What is the Implantable Contact Lens (ICL)?
The Implantable Contact Lens (or ICL for short) is a device designed to reduce or eliminate nearsightedness and astigmatism. Nearsightedness, also called myopia, occurs when the shape of the eye is elongated so that light is focused in front of the retina (the "seeing" part of the back of the eye).
The ICL corrects nearsightedness by moving light rays onto the retina. The ICL is made of an inert material that is extremely well tolerated by the eye and is designed to be placed inside the eye. Hence, the ICL changes the focus of the eye.
The ICL was developed over 20 years ago, and has been used extensively in Europe for the past 20 years. ICL's have been implanted extensively in Canada since July of 2001, and is approved for use by the United States F.D.A. (Food and Drug Administration). Over 200,000 ICL procedures have been performed worldwide.
Who is a Candidate for the ICL?
Candidates for the ICL may experience difficulty wearing glasses and contact lenses. Some people have tried contact lenses and have difficulty wearing lenses due to allergies, dryness of the eyes, astigmatism, or other irritants. Generally the best candidates are those who are between the ages of 21 to 60 who are outside the effective treatment range for iLASIK. In addition, their lifestyle or career may require good vision without the use of glasses or contact lenses.
Candidates are encouraged to attend a free educational seminar or visit the office for a FREE Complementary Consultation. A thorough eye examination by your eye doctor is required prior to having ICL surgery. If there are no contraindications for surgery, the next step is an "ICL Evaluation". This includes computer mapping (computed topography) of the cornea, biometric measurements of the eye (A scan and pachymetry), and a counseling session.
Patients also have the opportunity to have their questions answered by the surgeon in a face to face session prior to treatment.
How Will My Eyes be Corrected?
No two individuals are alike and your surgeon will take the time to discover your unique lifestyle, career goals, and physical needs. No single formula can provide the perfect correction for everyone. Your specific needs are taken into consideration when the treatment plan is developed. This is why the refractive evaluation is so important in planning for the ICL.
For example, if you spend 8 hours a day working at a computer screen, your visual needs will differ from someone who spends much of the day driving. If you are over 40, you may experience problems with your near vision focusing up close. By setting the focus point for one eye at near, the need for reading glasses can be reduced. This technique, called monovision, has proven successful in helping individuals adapt to the natural aging process.
As the accuracy of ICL is not always perfect, the surgeon may need to perform an enhancement after the initial operation to fine-tune the result.
What is the ICL?
The specific implant that will be used depends on the length of your eye as measured by ultrasound and the width of your cornea. The implants are made of the same material as cataract implants, which have been successfully used for over 40 years. They are designed to be permanently implanted into your eye, however, it may be removed or exchanged if necessary.
What if I have Astigmatism?
Astigmatism is a condition in which light that enters the eye is focused at more than one place inside the eye. This is caused by an irregularly shaped cornea (many times the shape of a football.) Astigmatism can be reduced by limbal relaxing incisions (LRI) made at the time of ICL, or by performing iLASIK at a different time.
What Happens before the Surgery?
Approximately one week before the ICL is placed in your eye, you will need a laser treatment to make a small opening in the iris. This is the colored part of the eye. The opening prevents an elevation of eye pressure after ICL implantation. It is not noticeable to the patient or to an observer.
Prior to your surgery date, you will receive a list of pre-operative instructions including food and liquid restrictions for the day of surgery. A pre-operative history and physical examination may be necessary by your family doctor.
You are required to make arrangements for a relative or friend to drive you home after the surgery.
You will be instructed to stop wearing your contact lenses 3 days prior to surgery if they are soft lenses and 1-2 months prior to surgery if they are hard or gas-permeable contact lenses.
Payment in full is required 5 business days before the operation, unless a financing arrangement has been made. If it is not received, the surgery will be postponed.
What Happens the Day of Surgery?
Surgery is performed on an outpatient basis at a fully certified and accredited surgery center. In this relaxed atmosphere, you will receive professional experienced care. The staff is there to answer your questions and assist you in understanding the procedure.
Before the operation you will receive a pre-operative sedative (usually a Valium pill). A topical anesthetic (numbing drops) with a local anesthetic is all that is usually needed so that you will not feel discomfort during the operation.
During the procedure you will be positioned on a surgical bed under an operating microscope in a sterile operating room. The microscope is used to view your eye during the surgery.
A small incision is made to gain access to the eye. The ICL is then placed into the eye. The incision may require several sutures. The actual procedure will take about 15 to 20 minutes.
After surgery a shield will be placed on your eye. This will be removed later in the office. Post-operative medications will be given to you and the staff will discuss your post-operative written instructions with you.
