VISIAN ICL
Author: Sherman Winston Reeves, M.D., M.P.H.
Definition: The VISIAN Implantable Contact Lens (ICL) is a refractive surgery procedure in which an artificial lens is implanted in the in order to correct refractive error. The VISIAN ICL is a form of phakic IOL, or secondary lens implant that works in addition to the eye’s natural crystalline lens, which is left inside the eye rather than being removed, as in refractive lens exchange.
How Does VISIAN ICLWork?
In myopic(nearsighted) patients, the light coming into the eye is not focused properly on the retina. This poor focus may be due to the eye’s crystalline lens being either too weak or too strong to help focus light appropriately. By placing an artificial lens inside the eye, the light can be better focused on the retina, reducing the person’s dependence on glasses and contact lenses to see clearly. The artificial lens placed in the eye, in this case, the VISIAN ICL, can be chosen depending on the refractive needs of the patient’s eye.
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Who are candidates for the VISIAN ICL?
The VISIAN ICL is typically used for myopic individuals who have low amounts of astigmatism and who are otherwise not candidates for LASIK or PRK. Typically, very high levels of myopia or thin or irregular corneas are reasons why LASIK and PRK may not be the best choice for a person. In these cases, the VISIAN ICL can offer a good alternative to correcting the refractive error.
In general, candidates for the VISIAN ICL should be:
These conditions may prevent you from undergoing the VISIAN ICL surgery or other refractive surgeries. You should alert your eye surgeon if you have one or more of these conditions so that he or she can help you make the best choice about undergoing refractive surgery:
| Condition: | Reason for caution: |
| Autoimmune diseases (ex: Rheumatoid arthritis, Sjogrens syndrome, Lupus, scleroderma) | May result in poor or inadequate healing after surgery. Surgery may cause activation of these diseases in the eye. |
| Diabetes | May result in poor or Inadequate healing after surgery. Poorly controlled diabetes can cause unstable refractive error |
| Immune deficiencies (ex : HIV/AIDS, history of an organ transplant, undergoing chemotherapy for cancer, taking oral corticosteroids | May increase chance of a severe eye infection after the surgery. |
| History of Herpes Simplex or Zoster eye infections. | May cause reactivation of the infection. |
| History of other eye diseases (Glaucoma, Fuchs Dystrophy, Macular degeneration, Cataract, Ambylopia or lazy eye) | May decrease the chance of success of surgery. |
| Pregnancy or Nursing | Can cause temporary changes in the shape of the cornea. |
| History of retinal detachment or eye trauma | May increase the risk of retinal detachment occurring after the VISIAN ICL surgery. |
Examination prior to the VISIAN ICL surgery:
Before you arrive at the doctors office:
If you are a contact lens wearer, you should stop wearing you lens for at least 2 weeks if you wear soft contacts or 1 month if you wear hard contacts. Contact lenses can cause mild warping of the corneal shape, which can interfere with the preoperative measurements of the eye and calculations for VISIAN ICL surgery.
Tests you may have at the doctor’s office:
The evaluation for VISIAN ICL surgery typically includes a complete eye exam of the front and back of the eye, plus several additional tests. Your visual acuity with and without glasses will be tested, as well as a refraction to determine if your current vision differs markedly from the vision corrected in your current glasses. If they do differ markedly, you may need to return for another visit several weeks later for a repeat refraction to insure that your prescription is not changing. Your eyes will be dilatedand examined completely. Your doctor will perform a slit lamp examination to examine the eye and the lens. A retinal exam may also be performed during the dilated examination . A second refraction may be performed after your eyes have been dilated. Lastly, measurements of the curvature of your cornea and length of your eye will be taken to help your doctor choose the appropriate lens implant for your eye.
Is 20/20 vision guaranteed with the VISIAN ICL?
VISIAN ICL surgery is an extremely advanced technology for surgical vision correction. The eye can be measured very precisely for the appropriate lens implant and your surgeon will be highly skilled in performing the procedure. As such, the vast majority of people undergoing VISIAN ICL surgery are very happy with their post-procedure vision. In fact, a person’s happiness with their vision after the procedure is a far more important measure of success than the somewhat arbitrary “20/20” measurement done in a dark room of a doctor’s office. However, several factors may lead to a person having vision after the surgery which still requires additional help from glasses or Contact lenses. Though very precise measurements and surgical technique are used for VSIAIN ICL surgery, the individual healing response of each patient may result in some variability of the final refractive outcome. Generally, though, this variability is very small and people are highly satisfied with the surgery. LASIK or PRK may sometimes be used after VISIAN ICL surgery to “touch up” any residual refractive error. Occasionally, though, glasses or contacts will still be needed for some viewing situations after VISIAN ICL surgery.
