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Implantable contact lenses: Hope for extreme myopia

WebMD Feature
Medically Reviewed by Dr Rob Hicks

If you're extremely short-sighted you've probably dreamed of life without glasses or contact lenses. You watch through smudged lenses or cloudy contacts as your less visually challenged friends get LASIK surgery and throw away their spectacles. However, there's an alternative to LASIK; you may be a candidate for implantable contact lenses, also known as intraocular lenses (IOLs).

Implantable contact lenses have been available in Europe for more than a decade. They are used to treat conditions such as:

  • Short-sightedness or myopia (inability to see clearly at a distance)
  • Astigmatism (irregular curvature of the eye).

Types of IOL surgery

There are two main types of IOL surgery for short-sightedness:

  • Insertion of a phakic implant, where a contact lens is permanently inserted in your eye without removing your natural lens.
  • Replacement of your natural lens with an artificial lens, also known as clear lens extraction (CLE) or refractive lens extraction (RLE).

Candidates for IOLs

Phakic implants are used in people aged 25-45 for whom laser surgery is unsuitable, or who may not be able to wear glasses (eg because of the type of work they do, or because of a disability). It is the preferred treatment for younger people (those aged under 45) because their natural (unaided) reading vision is preserved.

Clear lens extraction, or refractive lens extraction, is generally more suitable for older people with a high degree of myopia (and also long-sightedness). This procedure is essentially the same as that used in cataract surgery.

Cost of IOLs

Expect to pay from £1,200 to £2,500 per eye for phakic implants to correct myopia or astigmatism. For CLE/RLE, you would typically pay £1,300 per eye.

Safety of IOLs

Implantable lenses are meant to be permanent. However, they can be removed if there is a problem. Made of materials similar or identical to those used successfully for 50 years in cataract lenses, there's little risk of the body rejecting them.

While these are safe procedures, as with all surgery there are risks involved, including infection, which could have a serious impact on eyesight. Guidelines from the National Institute of Health and Clinical Excellence (NICE) issued in February 2009 concluded that there is good evidence of short-term safety and effectiveness with phakic implants, but there is an increased risk of damage to the cataract, cornea or retina and there are no long-term data on the procedure.

For CLE/RLE, possible risks include oedema, damage to the cornea and retinal complications.

Questions to ask an ophthalmologist about IOLs

IOL surgery is performed by ophthalmologists trained in the procedure. All independent laser eye surgery providers operating in England should be registered with the Healthcare Commission. It is illegal for surgeons to operate without approval from the Commission. To check whether your laser surgeon is regulated and approved, ask to see their Healthcare Commission certificate, which lists the services they are licensed to provide.

It’s important that you talk to your doctor about the procedures and the risks involved. Questions to ask also include:

  • How many procedures have you performed?
  • What problems have occurred?
  • Are there patients I can talk to?
  • What will happen if I'm still short-sighted or become long-sighted after surgery?
  • What is the plan for addressing my astigmatism?
  • If I need further treatment to correct my short-sightedness or astigmatism, is that included in the cost?

Improvements in vision are usually apparent immediately after the surgery.

Reviewed on March 01, 2010

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