Implantable Lenses

Who Benefits Most?

• People with very high degrees of nearsightedness or farsightedness, beyond what is easily corrected with laser surgery options which alter the 
  corneal curvature

Specific Advantages of Implantable Lenses

• Correction for very high degrees of nearsightedness and farsightedness (Low and moderate ranges of nearsightedness, farsightedness and astigmatism are also correctable with implantable lenses)
• Predictable outcomes, even in high corrections
• Fast visual stabilization
• Does not alter the tissue of the cornea
• Minimal side effects
• Can be combined with other corrective options
• Removable

Important Note: The Implantable Lens correction procedure was approved by the Health Protection Branch of the Canadian Federal government in June 2001 and by the US FDA in January 2006.

Implantable Lenses are tiny lenses designed to be placed permanently within the eye to correct vision problems. They are manufactured of materials that are biocompatable, so they can rest within the eye without needing any care. Various types of lenses are designed to rest in selected positions in the front chamber of the eye, and are removable, if necessary. Implanting one of these special lenses offers dramatic results that are quite predictable.

One to two weeks before the surgery, the implantable lens patient comes to Gimbel Eye Centre for a simple laser procedure known as an iridotomy. The surgeon uses an Nd:YAG laser to create two or three small openings in the peripheral iris, the coloured part of the eye. These openings help ensure that the placement of the lens will not cause blockage of fluid that flows through the front chamber of the eye. A blockage can lead to an increase of fluid pressure known as glaucoma.

Lens implantation is a simple outpatient procedure. Patients sit in a surgical chair, which is reclined back into a horizontal position. Attentive assistants ensure that patients are very comfortable as they drape them with sterile sheets in preparation for surgery.

Patients are sedated with oral or intravenous medications, if necessary. Only the selected eye is "frozen" for this painless surgery. In most cases, topical drops are used to anesthetize the eye, so no injection is necessary.

To begin, the surgeon makes a small incision of 1/8 to 1/4 of an inch (3.0 to 5.0 mm) in either the white sclera or on the edge of the cornea. The surgeon then inserts an open or a folded implantable lens through the incision and carefully positions it behind the cornea, in front of the eye’s natural lens. The implanted lens, selected with a specified focal power, becomes the eye’s third lens. The small incision surgery is usually completed without stitches, since the incision is designed to be self-sealing. The whole procedure takes approximately 20 minutes.

This procedure can also be used to treat astigmatism by using a Toric implantable contact lense, and other surgical procedures may be combined with lens implantation to solve astigmatic focusing problems.

In 1997, Gimbel Eye Centre became the first institution in Canada to perform Implantable Corrective Lens (ICL) procedures.

Visual recovery after a lens has been implanted, in most cases, is rapid. A few minutes after the surgery, patients are able to see well enough to engage in regular activities with dramatically increased visual freedom. Full visual recovery may take a few days.

Side effects are minimal. Patients can expect increased light sensitivity for a few days, so sunglasses need to be worn more often than usual during this time. The implanted lens cannot be felt inside the eye.

If the stable visual result is not ideal, a second surgical procedure to adjust or replace the lens is generally possible, or corneal laser surgery (LASIK or PRK) to fine tune the result may be recommended.

As with any surgery, there are some possible complications associated with an implantable lens procedure. The risks are minimal. The low incidence of complications listed here reflects the exclusive Gimbel Eye Centre experience:

• Increased Possibility of Retinal Detachment (less than 1%)
  Farsighted people have a very low risk of detachment, however, most nearsighted people have eyes that are longer than normal, resulting in retinas which are more vulnerable to detachments. The additional risk of retinal problems because of surgery is extremely small. A retinal examination required before the surgery helps to determine risk factors for each patient. Even if a detachment occurs, it can generally be effectively repaired.
  
  
• Inner Eye Surgery Complications (less than 1%)
  The following complications are very uncommon, but they can occur: hemorrhage or infection within the eye, swelling around the eye, reflections or sight distortions from the lens implant, an increase of floaters, loss of corneal or natural lens clarity, dislocation of the lens implant, wound leak, glaucoma and uveitis (inflammation). Most of these complications can be effectively treated if they occur.
  
  
• Corneal Surface Surgery Complications (less than 1%)
  The corneal surface problems of induced astigmatism and slightly increased dryness are not generally serious and may be treated, if necessary.