Phakic IOL Vision Correction – Better than LASIK?

Uncorrected refractive errors are the leading cause of moderate to severe vision impairment worldwide. These errors affect about 116 of 216 million people with vision impairment. They also rank as the second most common cause of preventable blindness, affecting 7.4 of 36.0 million people.

Common vision problems: myopia, hyperopia, astigmatism

Your eyes can’t properly focus images onto the retina when you have refractive errors, which leads to blurred vision. People with myopia (nearsightedness) see nearby objects clearly while distant objects appear blurry. This happens because their eyeball is longer than average or their cornea curves too sharply. People with hyperopia (farsightedness) experience the opposite – they see distant objects clearly but nearby objects appear blurry. A shorter than average eyeball or too flat cornea causes this condition. Astigmatism makes overall vision blurry because of an irregularly shaped cornea or lens.

These conditions are widespread. About 26.5% of adults globally have myopia. The numbers have shot up from 10.4% in 1993 to 34.2% in 2016. Children show an estimated pool prevalence of 11.7% worldwide.

Limitations of glasses and contact lenses

Regular vision correction methods come with several challenges:

• Practical inconveniences: Glasses get foggy in humidity, wet in rain, and make sports difficult
• Comfort issues: The weight of glasses on the nose and pressure on ears bothers many people
• Health concerns: Contact lenses need careful cleaning to avoid serious eye infections

Contact lens users risk corneal infections, scratches, and dry eyes because their eyes don’t get enough oxygen. Nearly 50% of people eventually stop using their contacts or glasses.

Rise of refractive surgeries

More people now want surgical options because traditional correction methods have too many drawbacks. The market for refractive surgical procedures should grow 4% yearly from 2019 to 2024. Annual procedures are expected to increase from 4.7 million to 5.7 million.

The COVID-19 pandemic created an unexpected surge in demand. Many clinics saw a 25% increase in refractive surgery consultations. People wanted solutions for their fogging glasses while wearing masks. The Refractive Surgery Council reported a 30% jump in laser vision correction procedures at the start of 2021.

Modern patients want permanent vision solutions that fit their active lifestyles. India alone has 54.5 million people with uncorrected refractive errors. The market for alternatives like phakic IOL implantation keeps growing as procedures become more advanced and available.

Phakic IOL surgery helps people with high refractive errors who couldn’t benefit from earlier surgical options. More people now ask about alternatives as they learn about these specialized procedures. They don’t want to deal with the daily hassles of glasses and contacts anymore.

Limitations of LASIK for Certain Eye Conditions

LASIK surgery has transformed vision correction and helped millions of patients since FDA approved it in 1999. In spite of that, this popular procedure comes with several important limitations that make many patients unsuitable candidates if they want freedom from glasses or contacts.

Corneal thickness and high refractive error limits

LASIK’s success depends heavily on available corneal tissue, which determines patient eligibility. A normal cornea’s thickness measures around 540-550 microns. LASIK requires:

• Minimum 250-300 microns remaining after surgery (not including flap thickness)
• 90-120 microns to create the corneal flap
• Removal of 12-15 microns per diopter of vision corrected

To name just one example, fixing a -6.00 prescription needs 72-90 microns of tissue removal plus 120 microns for the flap. This means patients need at least 492-510 microns pre-operatively. Most surgeons avoid performing LASIK on corneas thinner than 470 microns. 

More importantly, LASIK isn’t recommended for prescriptions beyond certain limits—myopia exceeding -12 diopters, hyperopia greater than +6 diopters, or astigmatism above 6 diopters. Extreme corneal reshaping can lead to optical problems, even with adequate thickness.

Dry eye risks and night vision disturbances

Dry eye syndrome ranks as LASIK’s most frequent complication. Up to 95% of patients experience it right after surgery. Symptoms usually improve gradually, but 40% of patients deal with dry eyes for more than six months. LASIK cuts through corneal nerves, which can affect tear production and distribution.

Night vision problems also trouble many patients after successful LASIK procedures. Research shows LASIK increases the halo disturbance index by 2.15 times. Patients often experience:

• Starbursts and halos around lights
• Decreased contrast sensitivity
• Overall image degradation

Yes, it is concerning that 43.5% of patients report night vision disturbances according to one retrospective study. These problems occur whatever the surgery’s success in meeting international standards of predictability, efficacy, and safety.

