Kaiser Permanente Laser Vision Correction
Phakic Interocular Lens
What is phakic IOL implantation?
In the phakic IOL procedure, an intraocular lens (IOL) is placed inside the eye but the patient’s natural lens is not removed. The lens may be placed in front of or behind the iris, or may be secured to it. Phakic lens implants are a safe, effective option for patients who have high myopia (good near vision and poor distance vision), or who have thin corneas that are unsuitable for laser eye surgery. Unlike Refractive Lens Exchange (RLE), the natural focusing ability of the eye remains because the natural lens is left unaltered, and the procedure is reversible.
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Phakic IOL procedures are most commonly performed on healthy patients who have high levels of myopia, but are not yet presbyopic, and who have no eye disease; no iris, pupil, or corneal abnormality; and no history of retinal detachment. Phakic IOL is an alternative to RLE for people with high levels of myopia because there is a reduced risk of retinal detachment. This procedure is combined with LASIK. The phakic IOL is placed to reduce the amount of nearsightedness, then LASIK is performed later to correct any residual nearsightedness or astigmatism.
What are the potential benefits of phakic IOL implantation?
- Good-to-excellent far vision following monofocal lens implantation (some tasks may still require eyeglasses).
- The IOLs are removable.
- Reduced risk of glare, halos, or problems with low lighting that can result from high laser treatments.
- The natural lens is not removed, which means that the focusing ability of the eye is preserved in young patients.
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What are the types of phakic IOLs?
Especially useful for people younger than age 45 years old with significant nearsightedness (myopia), phakic IOLs offer a permanent solution without removing the eye’s natural lens. The FDA has approved two types of phakic IOLs, and we’ll review which one is a better option for you during your visit.
- Visian ICL: Known as a “posterior chamber” IOL, Visian is placed behind your iris, the colored part of your eye. Made from a biocompatible material called Collamer®, Visian lenses complement the natural chemistry of your eye, ensuring a comfortable experience and little risk of dry eye syndrome.
- Verisyse: This “anterior chamber” lens is placed in front of your iris, rather than behind it. Made from a medical-grade polymer, its one-piece design makes it simple to implant.
Like LASIK, the IOL placement procedure is brief. Most patients without corneal astigmatism can expect vision of 20/40 or better after implantation.
What are the risks of phakic IOL implantation?
Risks for this procedure include:
- A period of anisometropia, an imbalance between the eyes. This occurs because the operation on each eye is performed separately. The condition will resolve after the operation to the second eye.
- Potential mild discomfort for the first 24 hours after the procedure (severe pain is rare).
- Endophthalmitis, an intraocular infection that can lead to blindness. This occurs in 0.01 percent of cases after standard cataract or RLE procedures. If caught early and treated aggressively with antibiotics, the risk of vision loss can be reduced, but patients can lose their vision permanently. There have been no reported cases of endophthalmitis after phakic IOL placement, but the possibility is present.
- Retinal detachment.
- Cystoid macular edema, a swelling of the central area of the retina. This often can be improved with treatment, but some patients may experience permanent residual visual disturbances.
- Corneal edema, clouding and swelling of the front “window” of the eye. This condition is correctable with eyedrops, and may spontaneously heal naturally. In rare cases, a corneal transplant may be required.
- Iritis, an inflammation of the eye from mechanical irritation.
- Scarring of the iris, which may not be reversible, even with removal of the lens.
- Cataract development. Should a cataract develop, the IOL will need to be removed for treatment.
- Damage to the retina or optic nerve during administration of the anesthesia.
- Increased astigmatism.
- With an accommodative or pseudo-accommodative IOL, slightly blurred vision, glare, or halos around lights, becoming worse in dim light, in fog, or at night.
What should I expect on the day of surgery?
The phakic IOL implantation is an outpatient treatment that usually takes about 15 to 30 minutes. Your Northern California refractive surgeon will perform this procedure on only one eye at a time.
Before the procedure, you’ll be given eyedrops to reduce your pupil size. You’ll also receive a local anesthetic injection and IV anesthetic. A small incision is made in the cornea and the IOL is inserted in the space between the iris and the cornea. The IOL is centered in front of the pupil and is gently attached to the iris to hold the lens in place. The small incision is closed with microscopic stitches. You’ll need someone to drive you home after your surgery.
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What should I expect during recovery and postoperative care?
The day after your surgery, you’ll come in for an office visit to help ensure that you’re healing properly. Some patients have blurred vision the day after surgery, while some already see clearly-every patient heals differently.
Your sight should improve within a few days, although complete healing may take several months. It is a good idea to have a friend or relative help you at home if you can, especially if you find it difficult to put your eyedrops in. For the first four to seven days after phakic IOL implantation, you should avoid heavy lifting or bending over. After the first week, you can resume most of your normal activities, but you should minimize lifting heavy items, bending, and straining for the first month following surgery.Back to Top