NEW YORK—When did sticking your finger in your eye every morning and night become part of your normal daily routine? Most of us accustomed to disposable contact lenses can barely remember.
Implantable collamer lens, or ICL, represents the next step in the evolution of vision correction technology. It’s like a contact lens, only it stays inside the eye.
Visian ICL, manufactured by STAAR, is a soft gel lens that is surgically placed behind the iris, in front of the eye’s natural lens. The procedure requires a tiny incision and no stitches. It takes less than 30 minutes and most patients can return to work the next day. Once in place, the lens requires no maintenance.
“Many people are familiar with putting a contact on their eye, but that starves the eye of oxygen,” said Dr. Steven Stetson, medical director of Diamond Vision in Manhattan. “Putting it in the eye is brilliant because the body thinks the lens is part of the body and recovery is very, very rapid.”
Dr. Stetson is one of a minority of surgeons who operates on both eyes on the same day, which means fewer office visits and less time adjusting to better vision. ICL technology was approved in the United States in 2005 and the staff at Diamond Vision now do 10 to 14 ICL procedures a month.
Tired of Contacts
ICL was originally recommended for people when LASIK laser surgery was not an option because of thin or weak corneas, dry eyes, or because their vision was already too poor. Now, ICL is becoming an attractive elective procedure for people tired of the finger-to-eye routine.
“A lot of the patients I’ve seen are computer workers fed up with contact lenses and don’t want to deal with the post-op regimen required for laser surgery,” Dr. Stetson said.
Unlike LASIK, there is no manipulation or removal of cornea tissue and patients are required to use teardrops for only two weeks after the operation, instead of two months with LASIK.
The cost of ICL surgery is less than $5,000 per eye. The cost of contact lenses, solution, eyedrops, and glasses adds up to several hundred dollars per year, making ICL more cost effective in the long run for some, not to mention more convenient.
Precision and Clarity
Dr. Stetson uses a specialized imaging device called a Pentacam to measure the thickness, contour, and shape of the cornea. The Pentacam furnishes the doctor with comprehensive measurements that will be used to order a custom ICL for each eye.
“That technology is wonderful. If you don’t have it and you’re an ICL surgeon, you have to guesstimate [by shining a light into the eye] using a slit lamp. On this camera we can see down to the micron,” Dr. Stetson said.
After the surgery the Pentacam allows the doctor to visually confirm down to the micron that the lens has been placed at the right distance between the cornea and the natural lens surface.
After the procedure, which is typically done with topical anesthetic drops, the patient will return for a post-op visit at one day, one week, and then one month later.
With the exception of a few people whose strong blink reflex necessitates more sedation, virtually all of his patients have been problem free, Dr. Stetson said. In case of further vision deterioration, contacts and LASIK can still be used—or the ICL can be easily replaced.
Some patients also find they have better than 20/20 vision following the procedure.
“With ICL you’re able to take away extra aberrations that exist when you put a glass or a contact in front of your eye,” Dr. Stetson said. “It makes vision more precise.”
ICL has been a big boon for the severely myopic allowing surgeons to improve the eyesight of patients they would not have been able to help with LASIK alone.
“ICL puts this whole catchment of patients back into your lap as people you can help,” Dr. Stetson said. “All these negative 13, negative 15 [prescription] patients, they’re all enormously happy because they can’t believe the difference.”
The Next Generation of ICL
As is the case for many medical procedures, Europe is a step ahead in approving the latest ICL technology. As soon as the FDA gives the green light to these procedures, they will be available on the U.S. market.
- Toric ICL, which addresses astigmatism, has been awaiting FDA approval for several years. Currently available in Europe, South America, and Asia (Korea is currently the largest user of ICL technology).
- Centraflow is a lens Visian already makes. This lens has a hole in the middle to allow fluid to flow around the eye. With the current technology available to Americans, a small hole must first be made in the iris before surgery for fluid to be able to circulate, otherwise pressure would rise in the eye. Centraflow, currently approved in Europe, makes this step unnecessary.
- A Visian ICL lens shaped for farsightedness has not yet been developed. Farsightedness is more common among older people.
Candidates for ICL:
- Are aged 18–45 and not at risk for cataracts.
- Nearsighted, with a prescription of negative 3 to negative 18.
- Have no to moderate astigmatism. At Diamond Vision, doctors use a laser to correct whatever astigmatism the ICL cannot neutralize.
- Have not undergone any ophthalmic surgery and don’t have a history of eye disease.
- Have sufficient anterior chamber depth and endothelial cell density. Consult a qualified Visian ICL surgeon for an assessment.
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