Vision Learning Center Navigation... Refractive Surgery Options   -iLASIK® (CustomVue™ blade-free LASIK with Intralase)   -RL-Refractive Lensectomy/PRELEX℠   -CK-Conductive Keratoplasty   -ICL-Verisyse™ and Staar™ Implantable Contact Lenses   -PRK-Photorefractive Keratectomy   -INTACS®-Corneal Segments   -AK-Astigmatic Keratotomy Valley Eye Report Card Financing Options Testimonials Cataracts Frequently Asked Questions Prevention Guide Insurance Information Valuable Vision Links   INTACS®-Corneal Segments What are INTACS, (Corneal Ring Segments)? INTACS, (corneal ring segments) are designed to reduce or eliminate nearsightedness. 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.) INTACS correct nearsightedness by flattening the cornea (the clear window in the front of the eye). In the first step of the procedure, two small tunnels are made in the outer cornea, outside the line of sight. Next, two utrathin plastic arc-shaped segments are placed in the tunnels to reduce or eliminate myopia quickly, accurately, and safely. This plastic has a 50 year safety record of medical use in the eye (as contact lenses and cataract implants). INTACS do not get dirty or dry out like a contact lens. There is no maintenance required. They are barely noticeable to other people, appearing similar to a contact lens. The amount of correction is determined by the thickness of INTACS (currently available in five sizes). The INTACS remain in place without sutures. INTACS were developed in 1978 to specifically treat small amounts of myopia which affect an estimated 20 million Americans. The technique has been performed for several years in the United States under clinical trials and is now approved by the FDA for use in patients. These trials showed that four out of five patients wake up to 20/40 or better vision the day after surgery. After one year, over one-half of patients saw better than 20/20 without enhancements. INTACS may also be used to treat keratoconus, as well as enhance the vision of patients who have had LASIK or other (but not all) refractive surgeries. INTACS have also been shown to improve and/or stabilize the vision in patients who have keratoconus. Keratoconus is a condition where the cornea becomes warped and distorted, resulting in a loss of vision. Who is a Candidate for INTACS? Candidates for INTACS may have experienced difficulty wearing glasses and contact lenses. Generally, the best candidates have low levels of myopia (-1.00 to -3.00 diopters) with 1.00 diopter or less of astigmatism. In addition, their lifestyle or career may require good vision without the use of glasses or contact lenses to function well. In addition, INTACS may be used to treat keratoconus when contact lenses or a corneal transplant are not effective. Candidates are encouraged to attend a free educational seminar or visit the office for a Free Complementary Consult. A thorough eye examination is required prior to having INTACS. If there are no contraindications for vision correction, the next step is an "INTACS Evaluation". This includes computer mapping (computed topography) of the cornea, corneal thickness measurements (pachymetry), and a counseling session. The counseling session (including observation of a video tape) allows patients the opportunity to have their questions answered. Computed topography provides a detailed surface map of the cornea to guide your surgeon in formulating a specific treatment plan. How is the Procedure Performed? The INTACS procedure is performed in the professional atmosphere of the outpatient eye center at Theda Clark Laser Center. No single formula can provide the perfect correction for everyone. This is why the individual consultation is so important in planning for INTACS. For example, if you spend 8 hours a day working at a computer screen, your visual needs will differ form 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 leaving one eye slightly undercorrected, the need for reading glasses can be reduced. This technique, called monovision, has proven successful in helping an individual cope with the natural aging process. Your specific needs in terms of lifestyle and career goals are taken into consideration when the treatment plan is developed. As the accuracy of INTACS is not perfect, the surgeon will usually aim for a post-operative result in which the patient remains slightly nearsighted. If more correction is needed, it may be possible for the INTACS to be removed and replaced by another set of INTACS that can correct more myopia. INTACS can also be removed; returning the patient's vision to pre-operative levels in most cases. This brings a new level of flexibility to refractive surgery. 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 (similar to the shape of a football). INTACS currently do not correct astigmatism, so that if a patient has more than one diopter of astigmatism, INTACS are not used. In this case, iLASIK, RK, or PRK is indicated. What Happens Before the Day of INTACS? Prior to your treatment date, you will receive a list of pre-operative instructions for the day of surgery. No pre-operative history or physical examination is required by your family doctor. You will be asked to wear comfortable clothing when you have your INTACS insertion. You are required to make arrangements for a relative or friend to drive you home after the procedure. You will instructed to stop wearing your contact lenses 3 days prior to INTACS if they are soft lenses and 1 to 2 weeks prior to INTACS if they are hard or gas permeable contact lenses. This is to ensure