Frequently asked questions – Implantable Contact Lens Procedure

What is the Implantable Contact Lens (ICL) procedure?
The ICL is a very thin implant that is inserted through a microscopic opening in the cornea and positioned between the iris and the normal crystalline lens. The implant has a central thickness similar to a human hair, which is 50 microns.

How do I know if I am a good candidate for the ICL procedure?
Patients that are not satisfactory candidates for laser vision correction are usually good candidates for the ICL. This usually means that the prescription is too high, and/or the corneas are too thin or are irregular. Usually whatever vision you have with glasses or soft contact lenses can be achieved postoperatively without optical aids. Patients should have a pupil size measured in dim light of 7 mm or smaller. There must be a satisfactory distance between the back surface of the cornea and the crystalline lens of 3.0 mm or greater. The eyes should be healthy inside without evidence of cataracts or significant macular degeneration.

What tests are performed to be sure that I qualify for the ICL?
A refraction is performed to determine your prescription and your vision. An instrument called the Colvard pupillometer is used to measure the pupil size in dim light. A Pentacam or Orbscan is performed to determine the distance from your cornea to your crystalline lens. An IOL Master is performed to determine the width of your cornea to assist in determining the length of the implant.

Should I discontinue my contact lenses prior to the preoperative testing?
Yes, it is important to stop wearing soft contact lenses for approximately 5 days and rigid gas permeable lenses for at least 3 weeks prior to the preoperative testing. Contact lenses can potentially change the shape of the cornea and it is important that the corneas return to their normal shape prior to the preoperative testing.

Is the ICL customized for my eye?
Yes, the ICL is ordered directly from Switzerland where it is custom made for your eye. The lens has a specific prescription to correct nearsightedness, farsightedness, and/or astigmatism. In addition it is ordered with a specific length so that it fits well inside your eye.

How long does it take to receive the ICL from the time it is ordered?
It takes approximately 6 weeks for the Bochner Eye Institute to receive the ICL from Switzerland after it has been ordered. Once this occurs, patients can return to Dr. Raymond Stein, Dr. Harold Stein, Dr. Jordan Cheskes or Dr. Albert Cheskes to complete their treatment.

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Phakic Implants for High Refractive Errors

Dr. Raymond Stein of the Bochner Eye Institute wrote the following clinical update. We hope you find it of interest.

Phakic implants are used for the correction of high refractive errors that cannot be treated by a laser. Over the past 13 years we have been inserting the Implantable Contact Lens (ICL), a posterior chamber phakic implant made by Starr Surgical. Clinical outcomes for high myopia and astigmatism have generally been excellent with 95% of patients achieving 20/30 or better uncorrected vision. The main indications are refractive errors that are too high for laser vision correction. In general, patients are candidates for a phakic implant if they have myopia greater than 10 D or hyperopia greater than 5 D. Astigmatism can be treated up to 6 D. Patients must have a satisfactory depth of the anterior chamber (distance between the corneal endothelium and the crystalline lens) of greater or equal to 2.8 mm. Most of the high myopes will qualify for the implant. Patients should also have a pupil size of 7 mm or less.

Another surgical option, which patients need to know about in the informed consent, is refractive lens exchange (RLE). Our preference is not to perform a lens exchange for high myopia because of the increased risk of retinal tears and detachment. This is not the case with the treatment of high hyperopia, which is associated with a minimal retinal risk.

In patients that are good candidates for the ICL, a refraction is performed, the limbal white-to-white distance is measured to determine the length of the implant, and two small YAG laser iridotomies are performed to reduce the risk of elevated intraocular pressure from papillary block. The implant is custom ordered from Switzerland.

The surgical procedure is relatively easy for patients. At the Bochner Eye Institute we perform this procedure in our sterile operating room approved by the Ontario College of Physicians and Surgeons. Under topical anesthesia a 2.8 mm limbal incision is constructed. Intraocular xylcaine is injected to numb the contents of the eye. After the implant has been carefully folded into a cartridge, it is injected into the anterior chamber where it gradually unfolds. Using a specialized instrument the haptics are gently placed behind the iris. Miochol is then injected to constrict the pupil. Intraocular Vancomycin is injected to prevent infection. The patient is then checked one hour postoperatively, which allows Raymond Stein and his team to monitor the intraocular pressure and ensure that it is normal. Follow-up examinations are usually scheduled 1 day, 1 week, 1 month, and 3 months post-surgery.

Complications are rare. The main risk is inducing a cataract (1%). If patients are not satisfied with their level of uncorrected vision then laser vision correction can be performed. We have not had a case of infection for more than 13 years.

Specialized indications for the ICL include patients with keratoconus and those following radial keratotomy. In keratoconus patients if they have satisfactory best-corrected spectacle acuity (20/40 or better) then consideration can be given to the ICL. Patients may require an Intracorneal ring to reduce the degree of irregular astigmatism prior to a phakic implant. In the situation following radial keratotomy, if patients have developed a hyperopic shift then this can be corrected by the ICL. Unlike a natural hyperope the post-RK eyes were previously myopic and usually have a satisfactory anterior chamber depth.

The Bochner Eye Institute is a leading-edge eye care facility led by Dr. Raymond Stein Toronto patients visit for all their vision correction needs.

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“How do you know if you are a candidate for Laser Eye Surgery?” by Raymond Stein MD, Toronto

A detailed Laser Eye Surgery consultation is required to evaluate the health of your eyes and to determine the degree of your prescription. 95% of patients that come in for a laser consultation are felt to be very good candidates for laser vision correction. It is essential to identify the 5% of patients that may not have the desired outcome. Computerized topography and elevation topograpghy are performed which measures over 20,000 data points on the curvature and height of the front and back of your cornea. Raymond Stein MD says these tests will rule-out any unusual steepening, flattening, or irregularity. The thickness of your corneas is measured to be sure that it is satisfactory. Next an evaluation of the tear film is performed to be sure you do not have a dry eye that can affect postoperative healing. Pupil size is measured to make sure they are not unusually large.  A careful evaluation of the inside of your eyes is performed to be sure the lens, retina, and optic nerve are healthy. Your prescription is determined to be sure it is in the acceptable range for surgery. Today we can treat most ranges of nearsightedness, farsightedness, and astigmatism with laser vision correction.

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