Irreversibility of LASIK

LASIK permanently alters eye anatomy. The procedure removes corneal tissue to reshape the eye, and this tissue can’t grow back or return to its original state. One report explains it clearly: “LASIK and all laser vision correction methods permanently remove corneal tissue… the consequences of removing corneal tissue can be concerning as LASIK and all other laser correction procedures are irreversible”.

Patients who face severe complications have limited options. Enhancement procedures might fix some issues but only work when enough corneal tissue remains. This limitation makes phakic IOL implantation an attractive alternative for patients with high prescriptions or thin corneas. 

Phakic IOLs as a Modern Alternative

Patients who need vision correction beyond what LASIK can handle now have a breakthrough option with phakic intraocular lenses (IOLs). These lenses work best for people with moderate to severe myopia. 

What is a Phakic IOL and how does it work?

A phakic IOL is a specialized lens that surgeons implant inside the eye while keeping the natural lens intact. The implant works like an internal contact lens and blends perfectly with your eye’s natural structures. It fixes vision by changing how light enters the eye and focuses on the retina. Doctors place these lenses either between the iris and natural lens (posterior chamber) or in front of the iris (anterior chamber), depending on the design.

The surgery takes about 15 minutes for each eye as an outpatient procedure with light topical or local anesthetic. Of course, one of the biggest advantages is that patients keep their eye’s natural focusing power without reshaping the cornea.

Types of Phakic IOLs: Visian ICL vs Verisyse

Two FDA-approved phakic IOLs lead the market:

1. Visian ICL (Implantable Collamer Lens): Doctors can use it for myopia from -3.0 to -15.0D and reduce myopia from -15.0 to -20.0D. The lens material is Collamer—a biocompatible substance with purified collagen that protects against UV rays. The latest EVO ICL model has special ports that let fluid flow naturally, so patients don’t need laser procedures before surgery.
2. Verisyse/Artisan: This lens works for myopia from -5.0 to -20.0D. It’s made from medical-grade plastic (PMMA) and uses an iris-claw design to stay securely in place.

Studies show both lenses give excellent results. The Visian ICL performs better statistically with uncorrected vision, and 92% of patients achieve 20/20 vision or better. It also hits target prescriptions more accurately, missing by only 0.038±0.39D.

Advantages over LASIK for high myopia

Phakic IOLs have clear benefits compared to LASIK:

• They fix myopia up to -20D—way beyond LASIK’s reach
• Vision contrast is better than with excimer laser correction
• Patients lose much less of their best glasses-corrected vision
• Doctors can remove them if needed
• They work better optically for extreme myopia
• New models protect the eye’s endothelial cells

Research shows phakic IOLs are safer than excimer laser surgery for moderate to high myopia (-6.0 to -20.0D). More than 90% of patients in clinical trials say they’re happy with the results. This shows how well these lenses work when LASIK isn’t the best choice.

Comparing Safety, Effectiveness, and Recovery

Making an informed decision about vision correction requires a clear understanding of safety, how well the procedures work, and recovery time. 

Surgical risks: LASIK vs Phakic IOL

Phakic IOL and LASIK procedures both show low complication rates, but their risk profiles are different by a lot. Research shows phakic IOL surgery proves safer than LASIK for moderate to high myopia. Patients experience less loss of best spectacle-corrected visual acuity (BSCVA) 12 months after surgery. Studies of 216 eyes from three trials revealed phakic IOL patients had lower chances of losing one or more lines of BSCVA compared to LASIK patients.

Phakic IOL implantation comes with a small risk of early cataracts. Other risks include inflammation, retinal detachment, and eye pressure changes. LASIK complications usually involve dry eyes and night vision issues.

Visual outcomes and patient satisfaction

Visual performance studies show better contrast sensitivity with phakic IOL surgery than LASIK for moderate to high myopia. Mathematical vision quality measurements reveal implantable collamer lenses (ICL) consistently achieve higher modulation transfer function (MTF) than post-LASIK MTF across various pupil sizes.

