Intacs Surgery: Uses, the Procedure, Outcomes & More

Intacs are an innovative removable device that can stabilize the cornea. Intacs surgery is used to improve nearsightedness and as a treatment for keratoconus. 

The surgery consists of placing small plastic arcs into the eye to reshape the cornea. This procedure can help people who are currently not able to see well with glasses or contacts.

What Are Intacs?

Intacs is a trademarked name for very thin prescriptive inserts. These were first used to treat low levels of nearsightedness, also known as myopia. 

In 2004, the FDA approved the use of Intacs for keratoconus. This surgery is an alternative treatment to a corneal transplant, a major surgical procedure.

A primary advantage of Intacs is that they can be surgically replaced or removed. If there are further vision changes, Intacs can be taken out if needed.

Intacs are often a recommended treatment for keratoconus, as they adjust the shape and location of the cone. 

Essentially, Intacs offers a surgical procedure to successfully manage keratoconus. Because Intacs are available in different thicknesses, they can correct and treat different stages of corneal degeneration.

When Intacs are inserted into the keratoconus cornea, they change the shape and location of the cone. This flattens the cornea to be closer to its original shape. 

Looking for the Best LASIK Near You?

Find a LASIK Surgeon

How Are Intacs Used? 

Intacs themselves are the thin plastic disks that are inserted into the eye during the surgical procedure. They are used to flatten a bulging cornea to its original dome-like shape. 

This corneal reshaping process is designed to improve vision. The degree of vision improvement varies from person to person. 

• In some patients with uncorrected vision, vision may improve. 

• Patients who could not wear contacts before may be able to wear contact lenses again. They may also see better than before the procedure. 
• Patients who wear glasses may have vision improvement and be able to see better than before with glasses.

Intacs for Keratoconus 

Intacs also work to manage the deterioration of vision caused by keratoconus. 

Keratoconus is a medical condition that creates a dome-like bulge of the eye. It is a degenerative condition, with progressive treatments used to manage each stage. 

In many cases, keratoconus is first treated with cornea cross-linking procedures that strengthen the collagen fibers and stop the condition from worsening. 

If keratoconus has progressed, Intacs surgery offers the next step for vision improvement. It is an option for patients who can no longer see with glasses or contacts.

The placement of Intacs eliminates some or all of the irregularities caused by keratoconus. The procedure remodels and reinforces the cornea to provide improved vision. 

While this treatment can improve uncorrected vision, some patients may still need glasses or contact lenses to see clearly.

Intacs for Nearsightedness & Astigmatism

Intacs were originally approved by the FDA in 1999 as a surgical treatment for mild myopia or nearsightedness.

Since nearsightedness causes distant vision to be blurry, changing the corneal shape allows light to focus correctly on the retina. 

According to UM Kellogg Eye Center, the Intacs procedure is effective to treat mild myopia (-1.00 to -3.00 diopters). It won’t work as well for moderate to severe myopia. 

Intacs can also be used to correct up to +1.00 diopters of astigmatism.

The Intacs Procedure: Step by Step

This is a quick procedure, taking about 15 to 30 minutes. It is typically done at a doctor’s office on an outpatient basis. 

Here’s what to expect:

• You should not feel any pain as your doctor will use a topical anesthetic to numb the eye.
• The doctor will keep the eye open with an instrument designed to prevent blinking during the procedure.
• The doctor will operate on one eye at a time, making a small incision into the cornea.
• The eye is prepared for proper alignment using a centering guide. The layers of the cornea are carefully separated, making it easy to insert the Intacs. 
• The Intacs are inserted under the surface of the cornea. The small opening in the cornea is closed.
• After the surgery, your doctor may advise resting in the waiting room before having someone drive you home.
• You’ll have follow-up exams to monitor healing and assess how your vision is improving.

Cross-Linking Procedures

The Intacs procedure works by reshaping the cornea and providing strength to the structure, but it isn’t the only treatment for keratoconus. Corneal cross-linking is another popular choice.

Cross-linking works by strengthening the fibers of the cornea. This method has been shown to be 90 to 95 percent effective in European studies. 

In some cases, Intacs and corneal cross-linking may be used together for a synergistic combination. Intacs are considered to be more powerful than cross-linking alone. When combined, the treatments can reduce astigmatism and improve overall vision.

According to the American Academy of Ophthalmology, Intacs are better at restoring the shape of the cornea and improving tolerance to contact lenses. Crosslinking treatment is better at stopping the progression of keratoconus.

The main factors to consider in a combined treatment are a patient’s age, disease progression, and desired outcomes.

