Visian ICL is the most commonly used phakic IOL in the U.S. It is an outstanding option for many that desire to correct their nearsightedness. I placed a Visian implant in my little brother’s eye when it was time to correct his myopia and he has been very pleased with his surgical experience and his vision.
A Visian ICL is a small implant that is placed inside your eye to correct your vision. Just as glasses or contact lenses can be fashioned to correct your nearsightedness, the Visian implant can be fashioned to correct your prescription error. It is placed in your eye between your iris (colored part of the eye) and your lens. It stays there, correcting your vision 24/7 throughout your life. The term ICL originally stood for “implantable contact lens.” When the Visian implant was FDA approved, the government insisted that it not be called a contact lens. The problem was that everyone already called it the ICL so the company declared that ICL now stands for “implantable collimer lens.”
Visian implants are made of collamer. Collamer is a very biocompatible substance that is a mixture of collagen and a plastic polymer, hence col for collagen + amer for polymer = collamer. Collagen is a form of connective tissue that exists naturally in your body. This is a high-tech human/plastic hybrid material that is very biocompatible. This means that the body views it as family and doesn’t try to reject it. The material is very soft, flexible, and forgiving but holds its shape over time.
The first phakic IOL was implanted in 1953 by Bendetto Strampelli in Itally. It was made of a rigid material called PMMA. Since that time, there have been ongoing improvements in the shape of the phakic IOLs and the flexibility of the materials used. A number of different styles of phakic IOL have been used since then made by various companies around the world. The Visian ICL was developed at the Fyodorov Institue in Russia in 1992. Dr Fyodorov became famous for inventing radial keratometry. The ICL came from his quest to find a better way to correct vision. Since 1992, it has been widely implanted, modified, and refined. The current v4 model represents over twenty years of rigorous testing and research. My good friend, John Vuchich, MD lead the FDA trial study team. They began implanting the device v4 in patients in the U.S. in 2001 and FDA approval was granted in 2005 making it available to all patients.
Glasses, contact lenses, LASIK, and PRK are all options to correct myopia (nearsightedness). LASIK and PRK use an excimer laser to vaporize away part of your cornea. This gentle change in shape helps restore focus to your vision. In contrast, nothing is removed from your cornea with this Visian implant. If the Visian ICL is removed, your eye would usually be about the way it started. This reversibility is appealing to many that choose Visian ICL vs. laser eye surgery.
Dry eye seems to be a more common complication with LASIK than with implant surgery. Most LASIK patients have dry eye symptoms for the first 3-6 months. This fades for most, but the dry eye does persist long term for some. This is one of the advantages of the implant procedure over laser vision correction.
The quality of vision tends to be exceptional with this implant. This is because when the phakic IOL is made, it can be tested to make sure it is perfect before it is packaged and sent to your doctor for your eyes. Studies have shown that patients that have a phakic IOL in one eye and LASIK in the other generally prefer the vision from the phakic IOL.
The FDA met last week and reviewed the data for the Toric Visian ICL. This implant has astigmatism correction built right into the ICL. As a general rule, if the committee deems an implant approvable, the FDA officially approves it in short order. In the past, if a patient had a lot of astigmatism, we had to implant the ICL first and then do LASIK later to correct the astigmatism. With the astigmatism correction right in the phakic IOL, we will be able to address both the myopia and the astigmatism in one surgery. This will make even more patients ideal candidates for Toric Visian implant.
The day of your procedure is all about you. It is an outpatient procedure. Eye drops are placed to dilate your pupil. You are given either oral or IV medicine to make your world happy, peaceful, and beautiful. Topical numbing drops are placed so your eye is comfortable. Your eye is cleaned and an opaque plastic drape is placed. Several tiny incisions are created, the implant is placed behind your iris, and medicine is placed to un-dilate your pupil. I have never had a patient feel the ICL inside the eye. Most patients choose to have one of our OR nurses help administer the anesthesia for the procedure. There is no additional cost for this. If you are above average anxious about your procedure, you could choose to have the anesthesia administered by an anesthetist. There is an additional charge for this, but they are more comfortable taking you to deeper levels of anesthesia.