that your cornea resumes its natural shape prior to treatment. What Happens the Day of INTACS? INTACS are inserted on an outpatient basis at Theda Clark Eye 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 procedure, you will receive a pre-operative sedative (usually a Valium pill). A topical anesthetic (numbing drops) is all that is usually needed so that you will not feel discomfort during the procedure. During the treatment, you will be positioned on a reclining chair under a microscope. The microscope is used to view your eye for INTACS placement. You may feel slight pressure from the instrument that keeps your eyelids open. The actual procedure will take about 10 to 15 minutes. Rarely, the eyelids must be opened at the outer corner to allow INTACS insertion. If INTACS cannot be done due to the shape of your eye, iLASIK may be performed instead, but not on the same day. Please discuss this with your doctor if you have any questions about iLASIK. After the INTACS are placed, a shield will be placed on your eye. This will be removed the next day in the office. Do not remove it for any reason prior to this office visit. Post-operative medications will be given to you the next day and the staff will discuss your post-operative written instructions with you. How Do I Care for My Eye After INTACS? You should avoid rubbing or bumping the eye for the fist week after INTACS insertion. You may experience discomfort such as scratchiness, tearing, or increased light sensitivity. This is normal and may last for a few days. Pain relievers are occasionally needed and are prescribed if necessary. Women should refrain from wearing eye make-up for 7 days. The limitations on activities may vary from person to person. However, generally speaking, you may immediately resume normal activities like bending over, watching TV, taking a shower, or reading. Contact and racquet sports should be avoided for 1 week after INTACS. Water skiing/tubing can be resumed 1 month after INTACS. Please note that we recommend you wear protective eye wear anytime you participate in racquet sports, regardless of whether or not you have had INTACS or other eye surgeries. What Follow-up Care is Necessary? Patients are generally seen 1 day, 1 week, 1 month, and 6 months after INTACS. More frequent visits may be necessary. Visits during the first six months after surgery are included in the treatment fee. Of course, regular eye examinations by your eye care provider are essential to maintain healthy eyes. INTACS are normally inserted on both eyes at the same time. If only one eye at a time has INTACS inserted, a patient is asked to wait about 2 to 4 weeks before having the other eye done. The INTACS may be exchanged to enhance (improve) the initial effect one month after surgery. Note that iLASIK cannot be performed on an eye when the INTACS are in the cornea. The INTACS must be removed first. Patients referred by their optometrist will receive a portion of their post-operative care from this doctor. There is no additional fee for this service. What are the Risks of INTACS? 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 INTACS, there is a chance that the eye will be overcorrected or undercorrected, which would mean that glasses or contact lenses would be needed to obtain your best possible vision, if an exchange or removal of the INTACS does not produce the desired effect. 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 weeks or months after surgery. Vision fluctuation during the day is possible after INTACS. Vision may be temporarily affected by fatigue. This should improve in several months as healing progresses. Unlike other refractive procedures, such as RK, where vision is restored rather quickly, the healing process in INTACS can take weeks and possibly months before the best possible vision is obtained. Other complications that have been described with INTACS (but are rare) include continued problems with glare or vision fluctuations, development of irregular astigmatism with distortion of vision even with glasses or contact lenses, monocular diplopia, loss of effect with time, more effect with time, ingrowth of skin into the cornea; entry into the anterior chamber while the tunnels are being made, and loss of vision not correctable with glasses or contact lenses. Some patients will need glasses to drive at night. If iLASIK is performed after INTACS are removed, the patient is subjected to the inherent risks and benefits of this procedure as well. (See our handout, "iLASIK: Answering Your Questions"). This list is not a complete list of all the potential complications of INTACS. It is impossible to list all the potential problems with this procedure that may arise immediately following treatment or months or years later. No guarantee or warranty can be made as to the results or safety of INTACS. Will I Have "Perfect Vision"? The goal of INTACS 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 INTACS. The results of INTACS will depend on your cornea's response to the segments and the healing process. While the procedure can be done more than once, it cannot be performed an infinite number of times. How Much Will INTACS 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, once 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 and the cost of other segments in the event they need to be exchanged for 24 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. In some cases, when it can be documented that INTACS are medically necessary for the treatment of keratoconus, insurance may pay for the surgery.