LASIK surgery is so popular that you probably know at least one person who has had the vision-correcting surgery—and may even have had it yourself. But you may not have heard of an alternative procedure, Phakic (FAY-kick) intraocular lens implantation (IOL) implantation, a more invasive procedure that can help some people who are not candidates for LASIK.

We contacted David Rex Hamilton, MD, an ophthalmologist at Santa Monica Eye Medical Group in California, to find out how Phakic IOL compares with LASIK. But first, here is some background on vision.

Ideally, an image enters the eye and falls on the retina at the back of the eyeball. The optic nerve then transfers that image to the brain. The image will appear blurred if it falls in front of the retina (myopia, or nearsightedness)…or behind it (hyperopia, or farsightedness). In addition, the image also can be distorted if the cornea (the clear, outer window of the eye) has astigmatism—a football shape instead of a round, basketball shape. Glasses and contact lenses fix these refractive errors by bending light rays so that the image falls correctly on the retina and is in focus.

Both LASIK and Phakic IOL accomplish this same goal but use different techniques…

  • With LASIK, the surgeon cuts a thin flap in the surface of the cornea with a laser or blade…uses a laser to remove precise amounts of the underlying corneal tissue, reshaping the cornea to be flatter (to correct nearsightedness) or steeper (to correct farsightedness) and to make it more round (to correct astigmatism)…then folds the flap back into place, where it adheres immediately and heals on its own.
  • With Phakic IOL, no eye tissue is removed. Instead, a tiny synthetic lens is surgically implanted behind the cornea and in front of the eye’s natural lens. Depending on the type of Phakic IOL, it sits in front of or behind the iris (the colored part of the eye).

COMPARING PROS AND CONS

Neither procedure is superior to the other. It is more a question of which will work best when taking into account certain variables such as eye shape, health, age, current visual acuity and lifestyle.

Similarities in the procedures…

Both LASIK and Phakic IOL are outpatient procedures that take 15 to 20 minutes. Anesthetic eyedrops and a mild sedative may be administered. After surgery, the patient wears a clear eye shield for a few nights to protect against accidental rubbing during sleep and uses antibiotic and anti-inflammatory eyedrops for several weeks.

Astigmatism correction is now available using both LASIK and Phakic IOLs. The Visian Toric ICL, made by STAAR Surgical in Monrovia, California, was recently FDA-approved to treat up to four diopters (diopter (D) is a measure of refractive power) of astigmatism.

Presbyopia, a condition in which aging leaves the eye’s natural lens too stiff to focus clearly up close, can be addressed with either Phakic IOL or LASIK by creating monovision—one eye is corrected for near vision and the other eye is corrected for distance vision.

For Phakic IOL and LASIK patients alike, vision generally is excellent the day after surgery. However, there are no guarantees. With either procedure, patients have a small risk of experiencing glare, double vision or halos around lights. Rarely, patients still may need contacts or glasses to achieve the best vision…very rarely, they can wind up with worse vision than before.

Phakic IOL advantages over LASIK…

  • Phakic IOL can correct more extreme nearsightedness—up to -16.0 D, compared with up to -8.0 D for LASIK.
  • Phakic IOL works for people whose corneas are too thin, flat or irregular for LASIK.
  • Patients who get Phakic IOLs seldom develop dry eye syndrome, whereas it’s fairly common for LASIK patients to experience dry eyes, typically lasting three to six months.
  • Phakic IOLs are intended to be permanent, but if results are unsatisfactory or if complications develop, they can be removed, allowing (though not guaranteeing) the eye’s return to its original condition. LASIK cannot be undone, though it can be redone—in fact, 5% of LASIK patients need a second “touch-up” surgery for optimal results.

Phakic IOL disadvantages compared with LASIK…

  • In the US, LASIK devices were first FDA-approved in 1998, versus 2004 for Phakic IOL—so doctors have less experience with Phakic IOLs and there is less data on its long-term safety.
  • There is no FDA-approved Phakic IOL for farsightedness (though such lenses are used in other countries)…whereas LASIK can correct farsightedness of up to about +4.0 D.
  • Phakic IOLs cost more—about $4,500 to $6,000 per eye, compared with about $2,500 to $3,000 per eye for LASIK. Insurance generally does not cover either of these elective surgeries.

Phakic IOL potential complications…

Because Phakic IOL surgery takes place inside the eye, it is more invasive and there are potential complications that do not exist with LASIK. Problems occur only very rarely, but there is a risk for…

  • Cataracts (clouding of the eye’s natural lens). These can be treated and excellent vision restored.
  • A sudden rise in internal eye pressure that, if untreated, can lead to glaucoma and loss of peripheral vision. If elevated pressure occurs, it can be effectively treated and glaucoma avoided.
  • Damage to or loss of cells on the cornea’s inner surface. This can lead to corneal swelling that, in extremely rare situations, could require a corneal transplant.
  • If you’re interested in Phakic IOL or LASIK, talk with a refractive surgery specialist. Check the American Academy of Ophthalmology site for an ophthalmologist near you.