It might seem surprising for a refractive surgeon to love a procedure other than LASIK, one of the most successful medical procedures ever developed. As a former LASIK patient who has achieved total freedom from glasses and contact lenses by personally undergoing refractive surgery, and as an experienced refractive surgeon who has completed more than 130,000 successful laser vision correction procedures in the past two decades, I am a strong advocate for the amazing vision and lifestyle benefits that LASIK and PRK provide. But I love Phakic IOLs and I’ll explain why.
Every eye surgeon who seeks the best long term outcomes for patients will carefully perform preoperative imaging and tests to determine if the patient is a candidate for a procedure like LASIK. These important preoperative tests will help to identify patients who are not likely to do well with LASIK or PRK. LASIK and PRK are highly predictable and safe for patients who are good candidates. The vast majority of patients wearing eyeglasses may be candidates for laser vision correction. Each year, thousands of patients come to my practice to seek improvement in their vision to enhance their quality of life. I will not perform laser vision correction for patients who are not likely to achieve an excellent outcome and it can be very disappointing for patients to be advised that they are not a candidate for laser vision correction. While LASIK and PRK are great options for many, if not most patients, laser vision correction is not appropriate for everyone. LASIK or PRK may not be suitable for a variety of reasons, including a very high preoperative eyeglass or contact lens prescription, abnormally thin corneas, corneal scars, abnormal corneal topographies, or corneal diseases. In the past, these patients would be out of luck in their quest for visual freedom and they would be advised that they are not appropriate candidates for vision correction surgery. Now, newer technologies such as lens implants and implantable contact lenses provide a vision correction option for nearly everyone who seeks freedom from glasses and contact lenses.
The Staar Visian or Evo* implantable contact lenses are revolutionary lenses that now greatly expand the options for patients who are not good candidates for laser vision correction. These implantable contact lenses are placed behind the iris (the coloured part of the eye) and in front of the patient’s natural lens. The lens is custom selected for each patient to correct astigmatism, nearsightedness, and astigmatism. Patients with thin corneas or larger prescriptions who were not candidates for LASIK or PRK may now be an excellent candidate for an implantable contact lens. We can now help almost every person who visits our practice seeking greater freedom from the inconvenience, cost, and lifestyle effects caused by undesired dependence on eyeglasses and contact lenses. Implantable contact lenses (ICLs) are otherwise known as phakic intraocular lenses. These lenses can offer all the advantages of laser vision correction to patients who are not candidates for LASIK or PRK. Even when a patient may be a candidate for LASIK or PRK, an ICL may be the preferred option as an ICL may provide better quality of vision for certain patients.
To understand how ICLs work to correct vision in comparison to laser vision correction, and why an ICL may be a better choice for some patients, let’s consider how laser vision correction and ICL procedures work. Laser vision correction involves reshaping the cornea and it requires the removal of tissue from the cornea, the clear tissue at the front of an eye. As light passes through a cornea, depending on the corneal curvature, the light rays will be bent in varying amounts. Steeper corneas will bend light to a greater degree. If the patient’s preoperative corneal curvature is too steep or too flat in relation to the length of the eye, a patient may need eyeglasses or contact lenses to compensate for the excessive or insufficient bending of light that takes place at the patient’s cornea. Additional bending of light takes place as the light passes through the patient’s lens inside the eye. During laser vision correction with a PRK or LASIK procedure, the cornea is precisely reshaped by the laser to adjust the way that light is bent as it passes through the cornea, eliminating or reducing the need for eyeglasses or contact lenses. This amazing, miraculous procedure works for the vast majority of patients. Most patients who undergo laser vision correction have LASIK where a thin flap in the cornea is created and the laser vision correction reshaping of the cornea takes place on the corneal bed under the flap. Other patients may undergo PRK (Photorefractive keratectomy) where the laser treatment takes place at the corneal surface after removal of the surface skin layer.
In contrast, with an ICL, a lens is placed inside the eye to provide additional focusing power for the eye. By precisely selecting the phakic IOL implant based on preoperative measurements, the surgeon can correct nearsightedness and astigmatism without having to change the shape of the cornea. This can be advantageous for patients with thinner corneas or potentially weaker corneas where we seek to preserve tissue to preserve the structural integrity of the cornea. In other cases, a patient’s corneal shape would need to be changed to such a degree with laser vision correction that the patient may be more likely to experience postoperative symptoms like glare, haloes, decreased contrast or a recurrence of nearsightedness due to regression. ICL surgery involves the creation of a very small incision at the corneal limbus, the junction of the clear cornea and the white of the eye. The ICL lens is injected through this tiny incision and it is carefully implanted into position behind the iris and in front of the patient’s natural lens that remains intact. The small incision does not need stitches and as the surgery is minimally invasive, recovery is usually very rapid.
There are patients who may be ideal candidates for LASIK, others who may be ideal candidates for PRK, and others who are ideal candidates for ICLs. And there are others who are not suitable for any of these procedures, but would do well with another procedure, a refractive lens exchange where the lens inside the eye is exchanged for a lens implant. There are multiple options available to correct one’s vision, but usually one option is the best choice for each patient.
At King LASIK, we carefully evaluate each and every patient to determine the best solution to recommend for that individual who is seeking to reduce dependence on glasses or contact lenses. Whether the procedure is laser vision correction, a phakic IOL or a refractive lens exchange, we offer the full spectrum of vision correction options for our patients. If you are considering vision correction, be sure to visit a refractive surgeon who performs vision correction procedures other than LASIK to ensure that you are receiving the best procedure for your eyes.
I love LASIK. It has made an amazing positive impact in my life. I am grateful for having had the opportunity to help many tens of thousands of patients achieve visual freedom from eyeglasses and contact lenses. It’s my favourite technique for correcting vision and I will perform hundreds of these LASIK procedures every month.
I love the Visian and Evo implantable contact lenses too. ICLs are an amazing refractive surgery option that allows us to help more patients achieve their goal of clear sight and freedom from glasses or contact lenses. If you would like to visit our office to undergo an evaluation and learn which procedure is right for you, please schedule online at https:// onlinescheduler.kinglasik.com/map.php?ls=3294.
Joseph King MD
*The EVO lens is not yet FDA approved for use in the United States. In Canada, farsighted patients can be treated with the EVO lens.