as the ICL implant, thus avoiding the laser technique entirely.
Can both eyes be implanted with an ICL at once? If not, how long must I wait before surgery is performed on the second eye?
One eye is operated on at a time. The second eye may be implanted with the ICL later the same day, the next day, or a week or more after the first. In the interim, you can generally continue contact lens wear in your untreated eye, if applicable. Your doctor will help you decide which strategy is best for you.
Can the ICL dry out or become soiled or damaged like a contact lens?
No. The ICL is designed to remain in place within the eye without maintenance. We recommend an annual eye examination to make sure that everything is fine.
Can I feel the ICL once it is in place?
The ICL is not noticeable after it is implanted. It does not attach to any structures within the eye and does not move around after it is in position.
If I receive an ICL will I always remain free of corrective lenses?
- In patients with myopia of -3.0 to -15.0 Diopters (D), the vast majority do not require corrective lenses after ICL implantation. However, in patients with extreme myopia, -15 to -20 D or higher (“Coke-bottle” spectacles), use of corrective lens after ICL implantation may be necessary to correct any residual refractive error. In either case, complete independence from corrective lenses while very common, is not guaranteed. Glasses or contact lenses may only be needed occassionally (ie. driving at night or other activities performed in low light conditions). In certain cases, supplemental Laser Vision Correction to “fine tune” the result may be considered.
- Individuals in their teens to mid 20’s may naturally develop gradual changes in their spectacle or contact lens prescription due to continued growth of the eye. Implanting the ICL after your spectacle or contact lens prescription has remained stable for a year or more reduces the possibility that dependence on corrective lenses could again develop. Supplemental Laser Vision Correction to “fine tune” the result could be considered in those few who experience a refractive shift years after ICL implantation.
- In patients age 43 or older with presbyopia the ICL is capable of reducing or eliminating the need for distance glasses, but reading (near vision) glasses will still be required.
- As the eye ages, cataract formation may shift the refraction of the eye. If such a patient had an ICL implanted years earlier without subsequent need for distance corrective lenses, they may once again require glasses because of changes in the power of the crystalline lens induced by the cataract. More dramatic shifts in an eye’s refraction accompanied by optical degradation due to cataract formation are easily reversed by removal of the ICL followed by cataract surgery with an intraocular lens.
What should I expect if I eventually require cataract surgery and I have an ICL?
Many patients who developed cataracts years after they had a cornea refractive procedure (LASIK, PRK, RK) have had successful cataract surgery and intraocular lens (IOL) implantation with good results. However, the required implant power is more challenging to predict because the modified corneal curvature cannot be accurately measured. Further, the optics of the combination (modified cornea with an IOL) are generally not as optimal as a similar patient who develops a cataract years after ICL implantation. In the latter case, the ICL is easily removed, the original corneal curvature is preserved (never modified) and cataract surgery with an intraocular lens is implanted, yielding superior optical results.
Are there risks to ICL implantation?
No surgical procedure is risk-free. There are potential complications associated with the surgery itself. These include: irritation of the conjunctiva, corneal swelling, eye infection, non-reactive pupil and irritation of the iris. In the vast majority of cases, these complications are short term, transient in nature, and will be treated by the doctor performing the surgery.
Other complications that can occur are associated with the correction of your vision; these include: halo and/or glare around lights, under or over correction of your vision (which may require retreatment), and induction of higher order aberrations that can impact quality of vision. Again, the vast majority of these complications will be treated by the doctor performing your surgery. The Visian ICL procedure does not cause or worsen dry eye and the lens can be removed if needed.
Early complications reported at the time of surgery or within the first week after Visian ICL surgery include: removal and reinsertion of the Visian ICL at the time of initial surgery; removal or replacement of the Visian ICL after surgery; pupillary block resulting in raised eye pressure, which may necessitate the creation of an additional peripheral iridotomy to improve fluid flow, or by clearing the iridotomy made prior to implantation of the lens.
Potential Complications that can occur after the first week post surgery: The proximity of the ICL to the natural crystalline lens raises the possibility of the development of small cloudy areas or opacities on your natural crystalline lens, which may or may not cause visual symptoms. In a very limited number of cases (1.7% of eyes that received an ICL at seven-year follow-up in the US FDA Study) these opacities can become more widespread and develop into a cataract. Most cataracts occurred in those with very high myopia (> -15.0 Diopters). Experience also suggests that the development of visually significant cataracts is somewhat higher in patients who receive an ICL above age 46 (“off FDA label”). However, cataracts are considered far easier to fix than corneal complications following LASIK surgery.
Other complications include an increase in the rate of endothelial cell loss (a loss that occurs naturally with age) from the back surface of the cornea (which may require lens explantation and could result in a corneal transplant) and an increase in the pressure inside of the eye (post-op drops are used to minimize pressure increase).
Current evidence supports ICLs as being a very effective option for most patients who are suitable candidates. Your doctor will provide a more thorough discussion of the risks and benefits of this procedure during your office visit. With this information, you can make an informed decision about choosing this or other options available to reduce or eliminate your myopia (nearsightedness).