A small iridotomy is created in the colored part of your eye to allow the free flow of fluid within your eye. This could be created a week or so before your procedure or at the same time your implant is placed. Your surgeon will recommend the best timing for this iridotomy for your eyes.
Most have a quick and easy recovery. As you sit up after the procedure you will notice that you are no longer near sighted but it will still be somewhat blurry. I have my patients return for a quick eye pressure check 3-4 hours after surgery. The vision varies at this visit with some already seeing clearly and others still a bit blurry. I see my patients back again the next morning. Usually, the vision is already outstanding after the nights rest. If everything looks great on that exam, then you are free to return to normal activity during your Visian ICL recovery.
Someone will need to drive you home after the procedure. Most can resume driving 24 hours after the surgery. After the first eye is corrected and while you wait for the second eye surgery there can be some imbalance. Some patient do fine with this wearing their old glasses if we take the lens out of the glasses on the side that has already had surgery. Other struggle with this solution and are more comfortable wearing a contact lens in the un-operated eye until the second surgery.
It is important to avoid swimming, hot tubing, and circumstances where you could get poked in the eye for the first week or so after surgery. If everything look fine on your postoperative visit the day after surgery, then generally I will release my patient to resume excise during your Visian ICL. The exertion and sweat of exercise is not a problem, but trauma could cause damage so it is wise to avoid activities like contact sports, horseback riding, or skiing through the trees that first week. From that point on in your Visian ICL recovery, you can return to more aggressive exercise if you are confident you can protect your eyes with safety glasses/goggles for several weeks longer.
The possible Visian ICL complications include issues like infection, target error, astigmatism, inflammation, glaucoma, scarring, and cataract.
Infection is the worse case scenario. This could affect your vision long term. The odds of this are around 1 out of every 4,000. To protect against this, we use a sterile technique in the OR and have you use antibiotic eye drops.
Target error is a potential Visian ICL complication. Prior to your procedure, we measure your myopia and use these measurements to order your ICL. After surgery if you have a small amount of remaining refractive error, your options include glasses, contact lenses, laser eye surgery, or LRI’s to obtain clearer vision.
The implant fits into a space called the sulcus. We do measurements on the size of your eye prior to your procedure to help us determine the correct length of ICL to place so it will be just the right size to sit in the sulcus. We want it long enough that it vaults up off of your lens leaving room for the lens to grow over time without touching the implant. On the other hand, we don’t want the ICL to vault too much or it could cause your eye pressure to rise. We use careful science to obtain these measurements, but they are not perfect. Most determine the size of Visian ICL to place by measuring the outer diameter of the cornea. This is called the white-to-white measurement. They use this distance to estimate the size of the sulcus. It is more accurate to actually measure the size of the sulcus, but this requires a special type of ultrasound called a UBM. We have a UBM probe to gain this extra amount of safety for our patients and decrease the chances of a cataract Visian ICL complication.
Everyone blessed with long life develops a cataract at some point in his or her life. If the ICL has too much contact with the lens inside your eye, it could make your cataract come on at a younger age or even shortly after placing the implant. On average, chances of developing a cataract at a younger than expected age as a Visian ICL complication is about 1 out of every 100 to 200 patients in experienced hands.
When it is time for cataract surgery, the ICL is first removed and then a standard cataract removal is performed and an intra ocular lens implant is placed to correct your vision.
Some patients are sensitive to light with night driving after the procedure, especially if they are larger than normal pupil sizes so the their pupil is bigger than the implant at night. This can cause glare from the edge of the implant. This is rare. Some of these patients use eye drops at night when they are planning long drives to decrease this symptom. There are other patients that experience glare from the peripheral iridotomy openings. If this is problematic, corneal tattooing can be done just over the peripheral iridotomies to stop the symptoms.
If you ask several optometrists and your primary care physician who they recommend for your ICL Visian surgeon you will start to hear a couple of names that come up over and over again. That is probably a good place to start. If you visit with those surgeons, you will find the one where you feel a good rapport and most comfortable.
I have had a very good experience with Visian ICLs and it is currently the phakic IOL that I recommend most often. If I can answer any further questions about phakic IOL options, please schedule a time to meet with me or post a comment.
* Image from: The StayWell Company, LLC, 780 Township Line Road, Yardley, PA 19067, 267-685-2500