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Phakic intraocular lenses (IOLs) are like permanent contact lenses. They were designed as an alternative for people with severe myopia who are not candidates for LASIK.
There are many similarities between phakic IOL implant surgery and LASIK, including the amount of time the operation takes. Recovery time will be longer than with LASIK. Success rates for corrected myopia are lower with phakic IOL, and the procedure is more expensive.
Most refractive surgeries are not covered by vision or health insurance since they are considered cosmetic. Only medically necessary lenses, like those used to treat cataracts, are covered by insurance.
If you have a health savings plan or a flexible spending account, you can apply this to phakic lenses if you want to pursue this refractive procedure.
What Are Phakic Intraocular Lenses?
Phakic intraocular lenses (IOLs) are like a contact lens that can be implanted into your eye, so they permanently correct your vision. While not as popular as laser-based surgeries like LASIK, phakic IOLs are another option for correcting severe myopia, or nearsightedness, with or without astigmatism.
These small synthetic lenses come in two varieties. One can be placed behind the iris, but in front of your eye’s natural lens, while the other is placed behind your natural lens. Either way, these change how light is refracted through your eye and onto your retina.
These lenses are designed to permanently correct myopia, although they can be removed if necessary. Like LASIK, you will usually not need to wear glasses or contact lenses after undergoing this procedure. Unlike LASIK, your cornea will not have any part removed, so you are less likely to develop problems with that part of your eye. You are also at a lower risk for developing chronic dry eye after phakic IOL surgery.
Phakic IOL Surgery: What to Expect, Success Rates & Costs
If you choose phakic IOLs to improve your distance vision, there are the steps you can expect before, during, and after surgery.
- Before the procedure: Your doctor will ask you to stop wearing contact lenses at least a week before your preoperative exam or consultation. Contacts change the shape of your cornea, and your eye doctor will want the most accurate measurements possible.
You may also undergo a laser iridotomy. This is a laser-based procedure that creates small drainage holes in your iris, so fluid can drain after surgery, reducing your risk of developing glaucoma.
- Implanting phakic IOLs: You will receive numbing eye drops, and you may be given a sedative to help you relax during the surgery. Your eyelids will be held open, so you do not blink during the operation.
A tiny incision will be made in your cornea, so your surgeon can implant the lens. Then, the incision will either close by itself as your eyes heal and adjust, or you will receive sutures or special glue if needed.
The entire procedure takes between 10 and 30 minutes per eye. It is an outpatient operation, so you will go home after spending about an hour in a recovery room. You will need someone to drive you home. Your eyes will be adjusting to the procedure, and it is not safe for you to drive.
- After the implantation: Use anti-inflammatory and antibiotic eye drops as prescribed to prevent damage and illness. You should rest your eyes for a day when you get home, but you will probably experience clearer vision the next day.
You may also experience some side effects which will go away in a few days or weeks, like:
- Blurry or hazy vision.
- Increased sensitivity to light.
- Halos around lights.
- Mild itchiness or discomfort, as if something is in your eye.
Within two to four weeks, your vision will stabilize, and you should notice that you can see further into the distance.
For people who received the Verisyse phakic lens three years prior, 84 percent reported that they had 20/40 vision or better, and 31 percent reported that they had 20/20 vision or better. Among those who received the Visian ICL, 81 percent achieved 20/40 uncorrected visual acuity, while 41 percent achieved 20/20 vision. Most people who receive either type of phakic IOL report satisfaction with the surgery.
People who choose LASIK or related laser-based refractive surgeries report high rates of satisfaction with the operation while reporting better postoperative results. And LASIK treats more types of refractive errors, including a larger range of myopia. Finally, LASIK is less expensive than phakic IOL surgery — about $2,000 per eye compared to about $4,000 per eye.
Phakic IOLs Are Not Covered by Insurance
Phakic IOLs were designed as an alternative for people with myopia who are not good candidates for LASIK or similar surgeries. You can still get improved distance vision if you have naturally thin corneas or chronic dry eye, for example, but it will be at a steeper price.
Since phakic IOLs, like LASIK, are considered cosmetic surgery, getting insurance coverage for these will be hard. Other types of intraocular lenses (IOLs) will get covered by your vision insurance, but only when they are found to be medically necessary. For example, if you have cataracts, your eye doctor may eventually recommend that you undergo surgery so you can have vision restored.
Cataracts are clumps of proteins that leave white spots or darkened streaks in your corneas. There is nothing you can do, right now, to slow the progression of this form of vision loss once it starts. Your optometrist will monitor the cataracts’ progress and update any glasses or contact lenses you have so you can retain as much vision as possible. Eventually, you will need to have the damaged natural lens removed from your eye and replaced with an IOL.
This is not likely to be a phakic IOL. Most people who undergo cataract surgery receive a monofocal IOL because this is what vision insurance covers. There are other types of IOLs that allow for better close or distance vision, acting like bifocals or trifocals so you can see different distances. These IOLs will cost more, as they are not deemed medically necessary.
Phakic IOLs Might Be a Good Cosmetic Option for You
Phakic lenses are considered a cosmetic procedure. Your insurance company will cover glasses and contact lenses but considers refractive surgeries to be unnecessary.
If you have a health savings plan or a flexible spending account, you can apply this toward the cost of phakic IOLs. You could also potentially work out a payment plan with your eye surgery provider.
Phakic IOLs (July 2019). American Academy of Ophthalmology.
What Are Phakic Lenses? (January 2018). U.S. Food and Drug Administration (FDA).
What Happened to the Promise of Phakic IOLs? (February 18, 2010). Review of Ophthalmology.
IOL Implant: Lens - Replacement After Cataracts. (October 2019). American Academy of Ophthalmology.