Alternatives to Laser Eye Surgery
With the help of experienced surgeons and access to the latest technology, Laser Eye Surgery can successfully treat around 97% of patients. However, a small number of patients may find that the treatment is not an option for them. This may be due to their prescription, the shape or health of their eyes, or having an underlying health condition. Thankfully, if you are found to be unsuitable for Laser Eye Surgery, there may be alternative treatments open to you.
Phakic Intraocular Lens Implantation
Phakic intraocular lenses, or phakic lenses, are artificial lenses that can be implanted into the eyes to improve the natural focusing ability of the eye.The word “phakic” is derived from the Greek word, “phacos” for lens. This refers to the eye’s crystalline natural lens, which serves to add variable focusing power to the focusing ability of the cornea.
In “Phakic” Intraocular Lens Implantation, an artificial lens is implanted in the eye without removing the eye’s natural lens. This can refer to two procedures:The ‘Artisan’
The Iris Claw Lens – also known as the Artisan lens – is implanted behind the cornea. It features two clips that grip onto the iris (the coloured part of the eye around the pupil).
The Iris Claw Lens procedure became popular in the early 2000s thanks to offering a reduced risk of cataract development compared with implantable collamer lenses (ICLs). However, the procedure was since found to have some long-term implications for corneal health.
In recent years, developments in technology and practices have significantly improved the safety and efficacy of ICL surgery, including a reduced risk of cataract formation. As a result, Iris Claw lenses are now used less commonly than ICLs.
Implantable Collamer Lens (ICL)
ICL surgery is the most commonly performed type of Phakic Intraocular Lens Implantation. This procedure involves implanting a small, thin lens behind the iris and in front of the eye’s natural crystalline lens. ICLs are extremely versatile and can be used to treat almost all prescriptions. ICLs are also available in a range of sizes.
ICL Surgery can be used to correct short-sightedness from -0.50 D to -18.00 D, long-sightedness from +0.50 D to +10.00 D, and astigmatism up to 6.00 D.
While earlier types of ICLs were previously linked to an increased risk of cataract development, more modern models (including the EVO Visian ICL) feature a tiny hole in the centre of the lens. This hole, known as the “aquaport”, allows for better flow of aqueous and nutrients around the eye’s natural lens. This helps to mitigate much of the risk of early cataract formation.
The EVO Visian ICL is commonly used in the correction of myopia (short-sightedness); however, they are not used in patients with hyperopia (long-sightedness). Long-sighted patients may instead require a short laser procedure before their ICL surgery to create a small hole in the iris for fluid to flow through.
To date, over one million ICLs have been implanted worldwide.
Eligibility for ICL Surgery
Your suitability for ICL surgery will be determined through an extensive consultation process. Various tests and examinations are performed to assess the health and various measurements of the eye, including the vitreous and retina. For example, state-of-the-art wide-field imaging to check for certain retinal pathologies that could affect the success rate of ICL surgery.
It may also be necessary for a retinal specialist to evaluate the stability and health of your retinas. Some patients may need to undergo treatment for asymptomatic retinal holes or tears before being approved for ICL surgery.
The ICL Procedure
ICL Surgery is usually performed on one eye at a time, with around 1-3 days between each procedure. Each treatment takes around 10 minutes and is followed by a final check, including an eye pressure and lens position review.
After the Procedure
Most patients will be able to return to many normal activities the day after their procedure; however, there will be some restrictions that will be explained by your surgeon. Generally, swimming, intense physical activities, and dusty or dirty environments should be avoided for at least a few days.
ICL patients will typically be advised to apply lubricating eye drops for 2-3 weeks following their treatment. This will help to manage any discomfort or dryness associated with the procedure. Some patients may also experience temporary side effects such as glare around light sources, particularly in low light conditions.
It is extremely rare to need to have ICLs removed due to side effects; however, they can be removed without affecting your pre-corrected vision.
Risks and Complications of ICL Surgery
The most common risks of ICL surgery are pupillary block, cataract formation, and glaucoma. However, these complications are still rare and most are associated with the use of incorrectly sized lenses.
The most suitable lens size should be determined based on several measurements taken during a comprehensive pre-operative assessment. For example, exterior measurements of the eye are often used to estimate the dimensions of the inside of the eye. However, this isn’t always the most effective way to determine the most suitable ICL size as exterior measurements do not always correlate sufficiently with the internal structure of the eye.
With the help of the latest technology, it is possible to collect more accurate measurements. The Artemis Insight 1000 VHF digital ultrasound scanner allows surgeons to directly measure the area inside the eye where the lens will sit. This makes for more accurate ICL sizing and a reduced risk of complications.
If you are considering ICL Surgery, ensuring your provider has access to the latest technology can minimise the chance of experiencing complications after your treatment.
Clear Lens Exchange
Also known as Refractive Lens Exchange (RLE), Clear Lens Exchange (CLE) can be performed as an alternative to Laser Eye Surgery.
The basis of CLE is the same as that of Cataract Surgery, except it is performed to correct refractive errors as opposed to removing cataracts. Like ICL Surgery, CLE can be used to correct virtually all prescriptions.
Unlike ICL Surgery, CLE involves removing the eye’s natural crystalline lens. A synthetic lens is implanted into the eye to replace the natural lens and correct the way light is directed into the eye. The new artificial lens is placed inside the lens capsule once the natural lens has been removed.
While CLE can be effective at correcting specific prescriptions, it removes the eye’s natural focusing ability. This means that CLE is usually used in presbyopia patients who have little short-distance focusing power, while ICL Surgery is often preferred for younger patients (under 65).
CLE may be the only option for patients with hyperopia outside the limit of Laser Eye Surgery when there is not enough space in the eye to accommodate ICLs.
Benefits and Risks of CLE
CLE is widely considered a permanent solution to refractive errors as the lenses used are designed to last a lifetime. However, the procedure cannot prevent the natural changes that affect your eyes over time. This means you may require further correction for presbyopia in the future.
CLE is more invasive than Laser Eye Surgery and it is important to be aware of the risks.
Serious complications such as bleeding or infections are very rare; however, your surgeon should discuss all the potential risks and complications with you before your treatment. Other risks can include retinal detachment or swelling in the back of the eye.
CLE is often an effective vision correction procedure; however, all aspects of the treatment should be discussed in detail and weighted against all other treatment options. As stated in The Royal College of Ophthalmology Guidelines, all alternative interventions need to be discussed that could meet the vision correction needs with less risk, including from other practitioners.