How do I Care for My Eye After Surgery?
You should avoid rubbing or bumping the eye after surgery. You may experience mild discomfort such as scratchiness, tearing, or other sensations in the operative eye. This is normal and may last for a few days. Pain relievers are occasionally needed and prescribed if necessary. Women should refrain from wearing eye make-up for a few days.
The limitations on activities may vary from person to person. However, generally speaking, you may immediately resume normal activities like watching TV, reading, or driving a car the following day after surgery. Contact or racquet sports should be avoided for 2 weeks after surgery. We recommend that you wear protective eye wear anytime you participate in racquet sports, regardless of whether or not you have had the ICL or other eye surgeries.
Care must be taken not to get soapy water in the eye for a week, and patients are encouraged to bend at the knees when lifting objects off the floor (keeping their head above their heart). In most patients, the eye is completely healed in 3 weeks.
What Follow-up Care is Necessary?
Patients are generally seen 1 day, 1 week, 1 month, and 6 months after surgery. More frequent visits may be necessary. Visits during the first 6 months after surgery are included in the surgical fee so no additional payment is required. Patients referred by their optometrist or ophthalmologist may receive a portion of their post-operative care from this doctor. Of course, regular eye examinations by your eye care provider are essential to maintain healthy eyes.
In general, if one eye has the ICL, a patient is asked to wait at least several weeks before having the other eye done. If there is a complication as a result of the surgery, additional visits to other doctors may be required. These visits or treatments are not covered by the surgical fee, but may be covered by your insurance.
What are the Risks of the ICL?
As with any surgery, there is always a slight risk of post-operative infection, although this is minimized by the use of pre-operative and post-operative antibiotics. With the ICL there is a chance that the eye will be overcorrected or undercorrected which would mean that glasses, contact lenses, additional refractive surgery, or replacement of the ICL would be needed to obtain the best possible vision.
In the first weeks after surgery, you may be sensitive to bright lights or see starbursts around lights at night (glare). This usually decreases several days after surgery.
Other complications that are possible with the ICL (but are rare) include continued problems with glare, halos, or vision fluctuation, development of irregular astigmatism with distortion of vision even with glasses or contact lenses, monocular diplopia, glaucoma, bleeding in the eye, elevated intraocular pressure, lid droop, unequal pupil size, enlarged pupil, capsule opacification or cataract, chronic uveitis, dislocation of the ICL, retinal detachment, retinal edema, corneal edema (lack of clarity), loss of vision not correctable with glasses or contact lenses, and loss of the eye (extremely rare).
Additional surgery that would be required to correct these complications, might include, but are not limited to, corneal transplantation, glaucoma surgery, glaucoma laser treatment, cataract surgery with intraocular lens implantation, retinal detachment surgery, and YAG laser capsulotomy. These operations are not covered by the surgical fee. If iLASIK, Photorefractive Keratectomy, or Astigmatic Keratotomy is performed after ICL, the patient is subjected to the inherent risks and benefits of these operations as well. iLASIK is included in the cost of the surgical fee, if indicated, within one year of the initial date of surgery. Additional refractive surgery is not covered by the ICL surgical fee, but is provided at a significant discount. This list should not be considered a complete list of complications as it would be impossible to list all potential complications and it is possible that complications may occur weeks, months or years after surgery.
In general, the risk of a severe complication with ICL is less than 1%. The success rate is approximately 99%. If the ICL is used in someone over the age of 45, it is considered by the F.D.A. as an "off label" use of the ICL.
Will I Have "Perfect Vision"?
The goal of the ICL is to reduce your dependence on glasses or other optical aids. A small amount of correction may be needed for near vision or far vision. Contact lenses can be used after ICL implantation. The results of the ICL will depend on your eye's response to the surgery and the healing process.
How Much Will Surgery Cost?
You will be charged a surgeon's fee, a facility fee, and if applicable, a co-management fee paid directly to your optometrist or ophthalmologist, for each eye. The surgeon's fee is reduced by the co-management fee when your optometrist provides part of the post-operative care. Your payment covers follow-up visits for the next six months.
Prior to surgery, you can meet with a financial counselor who will answer your questions about the fees. For our patients' convenience, we accept cashier checks, cash, MasterCard, VISA, and Discover. A discount for cash payment is available, as well as a 0% down, 0% interest financing plan.
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Payment in full is required 5 business days before the procedure, unless a financing arrangement has been made. If payment is not received 5 business days before the procedure, the procedure will be postponed.
Very few insurance companies cover refractive surgery. However, we do encourage you to check with your insurance provider before the surgery.