Visian ICL

[michael66]

There's not a lot about ICLs in this forum, so I thought I'd share my experience. I'm male, 41, and about -12 in both eyes. I had Visian ICLs inserted in both eyes in August 2007 and the outcome was simply amazing. However, I recently developed a cataract in my right eye. Before this I have never had any complications other than some choroidal neovascularization. This was rectified by wearing highly gas permeable soft contact lenses which at the time I could only get  in a -10, and then glasses over top to correct the rest. I was managing quite well this way and my vision was really good.

I've given this a lot of thought and I'm pretty sure I want to remove the ICL from my left (cataract free) eye. I think in my case the risk of developing another cataract is too great and worrying will it be next week, next month, etc. just so I could have freedom from glasses and contact lenses is just not worth it to me. I feel very strongly that I want to keep my natural lens in my left eye (my dominant and best corrected eye) as long as possible and I do not want double cataract surgery at my age.

Freedom from contact lenses and glasses with this risk attached will never make me happy, but peace of mind, having my natural lens for another 10, 15, maybe 20 years, and just being grateful for what I have (a healthy eye, even if it is -12) will make me happy. As I said, my corrected vision before was really good and 10 years from now who knows what advancements will have taken place.

If I could go back in time and choose not to have the ICL surgery, I think I would do so without hesitation. So, if you are considering ICLs, PLEASE think long and hard about it and weigh the risks carefully against the perceived benefits in your particular situation.

I'm fairly settled in my decision to remove the lens from my cataract free eye and return to -12, but other perspectives would be really helpful and much appreciated. Thanks for listening and I hope this helps someone.

[kg17]

My eyes have never been the same.  I had the "best" refractive surgeon at a teaching university hospital perform my surgery.  The STAAR company claims that the surgery is reversible.  That's technically true, but the fact remains that the eye has been operated on and can never again be in its pristine condition.

In my case, I have damage to my iris (small holes from the chafing of the Visian ICL against my iris) that has caused photophobia, vacuoules on the anterior chamber of my crystalline lens which is resulting in the development of cataracts in both eyes, chronic low-grade uveitis, dry eye, and increased eye pressure that puts me into the category of "glaucoma suspect."  I lost 2 lines of best corrected vision in my left eye and one line in my right, have very poor contrast vision, and disabling glare with the ICLs out of my eye.

Because I had very scrupulous, attentive ophthalmologists with access to the latest diagnostic equipment, I was able to have many tests/optic photos to show the damage to my eye caused by the Visian ICLs.  The inconvenience that I put up with as a -17, having to wear contacts and glasses, is so very minor compared to the grief I experience now.

As I've said before, when you see ophthalmologists with high myopia willing to put their own eyes at risk for this surgery, then you can really know that the risk is minimal.

[NewYork28]

Many thanks for your advice.  In the UK, where I am currently residing and thinking about having the operation. They are already using the Artiflex.

Im sorry to hear that the ICL wasnt successful for you. It is indeed a very difficult choice as after trawling on the internet for months researching about what to do, I do still ponder away...

I do feel that the Artisian is maybe safer as its further away from the crystalline lens  (if it can be). I have found that there is no site/ forum where we can find out who's the best surgeon performing these operations? Umm... a difficult choice indeed.

Many thanks for your words of wisdom!

P.S After removing the ICLs  (which I will probably have to do after 20 years as studies point to an estimated 50% endothelial cell loss after 20-25 years) how have your eyes been apart from the high pressure?

[kg17]

If you elect to accept the many numerous documented and theoretical risks associated with these lenses, you might want to wait for FDA approval for the Artiflex phakic lens which is due soon.  The Artiflex is the foldable version of the Artisian or Veriseye, thus requiring only a 3 mm incision (as opposed to the 6 mm of the Artisian).  The advantages of the Artiflex/Artisian is that there is less risk of contact with your crystalline lens or contact/adhesions with the delicate structures in the posterior chamber that can result in pigmentary glaucoma, damage to the ciliary body, etc.

