Phakic Intraocular Lens (IOL) Surgery

Phakic intraocular lens surgery involves placing a synthetic lens over the eye’s natural lens, helping to correct refractive errors. 

This stands in contrast to an IOL procedure, such as refractive lens exchange, which instead permanently removes the eye’s natural lens and completely replaces it with a synthetic one.

What Can Phakic IOLs Treat?

Phakic IOLs can treat refractive errors. Doctors primarily use phakic IOLs to treat myopia and myopic astigmatism, specifically when laser surgery cannot achieve the desired level of correction. 

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How Do Phakic IOLs Work?

The key principle behind phakic intraocular lenses is that a surgeon can correct a patient’s vision by placing a synthetic lens over the patient’s natural eye lens. 

This can refocus incoming light, helping a patient achieve a better level of visual acuity, often at or near the levels needed to perform activities such as driving or reading without additional corrective lenses. 

Benefits

Phakic IOLs have a significant benefit over two alternatives, laser surgery and refractive lens exchanges. Unlike with those procedures, there is virtually no risk of corneal ectasia, where the structural integrity of the cornea fails, resulting in various complications.

In one study, about 81 percent of patients who received phakic IOLs achieved a 20/40 level of uncorrected visual acuity (UCVA) in three years. This 81 percent of patients, with no additional correction from corrective lenses like glasses, could see at 20 feet what a person with normal vision could see at 40 feet. This is not a perfect level of vision, but it represents a significant improvement for most patients who might consider this procedure. 

This doesn’t mean that 19 percent of patients saw worse or had no change to their visual acuity. It only means that a level of 20/40 vision wasn’t achieved in that group. Complications can occur that result in worsening vision, but they are rare.

Types of Phakic IOLs

There are two types of phakic IOLs that are currently approved by the U.S. Food and Drug Administration.

Visian ICL

The Visian implantable collamer lens (ICL) sits in front of your natural lens but behind the iris, making it a posterior chamber IOL. This lens can correct myopia from -3.00 to -20.00 D.

Verisyse

This lens is placed in front of the iris, making it an anterior chamber phakic IOL. The Verisyse IOL is more rigid than the Vision ICL.

Preparing for Surgery Phakic IOL Procedure

Prior to the surgery, your doctor may recommend an iridotomy, which prepares your eye for the phakic IOL. During an iridotomy, a laser makes a small hole in the outer edge of the iris to prevent the buildup of fluid and pressure during the phakic IOL procedure.

Your doctor may prescribe antibiotic eye drops, which you’ll start using in the days leading up to surgery. These will help to prevent infection. Anti-inflammatory eye drops may also be prescribed. 

Phakic IOL Procedure

Phakic IOL surgery is somewhat similar to RLE surgery. 

First, you’ll be administered anesthesia so the procedure is painless. You may also be given anti-anxiety medication ahead of time to reduce any stress about the procedure. Patients are generally awake during phakic IOL surgery.

The eye is kept open with a special device while the doctor works. The pupil is also constricted with an injection. Then, the doctor will make a cut so they can access under the surface layers of the eye. 

The eye’s natural lens is kept in place as the surgeon carefully positions the synthetic lens to better focus light on the retina. The doctor will make sure the lens is properly in place. 

The doctor may stitch up the incision, depending on the type of incision made. Often, the doctor will cover the eye with a patch after applying eye drops or ointment.

Recovery From Phakic IOL Surgery

Your sight will improve almost instantly after the procedure, as the lens is immediately in position to begin correcting light refraction. Vision will likely be blurry for a few days, but it will continue to clear each day.

Full recovery takes between two and four weeks, but you should be able to resume most of your normal activities within a couple days. 

For some activities, your doctor may recommend a longer waiting period. Heavy physical activity should typically be avoided for at least one month. Don’t resume contact sports or swimming without getting express permission from your doctor. 

While there is usually not much pain or discomfort following phakic IOL surgery, you may experience a mild irritation or scratching sensation in your eye. If this is bothersome, talk to your doctor about potential medication solutions that can help.

Risks

Phakic intraocular lens surgery is considered a safe surgery, although it still carries some risk. Potential risks associated with phakic IOL include the following:

• Bleeding
• Infection
• Inflammation or endophthalmitis (severe inflammation)
• Increased pressure in the eye
• Retinal detachment

Serious and permanent vision loss is possible with this surgery but very rare.

If you experience any of the above symptoms or any symptom your doctor did not discuss with you ahead of time, contact them right away. If complications are promptly treated, the risk of serious issues is reduced.

Can IOLs Be Removed?

Phakic IOLs (pIOL) can be surgically removed if necessary, though they are intended to be a permanent vision solution. Removing a pIOL undoes any vision correction it was providing. The eye’s natural lens is not altered by this procedure, so vision returns to what it was before the surgery.

This is in contrast to RLE. The natural lens is removed during RLE. While you can remove and replace an IOL, it is not an easy procedure. A new IOL needs to be placed once the prior IOL is removed.

Phakic IOLs may need to be removed to treat some conditions, such as cataracts. 

Phakic IOL Surgery vs. Refractive Lens Exchange

One important point of comparison when considering phakic IOL surgery is how the result might compare to refractive lens exchange (RLE). Unlike with phakic IOL surgery, RLE involves the destruction of the eye’s natural lens, effectively replacing it with a synthetic lens. 

A phakic IOL procedure leaves your natural lens in place. This is the same lens that a cataract can form on. You may want to avoid this procedure if you have a high chance of developing cataracts, although further surgery can often correct any problems that develop.

As a general rule, RLEs provide better correction for near-vision problems. Phakic IOLs provide better correction for distance vision. When both options seem otherwise equally valid, many patients prefer phakic IOLs as it leaves their natural lens in place whereas it is permanently destroyed with RLE. 

Phakic IOL Costs

Cost is one of the biggest disadvantages of IOLs, including phakic lenses. A phakic IOL procedure can cost as much as $4,000 or more per eye. This means many surgeons are reluctant to recommend it for patients who only have a minor refractive error. 

If you otherwise would want an IOL and don’t view cost as an obstacle, mention this to your doctor.

Is Phakic IOL Right for You?

Ultimately, the decision will come down to your specific refractive error, your age, and your overall health. Talk to your doctor about the advantages and disadvantages of phakic IOL surgery for your situation. They can also present alternatives that may work better for you.

References

1. Phakic Intraocular Lenses. (September 2021). American Academy of Ophthalmology.

2. Phakic Intraocular Lenses and Their Special Indications. (October 2016). Journal of Ophthalmic & Vision Research.

3. Refractive Lens Exchange Versus Phakic Intraocular Lenses. (January 2012). Current Opinion in Ophthalmology.

4. Phakic IOLs: Tips and Techniques. (November 2021). Review of Ophthalmology.

5. What Are Phakic Lenses? (January 2018). U.S. Food and Drug Administration.

6. What Happened to the Promise of Phakic IOLs? (February 2010). Review of Ophthalmology.

7. Phakic IOLs May Make Cataract Surgery More Challenging. (September 2016). Healio.

8. Phakic IOLs: Clinical Guidelines and Best Practices. (September 2020). Cataract and Refractive Surgery Today.

9. Phakic Intraocular Lenses (IOLs) or Implantable Contact Lenses (ICLs). Kellogg Eye Center, University of Michigan Health.

10. A Systematic Review About the Impact of Phakic Intraocular Lenses on Accommodation. (July –September 2020). Journal of Optometry.

11. Complications Associated With Placement of Phakic Intraocular Lens. (April 2004). Investigative Ophthalmology and Visual Science.