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Refractive Surgery | Jul/Aug 2009

What a Bright World!

My firsthand experience undergoing phakic IOL implantation under the care of my brother.

Refractive error, particularly myopia, is a major issue in Asian countries—our population has a much higher incidence compared with other ethnic groups. Although LASIK is the favored procedure to treat low refractive errors, its predictability falters when used to correct moderate to high myopia or high astigmatism. At Saint Mary's Eye Hospital in Busan, Korea, we integrated the Visian ICL (STAAR Surgical, Monrovia, California) into our practice 12 years ago. This phakic ICL has become a true breakthrough treatment for our large group of myopic and myopic astigmatic patients, including myself. I had a Toric ICL implanted in 2006. Here is my story.


Before undergoing ICL surgery, I had horrendous eyesight (-5.50 -4.00 X 5¡ in the right eye and -6.00 -3.50 X 175¡ in the left). I was severely myopic, had high astigmatism, and wore thick glasses. Whenever I opened my eyes in the morning, I had to search for my glasses. Whenever I took off my glasses to wash my hands and face or take a shower, I felt uncomfortable.Ê

I gradually developed presbyopia and felt even more uncomfortable with my glasses. I wanted to take them off to live a more comfortable daily life. I also wanted to be able to wear nice sunglasses, like other people. I wanted to be elegant and stylish. No doubt, I had to do something to improve my vision.

Until recently, there had been no suitable refractive procedure to treat my refractive condition. Corneal refractive surgery was not a viable option because of my severe astigmatism. But when I heard about the Toric ICL in 2003, I knew it was the right option for me. By that time, I had performed ICL implantation for approximately 3 years—plenty of time to convince me of the lens's safety and accuracy.

As my presbyopia continued to develop, I decided to undergo ICL implantation aiming for -1.00 D of sphere. (When I think about it now, monovision would have been better for me, but I have been happy with my result.) I anticipated that I would have to wear thin glasses after surgery.

I asked my brother, Kyung Heon Lee, MD, to perform the surgery. I think the main reason it was easy for me to consider ICL implantation was because I knew my brother would be on the other side of the microscope. He is a pioneering member of the Korean Ophthalmological Society and has played a leading role in both phaco and IOL use in Korea since 1980. Additionally, I had complete confidence in our refractive team. Each year, our hospital performs more than 300 ICL cases and more than 3,000 corneal refractive surgery cases.

A few days before the surgery, I was a bit nervous and apprehensive. However, the day of the operation, I felt calm and relaxed (Figures 1 and 2). It was a strange feeling not only to be the patient but also to be on the same bed as my patients are when I perform surgeries.

I believed in my brother's surgical technique and the Toric ICL unconditionally. I could feel the lenses being inserted into my eyes; I had some pain when the carbachol was applied. All in all, the procedure lasted only 15 minutes before I hopped off my operating bed to face the world again. Immediately, I knew my vision was corrected because I could distinctly see the faces of those in the operating room. It was magical.

The surgery results indicate that the position of the lens (ie, vault) is about 1.5 times the corneal thickness. My refraction is stable, with a UCVA of 0.6 for far and J1 for near. I do not need glasses when seeing patients or performing laser refractive surgery. I need glasses only when I drive at night, watch movies, or perform a microscopic surgery. With correction, my distance vision is 1.0. Three years have now passed since the surgery, and there has been no change in my eyesight and, so far, no complications. I can enjoy a comfortable and satisfactory quality of life because I no longer need to wear glasses in my daily life.

Since 1997, our hospital has performed more than 1,500 ICL implantations with excellent outcomes. I am proud to say that I am one of the successful cases. My surgical experience with the Visian ICL has made me understand my patients better. I understand each patient's reasoning for making the decision to have ICL surgery, which is an important asset in my profession. In my case, I felt I needed surgery not only to get rid of my thick glasses and have the option of wearing nice sunglasses, but also to achieve a better quality of life. For me, the more my presbyopia developed, the more uncomfortable I felt.

I now understand that it is important for patients to trust and believe in their doctors. I believed in my brother's surgical technique, so I could proceed to have the surgery comfortably. I appreciate the work of my brother and Saint Mary's refractive team. I am happy with my vision and lifestyle, especially when compared with my life with glasses before surgery.

If someone is considering the ICL, I would recommend having surgery earlier in life than I did.

Tae Heon Lee, MD, is the General Manager of St. Mary's Eye Hospital, Inc., Busan, Korea. Dr. Lee states that he has no financial interest in the products or companies mentioned. He may be reached at tel: +82 51 743 0775; fax: +82 51 743 0776; e-mail: eyedear@naver.com.