What are the Risks of VISIAN ICLsurgery?
Though the risks of VISIAN ICL surgery are small, vision can be lost in several ways:
Infection: Since cuts are made on the eye, it is possible that bacterial could gain access to the corneal tissue and start an infection. Scarring from such an infection could lead to vision loss. This is very uncommon as powerful antibiotics are used after the VISIAN ICL to prevent infection. The risk of severe infection is probably less than 1 in 500.
Swelling of the cornea or retina: Swelling of eye structures can occur after VISIAN ICL surgery. Generally, these are mild and self-limited problems which resolve with time and eyedrop treatments. Rarely, though, swelling may persist and lead to decreased vision. Additionally surgical methods are available to help in those cases.
Retinal detachement: Rarely, surgery inside the eye can cause small tears in the retina to occur which may lead to a retinal detachment. Usually, a patient will experience flashes of light and multiple new floaters if a tear occurs. Lasers and surgery can be used to repair retinal tears and retinal detachments that occur after lens removal surgery.
Increased eye pressure: High eye pressure can sometimes occur after lens Visian ICL surgery. Usually, this resolves within a few days, though sometimes medications need to be used to help keep the pressure low. Rarely, the lens will need to be removed to lower the eye pressure.
What will I experience during the VISIAN ICLprocedure?
A week or two prior to your VISIAN ICL surgery, your surgeon will perform a laser surgery to make several small holes in the edge of the iris. This procedure is called peripheral iridotomy, and usually takes about 10 minutes to complete. The procedure is not painful, but you may occasionally you might feel a snap, like a rubber band striking the skin, which lasts a spit second as the small hole is made in the iris. These small holes help the eye fluid flow appropriately to the drainage system of the eye, and help prevent high eye pressure after the surgery.
On the morning of your procedure, your surgeon will ask you not to wear any makeup, which may contaminate the eye during surgery. At the surgery center, you will usually be given an intravenous line (IV) so that Valium and pain medication can be given during the surgery. The VISIAN ICL procedure itself usually takes about 20 minutes or less to perform. An injection of numbing medicine may be given behind the eye while you are partially asleep, or eyedrops may be used to numb the eye. During VISIAN ICL surgery, extremely small incisions, usually less than 3 mm long, are made at the edge of the cornea. Next, the prosthetic lens is inserted into the eye just behind the iris. This prosthetic lens stays in the eye permanently, and works to focus light on the retina again. The wounds in VISIAN ICL surgery are so small that often the do not even require a suture to close them at the end of the surgery. Last, antibiotic eye drops are placed in the eye. A patch or plastic shield may be placed on your eye after the surgery, though sometimes neither is needed.
During the surgery, you may see bright and multi-colored lights as well as blurry shapes moving in front of the eye. Generally, you will feel calm and comfortable during the surgery from the intravenous medications.
After the procedure is done, you will rest in the recovery area for an hour or two, after which someone can drive you home. As you have had intravenous medications, driving yourself to and from the surgery center will not be allowed. Your eye may start to burn and feel irritated about an hour after the surgery as the numbing medicine wears off. Artificial tears can help make the eye feel more comfortable. Your surgeon may also have you start antibiotic and ibuprofen drops on the evening after your surgery as well.
After your surgery, you should not rub or press on the eye for at least 1 to 2 weeks. Gentle cleaning around the eye with a damp wash cloth or cotton ball is fine, though. You should avoid lifting objects that weigh more than 20 to 30 lbs and refrain from heavy activity for at least 1 to 2 weeks. You should avoid bending at the waist to pick up objects on the ground for the same period of time. These measures help ensure that excess pressure is not put on the eye which may open the wound before it is healed. Lastly, avoid getting soapy or dirty water in the eye, and do not swim or use hot tubs for at least 2 weeks after the surgery.
Your doctor will see you the next day, at which point the eyes are usually feeling pretty comfortable. You will continue using eye drops for several weeks after the surgery, and then see your doctor again in 1 to 3 weeks for a vision check. If all is well, as it typically is, your doctor will usually see you again in 6 months to a year for another vision check.
