Introduction to p-IOLs or ICLs

Implantable contact lens (ICL) or Phakic Intraocular lens (p-IOL) Implant Surgery is the only exchangeable/reversible of all the eye surgeries. This is a very modern and increasingly popular procedure for people 20-45 with significant prescription and is a more successful alternative to laser eye surgery. Here an implantable IOL like a CL is implanted either in front of the iris (Iris clip lenses like Artisan/Artiflex) or behind the iris but in front of the natural crystalline lens (STAAR ICL or IPCL). Rehabilitation is very fast in a day with no pain, it is easier than LES but more invasive.
 

This is a very thin lens, similar to a contact lens. The difference is that the ICL is placed inside the eye and behind the pupil, rather than on the surface of the eye. The lens is very soft and specially shaped to correct shortsight, farsight, astigmatism or a combination of these. The lens works in a similar way as glasses or contact lenses by changing the way light is focused on the retina.

Very high corrections up to -20.00D shortsight and +8.00D farsight along with 6.00D of Astigmatism can be corrected. The ICL is invisible and its treatment is completely unrelated to thin corneas, dry eyes, or large pupils, as it does not involve removing tissue from the cornea.

The ICL can be injected into the eye in seconds through a small key-hole self sealing opening. Once injected, the ICL unfolds into position in the liquid between the iris and natural lens. ICL corrects the eyesight usually without any further treatment being necessary (the ICL can also be removed or replaced, if required, in another simple procedure).

The ICL is made of a unique bio-material called Collamer and the body does not react or reject the ICL as a foreign body. Other special features of Collamer are its optical clarity and the flexibility and elasticity that allow it to be folded up and then to recover its correct shape in the liquid inside the eye.

ICLs are intended to remain in place without maintenance however patients are advised to be seen annually by their eye surgeon to ensure all remains well. Since the lens does not permanently alter any structures within the eye or on the cornea, it can easily be removed if necessary. Visual outcomes for higher levels of correction are better with ICL.

Some images relating to the ICL (top to bottom): The latest model Visian ICL with CentraFlow technology, Implantation method, final position inside the eye,
 
AM I A CANDIDATE FOR THE ICL?

The best candidates for the Visian ICL are those over the ages of 21, with moderate to severe myopia. It is best if the candidate has not had any previous ophthalmic surgery and does not have a history of ophthalmic disease such as glaucoma, iritis or diabetic retinopathy.

WHAT ARE THE ADVANTAGES OF ICL?

The Visian ICL is capable of correcting a wide range of myopia without the removal or destruction of corneal tissue. The ICL is a small, foldable, injectable lens that is inserted through a tiny, 3 mm incision that does not require sutures. The lens is made of a lens material called Collamer, which provides good biocompatibility. However, if there are major changes in ones vision the Visian ICL can be removed and replaced. With the ICL, one can still wear glasses or contact lenses if necessary. The ICL does not help presbyopia, or the need for reading glasses due to age.

CAN THE ICL DRY OUT OR GET DIRTY LIKE A CONTACT LENS?

No. The Visian ICL is designed to remain in place within the eye without maintenance. An annual examination done by your ophthalmologist is recommended to make sure that everything is fine.

CAN THE ICL BE SEEN OR FELT?

No. Because the lens is positioned behind the iris, neither you, nor an observer will be able to identify the lens in place. The cosmetic appearance of the Visian ICL is perfect, and there is no way for a non-professional to notice that a visual correction is in place. The ICL is not typically noticeable after it is implanted. It does not attach to any structures within the eye and should not move around after is placed.

WHAT ARE ICLs MADE OF? AND HOW LONG THEY STAY IN THE EYE?

The material is called Collamer, a collagen co-polymer that contains a small amount of purified collagen. It is biocompatible (doesn’t cause a reaction inside the eye) and stable. It also contains an ultraviolet light filter. ICLs are intended to remain in place without maintenance. It is recommended to have annual checkups with ECC measurements. If it becomes necessary, for any reason, they can be easily removed by a trained ophthalmic surgeon. I recommend that the lens is removed before the age of 60 and/or before the ECC becomes 1800. It would make sense for the ICL removal to be combined with an RLE to minimise ECC loss.

WHAT IS INVOLVED IN THE ICL PROCEDURE?

The ICL surgery is performed on an outpatient basis, which means that the patient has surgery and leaves the same day. Please note that someone will have to drive the patient to and from surgery. Topical or local anesthetic is administered and there is usually very little discomfort and normally no pain associated with the procedure. The procedure is done with a Certified Registered Nurse Anesthetist with I.V. sedation and a visit is usually scheduled the day after surgery.

WHAT KIND OF PROBLEMS COULD I EXPERIENCE?

The most common complication of the ICL is cataract. This can occur either if the insertion was difficult and the ICL bumps your crystalline lens or if there is no sufficient vaulting of the ICL over your natural crystalline lens thus the ICL is making physical contact with it which could cause a cataract if left untreated. In that case the implant should be exchanged for one of a slightly longer length to allow it to “vault” over your natural lens. If you should need any fine tuning of your result due to residual astigmatism, near or far sightedness following the ICL procedure, LASIK enhancement might need to be performed and the cost is usually included. Three months of healing time is recommended between the two procedures.