Yes! The Visian ICL can often help those who are very nearsighted as a result of keratoconus. For young people with keratoconus, we often recommend corneal cross-linking to make sure the cornea becomes stable and the keratoconus does not progress. In many cases, we place small reinforcing rings in the cornea called either intracorneal ring segments or Intacs. The plastic ring segments help stabilize the distorted surface of the cornea to improve vision and decrease astigmatism. Once all is stable, we can use a Visian ICL to correct the leftover nearsightedness or myopia. We are lucky to live at a time when we have a number of options to treat keratoconus such as corneal cross-linking, intracorneal ring segments (Intacs), and the Visian ICL.
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The UBM is an ultrasound that allows the doctor to see inside the eye, behind the iris (the colored part of the eye). Just like an ultrasound allows doctors to see inside our bodies for things like evaluating a pregnant woman to make sure a baby is OK, these ultrasounds allow us to look into an eye and make sure there are no abnormalities in the area of the eye where the Visian ICL is placed. It also allows us to accurately measure the space where the Visian ICL is positioned so the correct size can be determined. In my opinion, this has been more accurate than just measuring the width of the cornea. The width of the cornea is variable depending on how the white part of the eye and the cornea developed, or if there has been scarring from contact lens wear, infections, or other inflammatory problems on the surface of the eye. Although it takes a little longer to do the UBM measurements, I feel that it has greatly improved the outcomes with Visian ICL surgery.
This post has been updated on 9/24/18 to include the FDA approval of the Visian Toric ICL.
Yes you can still have a Visian ICL if you have astigmatism. STARR Surgical has announced the FDA approval for the Visian Toric ICL to correct myopia (nearsightedness) and astigmatism. In addition to implanting a Visian Toric ICL, there are other options to treat astigmatism. The first and most frequent method is to place the incision to insert the Visian ICL in a such a way as to decrease the astigmatism. The next way is to make small incisions in the cornea to relax, or reduce the astigmatism, either at the time of surgery or later. In cases with more significant astigmatism, we typically do LASIK to eliminate the astigmatism. LASIK is very accurate in correcting astigmatism, depending on which Laser is being used. In my opinion large amounts of astigmatism are accurately corrected with the Wavelight or Allegretto laser, and less so with the others, at least in my experience.
We have all heard of LASIK. LASIK has almost become routine as it provides rapid visual recovery, is safer than wearing contact lenses, and actually is much less expensive than contact lenses. So why would someone want a lens like the Visian ICL implanted inside the eye, instead? Here are 5 reasons:
1) In some cases a person has corneas that are too thin to allow either LASIK or
laser surgery on the surface of the eye (PRK, Advanced Surface Ablation,
LASEK).
2) In some cases one might have a refraction over 8 or 10 diopters (the
prescription in glasses or contact lenses). When the prescription in a pair of
glasses starts to get to 7 diopters, and certainly in the range of 8 to 10
diopters, using a laser to reshape the cornea is not as stable or predictable as
placing a lens inside the eye like the Visian ICL. The Visian ICL is approved
for prescriptions from -3.00 to -16.00 diopters. With the larger corrections
there is more variability in the laser results, but there is no increased
variability in the results for higher corrections with the Visian ICL. A person
can have excellent visual results even with high corrections without induced
aberations or problems being just on target.
3) Everyone gets cataracts if they live long enough. When one does get
cataracts, high corrections with lasers can make it difficult to get accurate
predictions for the correct power of lens implant used to fix the cataract.
However, with the Visian ICL there is no problem with the calculations, and
the Visian ICL lens can easily be removed at the time of cataract surgery
without increased risk to the eye when surgery is done by an experienced
Visian ICL surgeon.
4) When someone has very dry eyes, having LASIK or one of the surface
treatments(PRK, Advanced Surface Ablation, or LASEK) will increase the
problems with dry eyes – at least in the short term for 1 to 3 years. The
Visian ICL does not cause any increase in dry eye problems as it does not
interfere with the way the nerves work in the surface of the cornea.
