Dr Dylan Joseph gives his expert advice on everything you need to know about Phakic Lens Implant surgery, including the benefits, surgery limitations, risks, treatment options and costs. Read on to learn more.
If you are a contact lens wearer, you will be required to remove them for a period of time before your preoperative eye examination and before your surgery.
Why? By removing your contacts, you allow the corneas in your eyes to return to their natural shape.
Timeframe per lens type
Soft contact lenses: Remove 2 days before the evaluation and 1 week before surgery.
Rigid contact lenses: Leave the lenses out of your eyes for at least 2 weeks prior evaluation and 2 weeks before surgery.
The doctor will administer a general anaesthetic to ensure you are not awake during the operation.
Receiving a general anaesthetic, although not common, may include the risk of serious bodily injury or death. Before surgery, we encourage you to discuss any questions related to anaesthesia.
After you have been anaesthetised and your pupil has been dilated, the surgeon will make a small incision in your cornea to allow insertion of the lens.
The ICL is then inserted behind your iris and in front of the natural (crystalline) lens. Even though the incision is typically self-sealing, it could require closure with a few fine stitches (which will be removed at a later stage).
A temporary shield will be placed over the eye to protect it during the immediate postoperative period.
A few hours after surgery, your eye pressure will be checked at the clinic to ensure it is within the normal range.
Patients are generally able to return to their normal activities within 2 or 3 days following Phakic Lens Implant surgery.
Even though you may see some improvement in your vision as early as the first postoperative day, the visual effects of this surgery may take several weeks to stabilise.
Can You Treat Both Eyes at the Same Time?
No. Only one eye will be treated at a time. If you decide to have the second eye treated with Phakic Lens Implant surgery, you will need to wait until your surgeon has determined that the first eye has healed sufficiently. You will be required to wait a minimum of one week and possibly as much as three months following surgery on your first eye before receiving an implant in the second eye.
What Are the Benefits?
If you have a moderate to a high amount of short-sightedness/long-sightedness and/or astigmatism, lens implant surgery may improve your distance vision without the use of glasses or contacts.
Phakic Lens Implant Surgery Limitations
Phakic Lens Implant surgery may correct your vision but there are limitations as to what is possible.
It Does Not Prevent Presbyopia
Presbyopia is a condition that develops in patients, usually aged 40 years or older. As we age, the eye loses its ability to focus and near vision glasses are required.
It Does Not Prevent Cataracts
With increasing age, patients are likely to develop cataracts in the future and Phakic Lens Implant surgery cannot prevent this. If the cataracts are significant enough to cause visual problems, patients may need to undergo cataract surgery at that stage and the Phakic Lens Implant will need to be removed to facilitate this.
It Does Not Prevent or Influence Glaucoma or Macular Degeneration
It is recommended to have regular appointments every 2 years to monitor your eye health.
What Can I Expect Visually?
The ICL implant in your eye can be calculated to remove the need for glasses. Most patients undergoing Phakic Lens Implant surgery opt to have both eyes corrected to zero. This is the perfect distance vision.
What Are the Risks?
Depending on the type of anaesthesia used, risks are possible such as cardiac and respiratory problems.
A mild infection can be treated with antibiotics and will most probably not lead to permanent visual loss. A severe infection on the other hand, even if treated with antibiotics, could lead to permanent scarring and loss of vision.
3: Iris Damage
Damage to the iris (the coloured portion of the eye) may occur and/or the pressure in the front of the eye could rise (secondary glaucoma). If this occurs, you may require a YAG laser iridotomy or eye drops to control the pressure.
4: Retinal Detachment
Retinal detachment may occur postoperatively. This is the separation of the retina from its adhesion at the back of the eye which usually results from a tear in the retina and could lead to vision loss.
Who is at risk? Patients with moderate to high levels of short-sightedness have a higher risk of retinal detachment when compared to the general population. This risk level may be increased with the implantation of the Phakic ICL.
A cataract may develop as part of normal ageing. This may require the surgical removal of the Phakic Lens Implant and the natural lens. An artificial lens called an intraocular lens would be implanted in place of the natural lens.
Who is at risk? Patients with high levels of short-sightedness are at higher risk for cataract development, and that risk may be increased with implantation of the Phakic ICL.
6: Corneal Oedema
Corneal oedema and loss of endothelial cells may result in a hazy and opaque appearance of the cornea, which could reduce vision. It is not yet known how long the endothelial cell loss will continue and what effect the cell loss and Phakic Lens Implant will have on the long-term health of the cornea. If too many cells are lost over time, the cornea may become cloudy and a corneal transplant may be required.
Glaucoma can lead to vision loss and may require treatment with long-term medications or surgery.
Who is at risk? Patients with high levels of short-sightedness are at an increased risk for the development of glaucoma, and that risk may be increased by implantation of the lens. The effect of Phakic Lens Implant surgery on the future risk of glaucoma is not known.
There could be an increased sensitivity to light/night glare or a “star-bursting”/halo effect around lights at night.
Who is at risk? The risk of this side effect may be related to the size of the pupil, and patients with larger pupils may be at increased risk.
9: Visual Result
An overcorrection or under-correction could occur, causing long-sightedness, short-sightedness, or increased astigmatism. This could be permanent or treatable with either glasses, contact lenses or additional surgery. Potential complications of additional surgery will be discussed with your surgeon if required.
10: Decentration of ICL
The phakic lens may change position and need to be repositioned, removed surgically, or exchanged for another lens implant.
11: Drooping of Eyelids
There is a natural tendency of the eyelids to droop with age and eye surgery may hasten this process.
12: Vaulting/Sizing Complications
On very rare occasions, the ICL implant may be slightly too big or too small for your eye. If it is slightly bigger, it may increase the pressure inside the eye. The ICL may then have to be removed and replaced with one that is a size smaller. If the ICL is too small, it may lie too close to your lens and has a less than 1% chance of inducing a cataract. Once again, it may be necessary to have the ICL removed and replaced with one that is a size bigger. The risk of this, however, is exceptionally rare, with modern-day nomograms and formulae to work out the correct strength of your lens.
Other complications could threaten vision postoperatively, including, but not limited to, iritis or inflammation of the iris (immediate and persistent), uveitis, bleeding, swelling in the retina (macular oedema), and other visual complications.
Alternatives Treatment Options
You are under no obligation to have Phakic Lens Implant surgery. If you decide not to, there are other methods of correcting your short-sightedness/long-sightedness/astigmatism:
Surgeries like LASIK, LASEK, TE-PRK and PRK can provide independence from glasses and contact lenses.
How Much Does Phakic Lens Implant Surgery Cost?
Please check with your medical aid what portion, if any of the surgery, they are prepared to cover. We can provide you with a quote but depending on your level of cover, your medical aid may or may not reimburse the procedure.
If there are complications, the patient is responsible for the costs of any uncovered surgery-related procedures such as another surgery, eye drops, or even hospitalization.
You will not be charged for postoperative appointments 1 month after the surgery.
To find out what Phakic Lens Implant surgery costs, as well as your payment options, contact us today.
Dr Dylan Joseph
Cataract and Refractive Surgeon
MBChB(Pret), Dip Ophth(SA), FC Ophth(SA), MMed Ophth UFS (cum laude)