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Phakic intraocular lenses (IOLs) are a type of synthetic lens that are implantable in your eye, used to correct moderate or severe myopia. With more people in the U.S. being diagnosed with nearsightedness, phakic IOLs are a good option to treat those who may not be candidates for other refractive surgeries, like LASIK.
People who have thin corneas, misshapen corneas, or severe myopia that is not corrected easily with glasses or contact lenses can all benefit from the option of phakic IOL surgery. Good candidates for this procedure are healthy adults between the ages of 21 and 40, who have 20/200 vision without corrective wear, and who are not good candidates for laser-guided refractive surgery.
This operation takes about 30 minutes in total. It is more invasive than LASIK, so there is a longer recovery time. You may need to take a few days off work to manage healing, side effects, and follow-up appointments.
Phakic IOL surgery is also more expensive than LASIK. You could find vision insurance covers part of the cost if your eye doctor deems this operation necessary.
What Are Phakic Intraocular Lenses (IOLs)? What Is the Surgery to Implant Them Like?
Phakic intraocular lenses (IOLs) are, in many ways, like permanent contact lenses. They are made from either plastic or silicone. They are implanted in the eye so your need for removable contact lenses or glasses will at least be reduced. Unlike artificial lenses that replace your eye’s natural lens, like those used to treat cataracts, phakic lenses go over the natural lens of your eye to enhance its ability to refract light onto your retina.
Although there are several types of refractive errors — like nearsightedness, farsightedness, and astigmatism — phakic lenses have been approved by the United States Food and Drug Administration (FDA) to treat only myopia, or nearsightedness. This is the most common of the refractive errors, with about 9.6 million adults in the U.S. having some type of nearsightedness. About 820,000 of those individuals have a degenerative form of myopia, and thousands more suffer from other types of vision loss associated with being severely nearsighted.
Studies on the effectiveness of phakic lenses found that these devices were still safe and effective at a five-year follow-up point. They are not for everyone, but they may be a good option for those who want more permanent vision correction but are not interested in laser surgeries like LASIK.
Why Choose Phakic Lenses Instead of LASIK?
Typically, someone with nearsightedness would pursue a laser-guided eye surgery like LASIK to correct their sight. However, some people are not good candidates for this operation. For example, if you have strong myopia, laser surgery may not be able to safely remove enough tissue to correct the refractive error in your cornea. Some people have naturally thin corneal tissue, so they are not good LASIK candidates. But this group can benefit from phakic lenses.
A study of 31 people with 20/200 vision or worse found that phakic lenses were a great option for extreme nearsightedness. In this group, only about 60 percent could achieve 20/40 vision with the help of prescription glasses or contact lenses, which put limits on their daily activities. After receiving phakic lenses, 57 percent of the group could achieve at least 20/40 vision with the help of glasses, and 23 percent had 20/40 vision without additional vision aids.
Phakic lenses can also improve vision in people who have other eye conditions, like:
- Keratoconus, or a bulging cornea.
- Dry eye syndrome.
There are two types of phakic lenses, one that goes on top of your natural lens and one that goes beneath it.
- Visian ICL: This lens was approved by the FDA in 2005 to help myopia ranging from -3.00 to -20.00 diopters. It is placed on top of the natural lens behind the iris. It is undetectable to the naked eye, and it is made from a soft, flexible material.
- Verisyse: While the Visian lens goes on top of your lens, the Verisyse lens goes underneath it. This lens was approved by the FDA in 2004 for correcting moderate to severe nearsightedness, ranging from -5.00 diopters to -20.00 diopters.
Price may determine which option your eye surgeon goes with, but your vision needs will also be a factor.
Who Is a Good Candidate for Phakic Lens Surgery?
Phakic IOLs are intended to be permanent, but if it is medically necessary to remove them, a surgeon can take them out. Your eye doctor cannot guarantee that you will return to your original level of myopia after removal. Your eyesight may have become worse as you wore the lenses, so you may need a different glasses prescription.
There are other qualifications to undergo phakic IOL surgery.
- You must be between 21 and 40 years old.
- Your glasses prescription must be stable. It should not have changed much in the past year.
- Your eyes must be healthy otherwise.
- You must be in generally good health, without chronic conditions that impact your body’s ability to heal.
- You must understand, after speaking with your optometrist or ophthalmologist, that there are risks to this procedure.
- You must be able to avoid active exercise or sports for a few weeks after the procedure.
- You must have normal, healthy pupils.
- You must have a normal iris.
- You must have no inflammation in your eye from uveitis.
- You must be able to lie flat on your back for several minutes comfortably.
Your optometrist will examine your eyes to determine if you have any conditions that would make you a poor candidate for this procedure.
Your optometrist or ophthalmologist may decide that phakic lenses are the best solution for your severe myopia, so your vision insurance should provide coverage. The out-of-pocket cost is steeper than with other refractive surgeries. It’s roughly $4,000 typically, compared to $1,500 to $3,000 for LASIK. Price may be a limiting factor for some people, but you can ask your eye doctor if your insurance will cover some or all of this treatment.