5) The most common reason to be turned down for laser refractive surgery like
LASIK or PRK/Advanced Surface Ablation/LASEK is because screening tests
either show definite or suspected Keratoconus. Keratoconus is a condition
which causes the cornea to become weakened and bulge outward ruining the
vision. Any of the laser surgeries could weaken the cornea further so they
are not typically done if there is Keratoconus. However, the Visian ICL does
not weaken the cornea so it can be safely used to treat eyes that either have
Keratoconus or are suspected of having a tendency for Keratoconus.
Price Vision Group Earns Esteemed 2015 Angie’s List Super Service Award
Award reflects company’s consistently high level of customer service
Price Vision Group has earned the service industry’s coveted Angie’s List Super Service Award, reflecting an exemplary year of service provided to members of the local services marketplace and consumer review site in 2015.
“Only about 5 percent of the Ophthalmology practices in Indianapolis have performed so consistently well enough to earn our Super Service Award,” said Angie’s List Founder Angie Hicks. “It’s a really high standard.”
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Soft contact lenses have an inherent problem with trying to correct astigmatism.
The problem is that with each blink, contact lenses not only move up and down, they
also rotate either clockwise or counter clockwise. The rotation does not matter if
the correction is only spherical (meaning nearsighted or far sighted corrections).
However with astigmatism, the curvature of the corneal surface and the curvature of
the contact lens each vary in different directions (like the shape of an American
football). When the lens is in perfect position, everything is great, but then we have
to blink and the lens rotates a few degrees, and with the next blink a few more
degrees. Suddenly the soft contact lens is no longer correcting the disparity in
curvature, in fact when it rotates 90 degrees it actually makes the astigmatism twice
as bad as it was before!! In order to compensate for this rotational movement, soft contact lenses for
astigmatism are frequently made with ballasts or prisms so that when an eye blinks
and the lens rotates, the ballasts or prisms cause the lens to rotate back. This helps,
but many patients find this disorienting – especially as the two eyes rotate the
lenses in opposite directions. All contact lenses have to move up and down a little
with each blink to keep tears moving in and out from under the lens. So with each
blink the vision is made a little blurry with contact lenses, even spherical ones. But
with astigmatism we also get rotational disorientation typically different for the two
eyes. This is why many people don’t even have their astigmatism corrected at all
with their soft contact lenses. Lasik is far superior to soft contact lenses in correcting
astigmatism because the correction is applied directly on the surface of the eye.
The correction does not move with each blink; instead, it is stable in any direction of gaze.
A: There are many advantages of both the Visian ICL and Lasik over contact lenses. I
will answer this as a series of answers.
Contact lenses continually move around on the eye with each blink. Contacts
have to move on the eye in order for tears to get under them and keep the tear fluid
under them intact and nutrients moving into and waist products out of the cornea
under the contact lens. This movement causes some blurring of the images seen
through the contact lenses. Neither the Visian ICL or Lasik move on the eye with
blinks so the images seen are more clear and steady than with contact lenses. The
Visian ICL has the added advantage of not inducing or causing any dry eye issues as
both contact lenses and laser refractive surgery can.
Astigmatism correction is problematic with contact lenses. Not only do
contacts move with each blink, but the contacts rotate, or turn either clock wise or
counter clock wise on the eye with each blink – the direction depends on which eye
it is left or right. Since astigmatism corrections need to be in a particular alignment
relative to a particular clock hour on the surface of the eye, the rotating of the
contact with each blink causes the astigmatism correction move out of the proper
alignment. Some contacts try to minimize this distortion by putting a ballast or a
heavier portion in the lens so it moves back after the blink rotates it. Other lenses
have special shapes so the lids tend to push the lens back in position. No matter
what is done though, the contact lenses move back and forth causing some
distortion for astigmatic corrections. With Lasik, the astigmatism correction is
permanently etched onto the eye so that blinking causes no distortion and the vision
is always clear with astigmatic corrections.
