I have 11 years of experience implanting phakic IOLs. In my practice, more patients are choosing these refractive lenses than ever before, in part due to the technique's reversibility and preservation of corneal tissue. After several years of watching my phakic IOL volume steadily increase, I decided it was time for me to follow suit and undergo elective eye surgery with the Visian ICL (STAAR Surgical, Monrovia, California).
By the time I decided to have surgery, I had performed ICL implantation in a small study of eyes (n=66) with myopia between -2.50 and -16.25 D. Of these patients, 55% gained one line of visual acuity after phakic IOL implantation. Additionally, 30% gained more than one line, and 90% of patients were within ±0.50 D of intended correction, which for me was an adequate indication of the procedure's safety. I asked Bo Andersén, MD, to do the honors of performing my surgery. Dr. Andersén is a long-time colleague who has extensive experience implanting the Visian ICL. He agreed, and together we performed the ICL power calculations in my right and left eyes (Figure 1). In my right eye, my refraction was 2.75 -0.25 X 180°; in my left, -5.00 -0.25 X 180°. My keratometry readings were 42.75 and 43.25 in my right eye and 42.50 and 43.25 in my left.
MONOVISION
From personal experience, I have found that during the patient work-up it is beneficial to aim to make patients plano or as close to plano as possible. Because I had already tried (and liked) monovision, we decided to leave a small bit of myopia untreated in my nondominant left eye. Therefore, the aim of my treatment was 0.03 D in my right eye and -1.67 D in my left. Dr. Andersén performed a surgical iridectomy to prevent an increase in intraocular pressure, which also I routinely do in my phakic IOL cases.
Surgery was scheduled for July 18, 2004. I was not nervous until I reached the operating table. Then, for obvious reasons, the surgery became real. I tried to focus and stayed quiet so that I did not intervene or distract Dr. Andersén. The bright light from the microscope was annoying—it was the most disturbing thing about the procedure.
I was anesthetized with drops, and the operation was totally painless. I would have thought that it was possible to identify the different steps of the procedure because I had done hundreds myself; however, all I could sense was a shimmer and the sense of looking into a headlight from under water.
My left eye was done first, and I looked at my watch to see what time it was. I knew that all had gone well and that the calculation was accurate. Dr. Andersén immediately proceeded with the second eye. I had no sense of time, and to my surprise the procedure was suddenly over. It took approximately 10 minutes, from start to finish. I was among the first of his patients to have consecutive bilateral implantation of the Visian ICL at our clinic. Since this time it has become routine in our clinic.
After a short rest, I was able to go home on my own. I even went shopping for a pair of sunglasses on the way home. The same evening, I could read the subtitles on my television without correction—for the first time in my adult life. The next day, I was back at work. At the time of my surgery, we used levofloxacin and diclofenac three times daily for 10 days as postoperative medication. Diclofenac is a little uncomfortable because it stings. Now, we have replaced diclofenac with nepafenac, which is more effective and does not sting.
My quality of vision (Figure 2) was excellent from the first postoperative day. I was not able to read small print in the first few days. At 1 week postoperative (Figure 3), my refraction improved to 0.25 -0.25 X 180° in my right eye and -1.50 D sphere in my left eye. I was reading J2 at 30 cm, and my BCVA was 1.6 snellen in both eyes. I did a full acuity test 1 week after surgery, and my prescription remains unchanged.
CONCLUSION
Five years after phakic IOL implantation, I am still happy with my decision to undergo elective eye surgery. It has not only given me the ability to see clearly without glasses but also has provided me with the firsthand opportunity to understand what patients encounter during refractive surgery.
Göran Helgason, MD, is the Medical Director of Capio Medocular Eye Clinics, Sweden, and a consultant at Advanced Vision Care, London. Dr. Helgason states that he has no financial interest in the products or companies mentioned. He may be reached at e-mail: goran.helgason@medocular.se.
