Alternatives to LASIK
If you are not a suitable candidate for LASIK, Dr Tan may suggest alternative treatments for your vision problems, such as:
- ICL (Implantable Collamer® Lens)
- LASEK (laser in-situ epithelial keratomileusis) and Epi-LASIK
- PRK (photorefractive keratectomy)
- Conductive Keratoplasty (CK)
Always at the forefront of Ophthalmologic innovation, Jerry Tan Eye Surgery is pleased to offer the ICL to our patients.
We believe that our patients should be presented with a wide range of options when choosing a method of vision correction, and ICL is one of the most innovative, effective eye care solutions available.
Dr. Tan has been certified by STAAR® Surgical Company in year 2006 to perform the implantation of Visian ICLTM . The certification is a mandatory requirement for physicians who are implanting the Visian ICLTM lens.
First developed in 1992, the ICL has since undergone extensive development and clinical trails. In the past 15 years the ICL has been successfully implanted in over 120,000 eyes.
What is ICL?
The ICL (Implantable Collamer® Lens), also known as Implantable Contact Lens was created by STAAR® Surgical Company, and is a phakic intraocular lens (IOL) used for the treatment of myopia, hyperopia & astigmatism.
The word "phakic" means that your natural crystalline lens is left in the eye. This is important because your natural lens plays an important role in helping your eye adjust between seeing objects that are near and far.
The ICL is a lens that is permanently implanted in the eye behind the iris and in front of the natural lens. The lens is intended to correct moderate to severe nearsightedness (myopia), astigmatism & hyperopia ("youthful" longsightedness).
The unique Collamer® composition of the ICL has anti-reflective properties and high water content to greatly reduces the occurrence of glare and halos and provides a high quality of vision.
The ICL lens material also contains a UV blocker that prevents harmful UVA and UVB rays from entering the eye, possibly preventing the development of UV related eye disorders.
ICLs differ significantly from other refractive methods in that they do not involve changing the shape and/or structure of the cornea (the clear outer layer of the eye).
ICLs are placed over the natural lens of the eye and can correct very high refractive errors.
How does it work?
It works by bending (refracting) light rays to allow them to focus on the retina.
The Visian ICLTM by STAAR® Surgical Company is made with Swiss precision from Collamer®. This unique material contains a small amount of collagen, which provides excellent biocompatibility and superior optical capability. The lens is gently folded and placed between the iris and the natural lens.
The procedure involves placing the ICL behind your cornea between your iris and the natural lens of your eye. This gives your eye another focusing lens that provides high-quality, high-definition vision like a normal eye. Although the ICL is intended to be permanent, the procedure is reversible if desired.
The ICL procedure
- LASER IRIDOTOMY
One to two weeks prior to the procedure we need to prepare your eyes by using a laser to create two very small openings in the coloured part of your eye which lies between the lens and the front chamber of your eye. This allows for the natural passage of fluids between the two areas, thereby avoiding the build up of intraocular pressure following the treatment.
- ICL IMPLANTATION
The implantation procedure itself takes about 20 minutes and is performed on an outpatient basis, though you will have to make arrangements for someone to drive you to and from the procedure.
- The patient has the option to do the procedure under local or general anaesthesia, so the procedure is painless
- For better access to your eye, Dr. Tan will use an instrument to comfortably hold your eyelids open during the procedure
- A small incision is made in the cornea. This allows the ICL to be placed in the space between the iris and the natural lens
- The ICL is centred in the pupil (the black part in the centre of your eye), and is gently settled between the iris (the colored part of your eye) and the natural lens
- The small incision acts like a self sealing valve and usually no stitches are necessary
- A temporary shield will be placed over your eye to protect it during the time just after the procedure
Following surgery, you will require prescription eye drops and oral medication. The day after surgery, you will return to the clinic for a follow-up visit. You will also have follow-up visits one week, one month, three and six months following the procedure.
Who are the ideal candidates for ICL?
- Ages between the ages of 21 and 60.
- Nearsighted, especially those with severe myopia (300 degrees to 2000 degrees) and astigmatism up to 500 degrees.
- Must have an Anterior Chamber Depth (ACD) of 2.80mm or greater.
- Have not had a change in their eyeglass prescription of more than 0.5D in a year.
- Are not currently pregnant.
- Have no known allergies to medications used during refractive surgery or no other contraindications.
- Patient who have severe dry eyes, severe myopia, and a thin cornea (non-LASIK candidate) are good candidates for an ICL
What are the advantages of the ICL?
The ICL and its unique Collamer® Composition offer numerous advantages including:
- Performance - Outstanding Quality of Vision
- Versatility - Wide Treatment Range
- Simplicity - Lens Placement; Removable / Reversible
- Biocompatibility - Collamer® Composition
- Safety - Small Incision; Proven Track Record
- Short Recovery Time
When should it NOT be used?
