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The new and recently FDA approved ICL (implantable contact lens) for myopia.

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About the time LASIK was taking over refractive surgery in the country, a company in California, Staar Surgical, was developing an implantable contact lens. It was approved by the FDA in November 2005, and Moulton Eye Clinic has been certified to perform this surgical procedure. The ICL is placed in behind the pupil and in front of the normal crystalline lens.

Another option for individuals over 50 is a clear lens extraction followed by implantation of an intraocular lens right behind the pupil. The clear lens extraction and the ICL are probably the most dependable, reliable and reproducible refractive surgeries available at the current time.

We feel that these procedures, especially the ICL, will replace LASIK in the next few years. LASIK, LASEK and Radial Keratotomy for moderate to high degrees of nearsigntedness and/or astigmatism are inherently unstable, as has been proven from past experience. With LASIK, the laser is actually burning away clear corneal tissue that is not replaced by the body. Once LASIK or Radial Keratotomy is performed, it cannot be reversed. The benefit of the ICL is that it is totally reversible if the patient does not like the result. The ICL is by far the most stable, effective and safest refractive surgery available today.

Frequently asked questions regarding the ICL are as follows:

How does the VISIAN ICL correct nearsightedness? Your eyes work like a camera. The clear lens will focus the image that you see onto the retina, which transfers the image through the optic nerve to the brain. Both the cornea (the clear dome of the eye) and the lens (situated hehind the pupil) focus light onto the retina (the back surface of the eye). The vision is clear when light focuses correctly onto the retinal surface. Nearsightedness is that type of focusing error in the eye that results in blurred distance vision, because light from a distant object focuses in front of the retina rather that onto the retina itself. Wearing glasses and/or contact lenses have been the mainstay of correction for this problem prior to the advent of refractive surgery.

A small incision is made in the eye. The VISIAN ICL is placed behind the iris (colored part) and in front of the natural lens. When correctly powered and positioned, the ICL functions to focus light properly onto the retinal surface, thus correcting the nearsightedness.

The VISIAN ICL is manufactured from a soft collagen material similar to that used in the existing intraocular lens that replaces the natural lens in cataract surgery. It is designed to correct moderate to high degrees of nearsightedness, not large degrees of astigmatism. The VISIAN ICL has been proven to safely correct nearsightedness ranging from –3.00 to –15.00 diopters, and can partially correct for nearsightedness ranging from –15.00 to –20.00 diopters. The box that your contact lenses come in will indicate the “minus” numbers. If you are between –3.00 and –15.00, you are probably an excellent candidate for the ICL. If you are between –15.00 and –20.00, you will get a lot of improvement, but not as much.

What is the vision without glasses or contact lenses after surgery? In a number of studies with the ICL one year following surgery, 76.3% of the patients with a former contact lens prescription of –3.00 to –7.00 saw 20/20 or better and 98.8% had 20/40 or better. At three years after insertion of the lens, 72.4% saw 20/20 or better and 98.3% of the eyes saw 20/40 or better without glasses or contact lenses. 70% of the patients with a preoperative range of –7.00 to –10.00 saw 20/20 or better, 96% saw 20/40 or better without glasses or contact lenses one year and 62.7% saw 20/20 or better while 92.8% saw 20/40 or better after three years. In patients with –10.00 to –15.00 before surgery, 43.4% of the patients had 20/20 vision one year after surgery and 93.7% had 20/40 or better. After three years, 37.5% of the patients had 20/20 or better compared to 93.8% with 20/40 or better. In most states, the vision required to legally drive a car without glasses or contact lenses is 20/40 or better.

Patient satisfaction during the studies has been remarkably high, even though some patients will still need some form of glasses or contact lenses after surgery for distance. That is the exception rather than the rule, and that would involve patients with higher degrees of nearsightedness. In the studies, patients were asked to rate their degree of satisfaction with the VISIAN ICL surgery. At three years, 92.1% of the patients were very or extremely satisfied compared to 7.3% that were moderately or fairly satisfied. Only .6% of the cases were unsatisfied. Unreasonable expectations and high degrees of nearsightedness probably account for most of these.

The quality of vision following ICL was reported to be very good or excellent. Patients were asked to rate their symptoms before as well as three years after the procedure. Glare, difficulty with night vision and night driving symptoms were reported as mild or absent after surgery compared to preoperatively. Halos and double vision percentages were similar before and after surgery.

The Journal of Cornea and External Diseases published findings of a study comparing the results of LASIK and the ICL in their May 2003 edition. The article concluded that the ICL is safer, more effective, and appears to be a viable alternative to LASIK. The postoperative results of 210 eyes implanted with the ICL were compared with the postoperative results of 559 eyes on which LASIK had been performed. All of the patients were examined at one day, one week, one month, six months and one year postoperatively. The average preoperative level of nearsightedness for the ICL patients was –9.1 compared to an average of –9.3 for the LASIK patients. The report stated that in every index of best corrected visual acuity, the ICL outperformed the LASIK procedure. At six months, the study indicated that while 7% of ICL patients had gained two or more lines on the standard eye chart, only 3% of LASIK patients had gained two or more lines. Actually, 2% of LASIK patients had lost two or more lines of visual acuity on the eye chart. After six months, the predictability of the ICL procedure was much better than that of LASIK. The LASIK patients had a significantly less favorable result as compared to the ICL patients.

In every category of patient satisfaction, that being the degree of satisfaction, reproducibility of results, dependability of the procedure, safety, number of complications and accuracy, the ICL blew LASIK out of the water. The greatest asset to the ICL as compared to all other refractive procedures is that it alone is reversible.

If I am a candidate, what is the next step? Patients that qualify for the surgery go through an extensive ocular examination in order to determine the appropriate power of the ICL. A brochure and an indepth consent form is given to the patient in addition to information on what to expect day of surgery as well as the days, weeks and months following. All of the benefits, risks and potential complications are discussed in detail in the brochure that is included.

Is financing available for this procedure? Convenient financing is available through Care Credit upon approval of application. This is a medical credit card that is good at most medical facilities. No finance charge options are available. The applications are available in our office upon request.

In conclusion, we believe the ICL is here to stay. It is much safer than all of the other refractive procedures and we at Moulton Eye Clinic are here to provide this service to anyone desiring correction of their nearsightedness.