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Phakic Intraocular 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.

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 (refractive lens exchange) for people with high levels of myopia because there is a reduced risk of retinal detachment.

What are the potential benefits of phakic IOL implantation?

• Good-to-excellent far vision without contact lenses or glasses.
• 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 near focusing ability of the eye is preserved in patients under 40-years old.

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 and vaults above your natural lens. 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.  These lenses also offer astigmatism correction.
• 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.  This lens is less commonly used, but may be offered in certain circumstances.

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:

• 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 1 in several thousand cases after lens based procedures. If caught early and treated aggressively with antibiotics, the risk of vision loss can be reduced, but patients can lose their vision permanently.
• Retinal detachment.
• Cystoid macular edema, a rare 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.
• Cataract development. Should a cataract develop, the IOL will need to be removed for treatment. Cataract surgery will provide you with a lens implant that will allow you to see distance clearly.
• It is possible you will need a further LASIK touch up or a very light pair of glasses to fix slight defocus or astigmatism.
• Rarely the eye pressures can become elevated creating a condition known as glaucoma. Should this happen you may need to use eyedrops or the lens may occasionally need to be removed.
• Slightly blurred vision, or halos around lights, becoming worse with night driving.

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. You will generally be offered surgery in both eyes at the same time but you may choose to do one eye at a time if you prefer.

Before the procedure, you’ll be given eyedrops to dilate your eyes. You’ll also receive IV anesthetic to relax you. A small incision is made in the cornea and the IOL is inserted. The incision is self-sealing so there are generally no stitches. You’ll need someone to drive you home after your surgery.

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. 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 avoid lifting heavy items and swimming for the first month following surgery.

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