Patient satisfaction questionnaires rank phakic IOL surgery higher. This preference stems from preserved corneal structure and fewer night vision problems. Patients report reduced halos, glare, and starbursts compared to LASIK.

Recovery time and post-op care

Most phakic ICL patients see major visual improvements within 24-48 hours. LASIK remains an incredibly quick procedure that takes less than one minute per eye.

Phakic IOL patients need regular checkups to ensure the implanted lenses don’t damage surrounding tissues. LASIK patients might feel more discomfort and see vision changes in the first few weeks. The good news is they need fewer long-term checkups.

Each procedure suits different people. LASIK works best for low-to-medium myopia patients. Phakic IOLs better serve people with medium-to-high myopia, thin corneas, or existing dry eye conditions.

Cost, Accessibility, and Long-Term Considerations

Money matters a lot when choosing between vision correction procedures. Patients need to know how costs differ, what happens in the long run, and how to pick the right surgeon. This knowledge helps them choose between phakic IOL and LASIK surgery.

Cost breakdown: LASIK vs Phakic IOL

LASIK surgery costs between INR 126,570 to 168,760 per eye. This makes it much cheaper than phakic IOL implantation. Phakic IOL procedures cost from INR 253,141 to 421,902 per eye, and the average price sits around INR 337,521 per eye. The price gap exists because phakic IOL needs more invasive surgery, takes longer to perform, and includes the implantable lens cost.

Insurance companies don’t usually cover these procedures. They see both as elective cosmetic surgeries. Patients can employ health savings plans or flexible spending accounts to help with costs. Many clinics let you pay in installments.

Reversibility and future eye health

The biggest advantage of phakic IOL surgery is that doctors can reverse it. LASIK permanently removes corneal tissue, but surgeons can take out phakic IOL implants if needed. This returns the patient’s vision to what it was before surgery. The option to reverse the procedure gives patients more flexibility with their future eye care.

Doctors design phakic IOLs to stay in place forever. Yet knowing how to remove them helps if new vision correction technology comes along or if medical reasons require removal.

Choosing the right procedure with your surgeon

You need to talk carefully with qualified specialists to pick between these procedures. Here’s what to do as you decide:

• Talk to several certified surgeons
• Make sure consultations teach you rather than just try to sell
• Look at how clean the facility is and how professional the staff seems
• Trust your gut about the surgeon

LASIK works best for patients with mild to moderate vision problems. Phakic IOL implants suit those with stronger prescriptions better. Your surgeon’s job is to figure out which procedure matches your eye structure and vision needs.

Comparison Table

Conclusion

Phakic IOL and LASIK procedures both offer tremendous benefits for vision correction and serve different patient populations with distinct needs. Phakic IOLs are the better option if you have high refractive errors, thin corneas, or pre-existing dry eye conditions. Of course, you can reverse Phakic IOLs—this gives great peace of mind. LASIK can’t offer this benefit because it permanently removes corneal tissue.

LASIK costs less and takes less time, but phakic IOL implantation gives you exceptional visual outcomes with fewer night vision issues. Clinical evidence shows that phakic IOLs provide better contrast sensitivity and optical performance, especially if you have extreme myopia. This is a big deal as it means that patient satisfaction rates reach over 90% in clinical trials.

You’ll need to consider your eye anatomy, prescription strength, and lifestyle needs to choose between these procedures. Many patients feel the higher cost of phakic IOLs is worth it because they get better visual outcomes and fewer complications. This becomes even more important when LASIK might not work well for their prescription range. Getting a full picture from qualified specialists is crucial before you commit to either procedure.

Your surgeon should pick the option that fits your unique circumstances instead of using a one-size-fits-all approach. Each person needs different vision correction—LASIK works great for mild to moderate corrections, while phakic IOLs are perfect for people with higher prescriptions who didn’t have many surgical options before.

We have a long way to go, but we can build on this progress in both procedures to improve outcomes and safety. Refractive surgery advances faster now, which makes specialized procedures like phakic IOL implantation more available as alternatives to glasses or contacts. Your experience toward glasses-free vision begins when you understand these options and find the right surgical approach for your eyes.

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