Patients who are under 21 years old are not suitable candidates for the ICL. The ICL is also contraindicated in patients:
- With ACD less than 2.80 mm
- With anterior chamber angle that is very narrow
- Who are pregnant or nursing
- Have a low cell density in their cornea
- Who are affected by the following conditions: glaucoma, cataracts, collagen sensitivity, or a previous history of iritis, pigment dispersion syndrome, or pseudoexfoliation.
How do I minimise the risk in ICL?
Accurate measurement of ICL size
Calculation of the ICL power and selecting the correct size of ICL is of paramount importance to ensure a successful result with minimal risk.
The majority of complications after ICL are due to poor sizing. If the ICL is too big, there is a risk of shallowing the anterior chamber causing glaucoma. If the size is too small there is a risk of displacement of the ICL. This backward displacement can cause a premature cataract.
We are the ONLY CLINIC IN ASIA to use the Artemis High frequency Ultrasound to assess the sulcus-to-sulcus dimension in your eye. This allows us to choose the size of your ICL with the better precision. Most centers do not purchase this device as it is extremely expensive.
The Artemis UBM (Ultra-high Frequency) is used to examine the internal structures of the eye. It is unique because it incorporates a fixation device allowing precise alignment. Only the Artemis allows the surgeon to gain an understanding of where the lens implant is going to fit in your eye.
Most centers are assessing the diameter of your cornea "white-to-white" (WTW) measurement and extrapolating this information to obtain the sulcus-to-sulcus measurement. However studies have shown that there is NO correlation between the diameter of the cornea (WTW) and the sulcus-to-sulcus measurement. Therefore the sizing of the ICL from WTW measurement can be very inaccurate.
Measurement of Anterior Chamber Depth (ACD)
If too shallow, it is an ABSOLUTE CONTRAINDICATION TO SURGERY. The distance between the back of your cornea and the front surface of your lens must be more than 2.8mm. If this is not observed, there is a risk of glaucoma and damage to your cornea, ultimately leading to a need for a corneal transplant or cataract removal.
Some complications associated with the ICL differ from those associated with LASIK or PRK.
Damage to the Crystalline Lens
Since the ICL is placed inside the eye, there is a potential risk of touching the eye's natural lens may result. Damage to the natural lens may cause opacity of the natural human lens, in the most serious cases, requiring removal and replacement of the natural lens with a synthetic lens. These opacities, requiring surgical intervention, occurred in less than 1 percent of the Visian ICL patients.
Complications of Iridotomy
One to two weeks prior to the implantation of the ICL, the surgeon will perform a procedure called an iridotomy. Using a YAG-laser, the doctor will make one or two small openings near the edge of your iris. Complications from the iridotomy are rare, but could possibly include natural lens or corneal damage, inflammation, temporary increase in intraocular pressure, bleeding, and scar formation.
Increase in Eye Pressure
In some cases, there may be an increase in eye pressure (glaucoma). If this occurs, a surgeon may quickly remedy the problem with additional medications or surgical intervention.
Visual Recovery after ICL procedure
Data from research, including the FDA, show that corrective eye surgery using the ICL is safe and effective for the correction or treatment of myopia. It also shows that the ICL has some advantages over refractive surgical procedures such as PRK and LASIK, and has a lower chance of inducing higher order aberrations compared to standard LASIK.
American Academy of Ophthalmology - FDA Clinical Trial of ICL for Moderate to High Myopia: Three-Year Follow-Up
In the 2004 ICL clinical trial three-year follow-up conducted by the FDA, investigation results "support the safety, efficacy, and predictability of ICL surgery to treat moderate to high myopic errors.
The three-year data, based on the assessment of 526 eyes of 294 patients, also produced the following refractive results:
- 99 percent of patients were satisfied/very satisfied with their results.
- 98.3 percent of patients had uncorrected visual acuity of 20/40 or better.
- Once vision was corrected, the correction was stable and did not change over the follow up period.
- Additionally, the incidence of glare, halos, double vision, night vision problems, and night driving difficulties decreased or remained unchanged from before surgery.
LASEK and Epi-LASIK are a combination of PRK and LASIK. A very fine, plastic blunt blade (Epi-LASIK) or a dilute alcohol solution (LASEK) is used to create a thin flap from the outermost surface epithelium of the cornea. Then, laser is used to reshape the eye. With LASEK and Epi-LASIK, the cornea sustains less internal thinning and ectasia (progressive bulging) is less likely than in LASIK, especially when high powers are treated. However, vision recovery is slower compared to LASIK and patients have to wear a bandage contact lens for a few days to facilitate healing. Haze and scarring are more likely, but chemicals, such as mitomycin, are applied to the treated cornea to prevent scarring.
Comprising of three layers.
A flap is made of epithelium and anterior stroma. Laser is then applied to the cut stroma.
The epithelium is scraped off and removed before laser ablation.
The layer of epithelium is removed as a flap before laser ablation.
Laser is used to reshape the eye, but unlike LASIK, no flap is created. Usually, PRK patients experience longer healing times and more pain compared to LASIK patients. There is a higher chance of infection. Scarring and haze formation are also more likely.