Both the Visian ICL and Lasik can be more cost effective than contact lenses,
as well as greener. No more wasteful packaging for contact lens solutions or contact
lenses after Lasik or Visian ICLs, one has a permanent correction that should last for
years. Visit our website for information on the time it takes for these surgeries be
more cost effective than contact lenses.
Safety: while both Lasik and the Visian ICL involve surgery, once the surgery
is done, there is no more handling of contact lens solutions or removing and
inserting contact lenses. While contacts are great, infections do routinely occur with
them from either a breakdown of the necessary hygiene needed to keep them clean
or from contamination with water or contaminants in the air. Contact lenses are the
most common reason adolescents have emergency room visits. Extended wear
contact lenses are the ones most commonly associated with increased rates of
infections related to contact lens wear.
A: The Visian ICL, like all lens implants for nearsightedness, gives excellent visual
results. Some doctors have even referred to the outstanding visual results with the
Visian ICL as High Definition Vision – because it is so clear and predictably good.
One of the advantages of the Visian ICL for those who are very nearsighted is
that images will appear larger than with glasses. For someone who has a
prescription of -10.00 diopters, images will be 20% larger. In fact, for every diopter
of myopia (nearsightedness) corrected, there is a 2% increase in image size.
Glasses, in effect, make everything smaller if you are nearsighted – like looking
through a pair of binoculars the wrong way! The Visian ICL basically restores one’s
visual image to the size it should be normally.
A: Lasik is a great surgery; I have been doing it for over 20 years. Lasik is very
effective for treating astigmatism, nearsightedness, and farsightedness. However, in
some cases, Lasik may not be the best treatment or even advisable for some people.
The Visian ICL by Staar Surgical is an excellent option for those who are nearsighted and cannot have Lasik.
Visian ICLs work well for many people who have thick nearsighted glasses
often too much for Lasik corrections. Personally, I prefer the Visian ICL for
prescriptions greater than -8.00 diopters, and for many greater than -7.00 diopters.
In some cases with lower prescriptions, the Visian ICL may also be recommended if
someone’s cornea is too thin or there are signs of condition like keratoconus or a
tendency towards keratoconus.
There are other refractive procedures that can eliminate your need for glasses even if your corneas are too thin for LASIK. During a refractive exam at Price Vision Group, many special tests are performed to ensure you are indeed a good candidate for LASIK, including corneal thickness. The average corneal thickness is between 520 microns and 540 microns, however, the normal range for cornea thickness can range from as thin as 470 to as thick as 630 microns. In order to be a candidate for LASIK there needs to be enough corneal tissue to make a flap, take away the tissue in order to correct the refractive error, and still have enough corneal tissue to ensure that corneal ectasia, a progressive bulging of the cornea, does not occur. To learn more about cornea thickness and how it affects LASIK candidacy, please click here. If the cornea is not thick enough to result in a corneal bed, the remaining cornea beneath the flap, of approximately 300 microns then LASIK is likely not the best refractive procedure for you. During a refractive exam at Price Vision Group, the doctor runs calculations to ensure that the cornea is thick enough for LASIK.
A phakic IOL may be a better refractive option to eliminate your need for glasses or contact lens visual correction if the cornea is not thick enough. The Visian ICL (Implantable Collamer Lens) is FDA approved to correct myopia ranging from -3.00 D to -15.00 D. This small lens implant is implanted behind the iris (colored part of the eye) and in front of the natural lens inside the eye to correct the refractive error. The lens is designed to stay in position in the eye and requires no special care and the corneal thickness is not altered as in LASIK. The best candidates for this refractive surgery option are those under the age of 50.
If you are above the age of 50 and not a candidate for LASIK because of a thin cornea, then a refractive lensectomy or refractive lens extraction may be a better refractive surgery option. The natural lens is removed, as in cataract surgery and an IOL is implanted. The IOL is calculated to correct your refractive error. There are implants to correct astigmatism and even multifocal IOLs that allow patients to see well at both distance and near. This refractive surgery allows for the correction of myopia, hyperopia, and astigmatism without altering the cornea thickness.
If you have been told you are not a candidate for LASIK there are other safe surgical options that can eliminate your need for glasses or contact lenses.
