For some patients, there are instances where LASIK may not be the best option. Reasons might include thin or irregular corneas, prescriptions out of range for a good LASIK result, ocular pathology or unrealistic patient expectations. Fortunately, many patients can benefit from other procedures that we offer.
This procedure involves reshaping the cornea on the surface without creating a flap. It may be recommended if the corneas are too thin and/or irregular. Also, patients involved in certain avocations where there is a higher possibility of ocular trauma may be good candidates for this. Treatment outcomes are similar to LASIK. The recovery time takes longer and should be planned for postoperatively. Patients must not work or drive for the first 4 days. It may take at least one month for the vision to stabilize. We use the Allegretto Wave laser, the same laser as we do with LASIK, to reshape the eye. The only difference between PRK and LASIK is where we direct the treatment. With ASA we apply the laser to the corneal surface. With LASIK we apply the laser underneath a thin corneal flap.
Occasionally, there are patients that are not good candidates for LASIK because of high prescriptions, thin or irregular corneas or other reasons. In these cases we may recommend the Visian ICL (Implantable Collamer Lens). In this procedure, a small lens is permanently implanted in the eye behind the iris and in front of the natural lens. This procedure can also be combined with LASIK or ASA to correct any small residual nearsightedness, farsightedness or astigmatism.
Best candidates for the Visian ICL are between ages 21 and 50 with moderate to severe nearsightedness with or without astigmatism. The vision must be stable for at least a year prior to surgery. A complete eye exam and detailed measurements are made to make sure the best outcomes are obtained. In preparation for the procedure, your doctor will use a laser to make two small spots on the iris in each eye. The purpose of these is to reduce the chance of developing a pressure build up in the eye following the ICL surgery.
The actual ICL procedure is performed in an outpatient surgery center. After topical anesthesia and light sedation, the doctor performs a small incision on the edge of the cornea. The Visian ICL is then injected into the front chamber of the eye. The edges of the implant are then gently tucked underneath the iris, or the colored part of the eye. The pupil is then constricted with medication and antibiotic drops are administered. The identical procedure is then performed on the fellow eye. After the procedure, the patient goes to the recovery area for about 30 minutes and then is discharged wearing sunglasses. Patients are seen in the office later in the afternoon to monitor the intraocular pressure. Antibiotic and anti-inflammatory drops are prescribed for several weeks after the surgery. Postoperative visits are also scheduled for 1 day, 10 days, 1 month and 3 months. If any further laser vision enhancement surgery is needed, it is generally performed after the 3 month visit.
Vision recovery after ICL surgery is fairly rapid. Usually within 24 hours, patients can drive. It is best to take several days off from work to allow the eyes to heal adequately without complications. It is normal to have a mild foreign body sensation, light sensitivity and blurring right after the procedure. The symptoms gradually improve as the eyes heal.
An advantage of the Visian ICL is that it allows treatment of patients that might not otherwise qualify for laser vision correction. Another advantage is that after surgery, the vision is stable because there is very little wound healing that takes place.
Patients with Stage II Dysfunctional Lens Syndrome (DLS) or early cataracts may not do well with LASIK in the long term. This is because as the cataract grows, the nearsightedness, farsightedness and/or astigmatism might change. Also, as the cataract begins to cloud the eye, vision performance may drop off. It is for this reason that lens based surgery may be the best option. Another benefit is that after the lens is removed, there are implants that can correct astigmatism and reading vision (presbyopia). For all intents and purposes, lens based surgery is exactly the same as cataract surgery. Please refer to the Cataract tab to learn more about this procedure.