Verisyse IOL vs Staar ICL/TICL

[Kean]

Hi! Today I found out that I am not a candidate for Lasik because my cornea is too thin. However I was told that I can consider P-IOL or PRK, the doc recommended P-IOL eventhough her facility do perform PRK. She says PRK can develop haze, which cannot be reversed/treated with today's technology. After further inquiry, she did mention that PRK with Mitomycin and Vitamin C could produce good results, yet I could see that she was hesitant in recommending PRK because she said PRK was more suitable for < 6.0 D. Here's my prescription:

L: -7.25 -1.00 164 (490+ micron)
R: -7.5 -1.00 167 (500+ micron)

Age: 33

After some further reading about PRK and ICL, I am leaning towards P-IOL. Eventhough P-IOL is quite costly, the important thing is risk reward ratio. Though ICL is a surgery, however we have one very qualified surgeon (IMO), that have performed tens of thousands of complex eye surgeries including cataract extractions, corneal transplants and intraocular lens implants, and he has performed LASIK since 1996. I believe I'll be in good hands, don't you agree? From what I have find out, he can do Verisyse IOL and Staar ICL.

Here is my question. I have skimped through the Verisyse and Staar study from the FDA page, and what I gather is that Staar ICL's study seems to have better results, is that right? More importantly, seems like Staar Toric ICL is the only implantable lens that is approved by the FDA for myopia and astigmatism, right? Since I have astigmatism, looks like Staar TICL is the best option for me. Plus, I don't quite like the idea of Verisyse procedure where the lens is "clipped" to the iris. However if I don't qualify for Visian, I will definitely consider Verisyse.

I almost forgot. Does pupil size matter in P-IOL? I may have mistaken, is P-IOL has the 6.0mm limit? Five years back, I get to know that my pupil size is 7.5mm and 7.8mm fully dilated. With aging, I conservatively estimate my pupil size decreased by 0.3mm, now to be around 7.2mm and 7.5mm. Today, the doc didn't dilate my eyes.

Could you please give me any advise, options that I may have left out, or correct any wrong assumptions or unrealistic expectations that I have made above? I will try to talk to two surgeons qualified for this procedure hopefully soon before my Flex contribution deadline. I truly appreciate any help that you provide, thanks so much!

[Kean]

After further research, I realized I was mistaken about Visian Toric ICL getting approval by the FDA. One site was providing inaccurate info, the dates were all wrong plus the approval was for ICL not TICL.

So this complicates things a bit for me now. Back to square one. P-IOL seems like a good choice, but it treats only myopia now here in the US. So that means P-IOL for myopia + laser for astigmatism; which seems a bit much.

Please ignore what I have asked yesterday. I know that I am not a candidate for LASIK. So for correcting my myopia, I have either PRK or P-IOL. With my myopia of -7.5, in my case, PRK risk is higher of generating haze which is irreversible/not treatable. So P-IOL still seems to be a good option to treat my myopia. Plus I have read that Toric P-IOL may shift space, which will cause ghosting (astigmatism). So I can definitely consider getting P-IOL for my myopia, and use the next two months to think if I would consider laser to correct my astigmatism. Or I can always use glasses for my astigmatism, since my astigmatism seems to change slightly every two years, but my myopia is very stable. I'm just thinking out loud now.

Could someone please provide your experience or informational link with Toric P-IOL? Does it stay on the right plane? What are the chances of it shifting or what could cause it to shift? If it is reliable, that means I will have to wait till 2008 at the earliest before the FDA will approve it.

Lastly, will shrinking ACD with age affects implanted lens? I wonder if that will cause cataract with Visian ICL when we age. Thanks for any additional information that you are willing to share, this is the best informational exchange for people who are considering refractive surgery, thanks!

[ness27]

Hi there,
I am booked in to have visian ICL in 2 weeks time for bad hyperopia. I know only what i have researched myself, i'm not a dr by any means. What I do know is that my dr asked me if i wanted the toric lenses to correct my reasonably bad 3.5 astigmatism. He said the downfalls of this is that they can move and particularly if you play sports or are in a situation where you might get a blow to the head. I said no i didn't play sport etc and asked if there was no blows to the head would it still move and he said he couldn't 100% say for sure it would or wouldn't he said there was still the chance but then you go back in for more surgery and they re straighten it. My point to him was how many times would they cut my eye ball open to re straighten this thing if it moved continually he said that it was unlikely but none the less not impossible. I used to where toric contact lenses which occassionally shifted and i could blink them or turn them back into positiion with my finger my dr said the vision would be the same if the ticl shifted only i wouldn't be able to fix it myself. So I opted to have the ICL and he is performing another surgery on my eye at the same time to alleviate my asigmatism.
Hope that helps.

[LasikExpert]

Your moderately high myopia (nearsighted, shortsighted) vision, astigmatism, pupil size, and corneal thickness, puts you in the spot that is just a little too low for a phakic intraocular lens, and a little too high or PRK, and a little too thin for Lasik. Lasik would probably be the procedure of choice, but your corneal thickness means that it would only be within the safe parameters if you had a very thin Lasik flap. The large pupil size puts everything in the "maybe not" category.

Both types of phakic intraocular lenses (P-IOL) would resolve your myopia, but they are more invasive than a cornea based surgery like Lasik or PRK and carry enough additional risk that they seem to be best for people who have high refractive error and cannot be corrected with a cornea-based surgery. If your error was in the -10.00 or greater range, then I'd say P-IOL is probably the most appropriate refractive surgery technique - if anything is actually appropriate.

Your pupil size is an issue for any type of refractive surgery. The optics on the P-IOLs are smaller than your pupil size. Your pupils may even be large enough to interfere with the "clips" of the Verisyse-Artisan during dilation. Part of the optic on a toric IOL is even smaller. A larger treatment zone with PRK or Lasik requires more tissue removal, and you already have thin corneas. The largest optical treatment zone (full correction) with an excimer laser is 6.5mm and the astigmatic correction portion would have a more narrow treatment.

The toric Visian ICL can rotate after implantation, but studies have shown it to be reasonably stable. It can normally be manipulated after implantation. The Verisyse-Artisan does not normally rotate after implantation. Neither are available in the US.

At age 33 you are much too young for a Refractive Lens Exchange because you would lose all your accommodation (ability to change focus to see objects near) and the multifocal or accommodating IOLs simply are not as good as your natural accommodation.

We are a rather conservative bunch here. You have an elevated risk of a poor outcome for every refractive surgery technique possible. You might be able to have refractive surgery and get a good result, but your odds are not as good as someone who does not have thin corneas, large pupils, moderately high myopia, and astigmatism.

The most you can expect from refractive surgery is the convenience of a reduced need for corrective lenses. To achieve that convenience you must accept some risk. It appears that all techniques and technologies available today put you at an elevated risk for a poor outcome. Only you can decide if the convenience of a reduced need for glasses and/or contacts is worth the elevated risk of surgery.

[Kean]

Thanks for your response. I didn't see this response before I posted a new topic asking about corneal haze. Thanks so much for taking time to analyze my situation. I didn't know there's a 6.5mm optical ablation zone because I thought I've read where patience with similar pupil size as mine didn't experience much HOA after surgery. So I've started reading about surface ablation method for the past few days. Though it's disappointing to hear but that's exactly what I need to know. Now I need some time for that to sink in and have very modest expectation. Thanks very much Glenn, I really appreciate your response. Have a great one!

Kean

[LasikExpert]

You may find our article on Lasik Pupil Size interesting.