LASIK vs ICL?

[ksigler]

I went into a local clinic after a lot of research, talking with friends and acquaintances who have had the surgery and 4 years of considering whether or not to proceed with LASIK correction.

During my eval I was found to be a good candidate for LASIK. Healthy eyes, small pupils, slight astigmatism, -6.5 in both eyes, "big thick corneas" :) (I forget the exact size, but those were the words the ophthalmologist used after explaining the WAVEPrint results).

However the ophthalmologist suggested that I would also be a good candidate for Visian ICL if I opt'ed for it. The cost is more but that isn't a concern of mine. The idea of reversibility is appealing as is the fact that it doesn't remove tissue from the cornea. My primary concern is the newness of the procedure in the clinics in the US. I wonder how much experience the surgeons here have with the procedure compared with LASIK. Aside from that I'm not sure there is much difference in the two.

Most of the articles I've read talk about ICL as a substitute for when you are not a good candidate for LASIK. If ICL is an option is there a reason to choose LASIK over it? Thanks.

[LasikExpert]

In my opinion, a phakic intraocular lens (P-IOL) like the Visian ICL or the Verisyse/Artisan are only appropriate when a cornea-based refractive surgery is inappropriate. You have not mentioned anything that is a direct contraindication for Lasik. You should discuss with your doctor the exact reasons why he believes a P-IOL may be best, and then evaluate using our 50 Tough Questions For Your Doctor the surgeon's practical experience with P-IOLs.

[ksigler]

Thank you for the feedback. I have a new appointment set up with my doctor to have some more questions answered. They were more than happy to set up another face to face appointment. Thanks again.

[lance]

I guess I still didn't see the direct answers about if P-IOL is better than Lasik even though the patient qualifies for Lasik.

I understand if you are not a candidates for Lasik, than P-IOL is an alternative. But for the folks who qualify for Lasik, is P-IOL a better choice as it can be reversed and there is no need for cutting the cornea?

Thanks!

In my opinion, a phakic intraocular lens (P-IOL) like the Visian ICL or the Verisyse/Artisan are only appropriate when a cornea-based refractive surgery is inappropriate. You have not mentioned anything that is a direct contraindication for Lasik. You should discuss with your doctor the exact reasons why he believes a P-IOL may be best, and then evaluate using our 50 Tough Questions For Your Doctor the surgeon's practical experience with P-IOLs.

[LasikExpert]

A phakic intraocular lens (P-IOL) is significantly more invasive than cornea-based surgery. Lens-based is appropriate when required, but in my opinion is most often best avoided if not required. Not everyone agrees with this opinion.

[beingbobbyorr]

I have high myopia (-7.5 & -9 contact lens script, add another -1 for glasses script), but thick corneas, small pupils, and a trivial amount of astigmatism. The retina specialist (some ICL docs demand you see one pre-op) also gave me a 100% clean bill of health.

Half the refractive surgeons say "ICL!" The other half say "Lasik!" (and most of these doctors do both, so they're not pushing me in a certain direction because it's money walking out the door if I go with a technology they don't do).

Is one (Lasik vs. ICL) more/less likely to:

(a) get me closer to 20/15 (or better) final vision?
(b) avoid halos, starburst, ghost images, etc.,?
(c) avoid dry-eye?
(d) avoid infection?

[LasikExpert]

(a) get me closer to 20/15 (or better) final vision?

The best you can expect is vision after surgery the same as vision before surgery with glasses. 20/15 may be an impossibility.

Lasik will likely have regresssion of effect, so you will either need enhancement surery or deliberate overcorrection.

Getting a perfect calculation for P-IOL power plus perfect placement is challeging.

This one is almost a toss-up. Both have advantages and disadvantages.

(b) avoid halos, starburst, ghost images, etc.,?

Small pupils would indicate that the probability of halos or ghosting images is not elevated with both types. Starbursts would be more likely with Lasik than P-IOLs, but the probability is still relatively low.

(c) avoid dry-eye?

P-IOL is much less likely to induce Lasik dry eye symptoms.

(d) avoid infection?

P-IOL is much, much more likely to cause an infection, but still the probability is relatively low.

[beingbobbyorr]

... but thick corneas, ...

I keep getting told I have "thick corneas", but -- just as an academic question -- does anyone know what the "histogram of cornea thickness" (among the human race in general, or myopses in particular) looks like?

Just curious to know where I fall on the bell curve (if in fact it is a Bell/Normal/Gaussian curve).

[LasikExpert]

I do not believe that there is any correlation with corneal thickness and refractive error, but there is a correlation to ethnicity. Average corneal thickness for whites is about 550 microns, with blacks around 520, and Asians around 500. I think it is fair to say anything above 600 microns is a "big thick" cornea.

[bat]

Hi there
In a way I was lucky - I had no choice - huge pupils, average to thinnish corneas and high myopia plus astigmatism. Not suitable for lasik my consultant was clear (although one clinic offered to treat and get the prescription down. ) I was -9 in left plus 2.50 and -10 in right, with the same. I say was because I had my first ICL two weeks ago and the second will be done tomorrow. My right eye when tested the day of the op about an hour and a half later was 20/20. When last tested the following day it was one line better. My surgeon, who is one of the best in the uk, says that is a far better result than I would have got with lasik. But he was carefully chosen because I knew for this operation the skill of the surgeon was paramount in terms of placement of the lens , avoiding risks, etc. The procedure itself was a doddle, a local for the eye and a sedative in the arm for me, felt nothing, remembered nothing! The eye now looks untouched, although I must continue drops for two more weeks and avoid exercise for a few weeks yet. There was almost no pain the week after except the first few days first thing on waking. I wear the patch for one more week at night. I hope tomorrow goes as well. My vision in my right eye is now better than my left with my toric contact lens. I have been back at work a week, working with computers a lot, no dry eye or anything. So I say if ICL research your surgeon and clinic extensively, but I did the same with lasik. Good luck whatever.

[beingbobbyorr]

... and avoid exercise for a few weeks yet. ...

My script is just slightly better than yours (see post above), yet the surgeons pushing ICL to me are like "Exercise (non-contact sports) can be done basically the next day." Interesting how yours have you dormant for a number of weeks.

[bat]

I had my check-up for my second eye yesterday and confirmed the no exercise with the consultant, who was a different one. Apparently as the lens settles into the eye one possible thing is raised intraocular pressure which exercise increases. Also they don't want you falling over or jerking about, I was even told no yoga, due to positions with head upside down. I love my exercise and its a pain but these guys are top notch and I will definately be doing no running until my next check-up in a month. But the ICL leaflet needs changing, its from the makers of the lens and shows a lady standing on one hand! But the vision is excellent!