When contemplating intraocular surgery for phakic implants, it's important to understand that as a high myope, your eye is already at greater risk for retinal detachment, cataracts, and glaucoma.  By electing to do this procedure, you will only increase those risks.  I would suggest that you seek consultation with a retinal specialist and glaucoma specialist prior to surgery to ensure that no pre-existing condition exists that might be exacerbated before doing this surgery.  Finally, it's important that you understand that the long-term risks to having implants in your eyes are really unknown, especially for the Visian ICL.

[NewYork28]

I am contemplating having Artisian lens implanted in my -11.0 eyes (even after reading the problems people are experiencing.. ).

The question I would like to pose to you is: Can you tell me which type of lense is better - the Anterior Chamber lense (Artisian) or Posterior Chamber lense (Staar)? Which lense presents less problems?

Many thanks

[michael66]

Thanks for your comments. I've been advised to leave the lenses in my eyes by my surgeon and a medical consultant he contacted that was involved with the FDA study. I was told that the cataract that showed up 8-9 months after surgery was most likely caused at the time of surgery, these opacities often do not progress, and removing the implants naturally exposes myself to the same (possibly greater) risk.

I was beginning to accept this until I read some alarming things about endothelial cell loss in the FDA study for Visian ICLs. My concern is about cell loss associated with the ICLs compounded with cell loss associated with eventual cataract surgery (and the fact that I'm barely 42).

Can anybody comment on this and help me to understand. I realize that the rate of cell loss for ICLs was a prediction based on initial data, and I was reading about a follow up to the FDA study that indicated cell loss tended to stabilize.

But what about with cataract surgery? What is the long-term outcome for people who get cataract surgery in their 40s? I don't understand all of this and find it rather frightening.

[walkietalkie]

I think regardless you had the implant or not, other underlying factors, like genetics, etc., could play a part in promoting cataract. Developed cataract in my previously dominant eye, within months after torn retina, which was laser treated. Highly myopic though not as severe. We maybe kind of ‘young’ to get it, but it is not uncommon, going by the no. of posts here. (I thought once we hit 40, that’s it). I think as high myopes, we should be more concerned of retinal detachment than cataract. My eye doc is more worried about my retina than my cataract. We know post-cataract surgery poses its own set of challenges; abundant stories here, and especially at the eye care community. In 10, 20 yrs time, a ‘cure’ could be available, if only our eyes could wait.
Notwithstanding, yours and KG notes are timely reminders to others about the hazards of ICL implants.

[Sandy Feldman, MD, MS]

The Visian lens is amazing in that it can correct one's vision for high prescriptions.  As with any surgery, complications can and do occur.  Removal of the implant in the other eye is not indicated unless there is a problem as that surgery, could cause a complication too.  Enjoy the vision in the other and make sure you get checked by an EyeMD periodically.  Should you require cataract surgery, you do not need to go back to a -12.  You can still enjoy unaided vision as the implant that is placed in place of the natural lens can also correct one's prescription.  Thus, you will not have a large imbalance as you are thinking.

Good luck.
Dr. Feldman

[John C Hagan III, MD, FACS, FAAO]

I DO NOT recommend intra ocular contact lens for my patients. We've had a recent post of another cataract/glaucoma complication.

JCH III MD

[kg17]

Please correct my typo.  "the additional surgery to remove the ICLs (not cataracts)..."

[kg17]

I am, unfortunately, also a casualty from the Visian ICL surgery (perhaps you already read my posts during your search).  I had both ICLs removed due to high eye pressures.  The removal surgery resulted in small cataracts now developing in both eyes.  I would say that you need to know that the additional surgery to remove the cataracts will also increase your risk of developing a cataract.  My pressures have also remained high (26/27) with no explanation as to why.

Hindsight is 20/20 and I wish I'd done very thorough research before agreeing to this surgery.  But I made the decision based on emotion, coupled with the good sales job done by employees of the refractive surgeon.

My advice to anyone out there considering phakic implant surgery (Visian ICL, Veriseye), or any other new refractive procedure, consider the surgery only when you see that ophthalmologists are lining up to risk their own eyes.  Only then, will you have reasonable assurance as a layperson that the risk is truly minimal.