Cross-Linking: Epi-On & Epi-Off

Crosslinking is commonly divided into two types: epi-on and epi-off. 

• Epi-on is when the doctor loosens the epithelium, usually with eye drops or a sponge, before administering eye drops in the eye. 
• Epi-off is when the doctor removes the epithelium altogether before putting drops in the eyes.

In special cases, epi-on treatment offers advantages. This method preserves the thickness of the cornea and improves visual clarity. An additional advantage is reduced eye discomfort following surgery. 

Talk with your doctors to understand which crosslinking treatments they recommend for your unique case.

Recovery From Intacs Surgery

Typically, patients can resume normal activity two or three days after Intacs surgery. 

According to the American Academy of Ophthalmology, patients may feel as if something is in their eye. This sensation should decrease after a few days.

During recovery, you might have difficulty seeing at night. You may experience visual symptoms, such as light sensitivity, halos, or blurry vision. Usually, over-the-counter pain medication is sufficient to manage the pain.

Potential Risks

As with any procedure, there are some risks. Potential risks following Intacs surgery include the following:

• Eye infection
• Vision distortion
• Blurry or fluctuating vision
• Problems seeing clearly at night
• Seeing halos around lights

Since Intacs are removable, they can always be taken out if problems persist.

Outcomes

Long-term vision correction is the ultimate goal of Intacs surgery. Patients often notice an immediate improvement in vision. 

The recovery time is short, so patients can return to normal activities quickly, ideally with improved vision.

Who Is a Candidate for Intacs?

The following criteria make someone a good candidate for Intacs: 

• Degrading vision 
• Inability to obtain adequate vision correction with glasses or contacts
• At least 21 years old
• Not pregnant or nursing
• No autoimmune deficiencies
• Not taking medications that could impact recovery

Who Is Not a Candidate?

The following types of people are not candidates for Intacs: 

• People under 21 years old 
• Pregnant or nursing women 
• Those taking certain medications 
• People who are experiencing other eye conditions 

Talk to your doctor to determine if an Intacs procedure is right for you.

Intacs Surgery FAQs 

What is the Intacs procedure?

Intacs insertion is a quick procedure to reshape the cornea. It is used to correct nearsightedness or vision issues in patients with keratoconus. 

The process involves making a small incision into the cornea. Two plastic rings are placed on the outer edge of the cornea. Once in place, the rings flatten the edges of the cornea. This helps light rays properly focus on the retina. 

During the procedure, topical anesthesia is used to minimize pain. The procedure typically takes less than one hour. 

What are Intacs for keratoconus?

The Intacs procedure is a treatment to improve vision and flatten the bulging shape of the cornea, associated with keratoconus. With Intacs, the shape of the cornea is flattened to more closely resemble its original shape. Because of this, vision can be restored. 

What happens after Intacs?

Improvement in vision is usually immediate, with most patients returning to their normal lives two to three days after surgery. 

What are the advantages of Intacs?

Intacs involve a quick outpatient procedure to correct vision. A primary advantage is that if vision changes in the future, Intacs can be removed or replaced. This procedure may help eliminate or defer the need for a corneal transplant. 

Are Intacs a permanent solution?

Intacs are a permanent solution and can remain in your eye. They do not require maintenance. 

However, Intacs also offer flexibility. If your prescription changes, they can be removed or replaced.

How painful are Intacs?

Intacs surgery is typically not painful since your eyes are numbed. Most patients feel a pressure sensation during the surgery. Discomfort in recovery is often managed with an over-the-counter painkiller such as Tylenol.

References

1. Keratoconus. American Optometric Association (AOA).

2. Intacs Surgery for Keratoconus. National Keratoconus Foundation (NKCF)

3. Intacs or Intracorneal Ring Segments (ICRS). Kellogg Eye Center. University of Michigan (UMK).

4. Eye Treatment Brings Hope for Keratoconus Sufferers. (August 2018). University of California, Irving (UCI).

5. Crosslinking: Intacs and CXL. (August 2015). American Academy of Ophthalmology (AAO).

6. Intacs, Crosslinking Together Reduce Astigmatism. (October 2019). Ocular Surgery News.

7. Examining the Cross-linking/Intacs Link. (November 2012). Review of Ophthalmology.

8. Epi-Off versus Epi-On Corneal Collagen Cross-Linking in Keratoconus Patients: A Comparative Study Through 2-Year Follow Up. (July 2018). Journal of Ophthalmology.

9. Your Eye Concerns (FAQ). Intacs for Keratoconus.

10. How Painful Is Recovery From Intacs Surgery? (October 2015). American Academy of Ophthalmology (AAO).