What to Expect From Phakic Intraocular Lens Surgery
The operation to implant the phakic lens places this device between the cornea and the iris, typically on top of your eye’s natural lens. The procedure takes about as long as LASIK — approximately 15 minutes per eye, including prep time.
Phakic intraocular lens surgery is more invasive than LASIK or similar operations, so recovery time might be longer. After both LASIK and phakic lens surgeries, you will receive prescription eye drops to keep your eyes healthy. After LASIK, you use these drops for 10 days, but after phakic lens implantation, you will need to use them for between two to three weeks.
Here is what to expect from the procedure:
- Initial visit: You will have a visit with your ophthalmologist to get a full eye exam and discuss details of the procedure. Your doctor will probably ask you to stop wearing contact lenses prior to the exam, so your refraction and corneal curve rates are as accurate as possible. , During this visit, tell your eye doctor if you have any health conditions, are on medications, or take any dietary supplements.
- Preparation: You may have a laser iridotomy a few weeks prior to your phakic lens implantation. This procedure creates very small holes on the outer edges of your iris to help aqueous fluid in your eye drain better. Preventing fluid buildup helps to lower pressure, which can build up again after the IOL is implanted.
Your doctor may also tell you to stop wearing contact lenses and stop taking certain medications, like herbal supplements.
You’ll need to arrange a ride home after the procedure, as you will not be able to drive yourself. If you have been prescribed antibiotic eye drops, use those as directed. Do not eat or drink anything after midnight the day of your surgery.
- The surgery: You will have to lie down during the procedure. Your surgeon will place numbing eye drops in your eye, and you may receive a sedative to help you remain calm during the surgery. It is very rare that your doctor will use a full anesthetic, as it is better for your health if you remain awake during the operation. Your eye surgeon may also inject a medication to prevent you from moving your eye. Once your eyes have been set up, your surgeon will make an incision in the cornea, the sclera (the white part of the eye), or the limbus (where your cornea and sclera meet). The surgeon will gently implant the phakic IOL and then attach it to the iris. Then, the incision will be closed, and your doctor may use tiny stitches to keep it shut.
You will receive eye drops or ointment for your eye, along with an eyepatch to protect the area while you heal.
The procedure takes 30 minutes total for both eyes. You may wait in the recovery room for a couple of hours to ensure you are in good condition before you head home.
- After surgery: You may feel like you have something in your eye for a few hours, and you may be sensitive to light for the rest of the day. You will experience minor pain or discomfort, but if this is severe or gets worse rather than better, contact your doctor immediately.
You will have an exam with your eye surgeon the next day, so they can make sure everything is still in place. During that appointment, they will instruct you on how to use the prescribed eye drops over the next few weeks. You may need to wear an eye patch during the day or just at night to keep your eyes safe.
Your vision will stabilize over the next two to four weeks. Side effects as you heal may include:
- Halos or starbursts around lights.
- Glare or light sensitivity.
- Bloodshot eyes.
These side effects are normal and should decrease with time. If they do not, contact your eye doctor for more help.
Phakic Lens Surgery: A Rare but Important Option
A study comparing the results of LASIK to phakic IOL surgery found that both procedures had a similar chance of resulting in 20/20 vision without glasses at the end of one year. However, those who underwent phakic IOL surgery had better contrast sensitivity. The choice between the two procedures is personal, and vastly more people have LASIK than phakic lens surgery.
There are several factors that have made phakic lens surgery less popular than laser eye surgery. LASIK’s lower cost, shorter healing time, and improvements in laser-based procedures have all made it and similar options much more appealing than an implanted contact lens. Phakic lens surgery is still a solid vision solution for people who are not good candidates for laser eye correction.
Talk to your eye doctor about the pros and cons of phakic lens surgery for your specific situation.
Frequently Asked Questions
What is phakic IOL surgery?
Phakic intraocular lens surgery is the process of inserting plastic or silicone lenses into the eye to correct refractive errors like nearsightedness. The permanent implants are considered a generally safe alternative to glasses or contact lenses. Surgeons do not remove your natural eye lens during the procedure.
Can intraocular lenses be removed?
IOL implants can be surgically removed for medical reasons, although they’re meant to be permanent. Removal isn’t always ideal because it may lead to degradation of overall vision. There’s no guarantee that removing the devices will restore your eye’s pre-surgery focusing power.
Is Phakic IOL FDA-approved?
The U.S. Food and Drug Administration (FDA) approves of phakic IOL surgery under certain conditions. It has given the go-ahead for using phakic IOLs only when they’re designated to correct nearsightedness or myopia. To find out if a particular phakic IOL model is FDA-approved, go to the Devices@FDA page.
What Are Phakic Lenses? (January 2018). U.S. Food and Drug Administration (FDA).
Nearly 10 Million Adults Found to Be Severely Nearsighted in the United States. (June 2016). American Academy of Ophthalmology (AAO).
Phakic Intraocular Lenses for Nearsightedness. (February 2017). American Academy of Ophthalmology (AAO).
Are Phakic Lenses for You? (January 2018). U.S. Food and Drug Administration (FDA).
Before, During & After Surgery. (January 2018). U.S. Food and Drug Administration (FDA).