Many options now available for vision correction –

so maybe you don’t need those glasses!

Phakic Intraocular Lenses provide an excellent option to improve your vision. Advancements in vision correction have provided patients with numerous options for improving their eyesight, particularly for those who are not suitable candidates for laser vision correction like LASIK, SMILE, or PRK. One such option is phakic intraocular lenses (Phakic IOLs), including ICLs (Implantable Collamer Lenses) and Artiflex lenses. These offer a low risk, effective, and reversible way to achieve clear vision without glasses.

This blog explores the details of phakic intraocular lenses, including ICLs and Artiflex lenses. We will discuss how these lenses work, who they benefit, the procedure for implantation, and what patients can expect.

Phakic intraocular lenses are specially designed lenses implanted into the eye to correct focus errors, such as myopia (near-sightedness), hyperopia (far-sightedness), and astigmatism. The term “phakic” refers to the fact that these lenses are placed inside the eye, without removing your eye’s natural lens. The artificial lens is positioned on top of your natural lens. This distinguishes phakic IOLs from the intraocular lenses used during cataract surgery or refractive lensectomy, where the natural lens of the eye is replaced with an artificial lens.

The two main types of phakic IOLs are:

ICLs (Implantable Collamer Lenses):

• Made of patented biocompatible material called Collamer, which is the combination of collagen with a polymer.

Artiflex Lenses (Foldable Phakic IOLs):

• Made of a foldable silicone material.
• Secured to the iris using a claw-like design, also called an iris-fixated lens.

Phakic IOLs work by adding an additional focusing lens inside the eye. Think of them like a contact lens that goes inside of your eye. Unlike glasses or contact lenses that sit outside of the eye, phakic IOLs provide more stable vision correction, and a much wider field of view in focus. The phakic IOL is implanted between the cornea (the clear window at the front of your eye) and the natural lens of your eye (which sits behind your pupil). Your surgeon will select the lens power that will focus the image correctly onto your retina, enabling you to see without glasses.

ICLs are implanted behind the iris and in front of the natural lens. They give excellent clarity of vision and have been implanted in millions of eyes worldwide.

Artiflex lenses are secured to the iris, offering stable vision correction. They are often used for patients who may not be suitable for ICLs due to anatomical considerations or personal preference. Although they are more difficult to implant than ICLs, Artiflex lenses typically give slightly clearer night vision and no glare.

Phakic IOLs are a great option for individuals who:

• Are between 21 and 50 years old.
• Have moderate to severe myopia, hyperopia, or astigmatism.
• Prefer a reversible procedure, as the lenses can be removed or replaced.

Phakic IOLs may not be suitable for patients who:

• Have pre-existing eye conditions like glaucoma, or cataracts.
• Are pregnant or breastfeeding.
• Have shallow anterior chambers (not enough space for lens placement).
• Have focus error that has significantly changed within the last 2 years.
• Have active eye infections or inflammation.

Phakic IOL implantation is a minimally invasive surgery performed in a Day Hospital. It typically takes 15 minutes per eye and is performed under sedation, to ensure comfort. Most patients have absolutely no recollection of the procedure. Here’s a detailed overview of the process:

1. Preoperative Evaluation

A comprehensive eye examination is performed to assess:

• Refractive error and the stability of your glasses prescription.
• Corneal thickness and curvature.
• Eye measurements (to ensure adequate space for the lens).
• Overall eye health.

2. Preoperative Preparation

• Patients are instructed to avoid wearing contact lenses for 1-4 weeks before surgery, to ensure that the focus error of the eye is measured correctly.

3. Surgical Procedure

• The eye is numbed with anaesthetic drops, and the patient is given intravenous sedation.
• A tiny incision is made in the cornea (approximately 3mm wide)
• The lens (ICL or Artiflex) is folded and inserted through the incision using a specialized injector.
• The lens unfolds inside the eye and is positioned either behind the iris (ICL) or is attached to the surface of the iris (Artiflex).
• The incision is self-sealing in most cases, requiring no stitches.

4. Postoperative Recovery

• Most patients experience markedly improved vision within 24 hours.
• Antibiotic and anti-inflammatory eye drops are prescribed to prevent infection and reduce inflammation.

Phakic IOLs offer several benefits compared to other vision correction methods:

1. High-Quality Vision

• Phakic IOLs provide excellent visual clarity and contrast sensitivity, often superior to that achieved with LASIK for high prescriptions.

2. Reversibility

• The procedure is reversible, as the lenses can be removed or replaced if needed.

3. Preservation of Corneal Strength

• Unlike LASIK, phakic IOLs do not involve reshaping the cornea with a laser, preserving its natural structure and strength.

4. Suitable for Complex Cases

• Phakic IOLs are ideal for patients with thin corneas, high focus errors, or other eye problems that make to laser eye surgery unsuitable.

5. No Exacerbation of Dry Eye 

• Unlike laser vision correction, phakic IOLs do not disturb the cornea, and therefore they do not have a risk of permanently increasing dry eye symptoms.

6. Remain Suitable for Premium Cataract Surgery in the Future

• Because phakic IOLs do not disturb the shape of your cornea, your eyes will still be suitable for premium cataract surgery lens implants in the future.

7. The Ability to Treat a Very Wide Range of Focus Errors

• Phakic IOLs come in a very wide range of powers, which enables this technology to treat much higher levels of near-sightedness and astigmatism than laser vision correction.

While phakic IOL implantation is considered to be safe and effective, it is not without some risks. Potential complications include:

• Increased Intraocular Pressure (IOP): May occur due to poor aqueous flow; usually managed with medication or laser iridotomy.
• Lens Dislocation: Rare but possible, requiring repositioning surgery.
• Corneal Endothelial Cell Loss: Long-term monitoring of your corneal health may be required.
• Infection or Inflammation: Prevented with proper surgical technique and postoperative care.

Cataract formation:  Very rare with the current model of ICL (V4c), and almost non-existent with Artiflex lenses.

1. Immediate Recovery

• Vision may be blurry on the day of surgery but improves rapidly within a day or two.
• Patients are advised to avoid touching or rubbing the eyes.

2. Long-Term Care

• You may require periodic follow-ups to monitor the position of the lens and overall eye health.

The decision to undergo phakic IOL implantation should be made in consultation with an experienced ophthalmologist (eye surgeon). Your surgeon will assess your unique needs, eye anatomy, to determine whether ICLs, Artiflex lenses, or another procedure is the best option for you.

Phakic intraocular lenses, including ICLs and Artiflex lenses, represent a groundbreaking solution for individuals seeking clear vision, a reversible procedure, and without the risks or limitations of corneal laser vision correction. These lenses provide excellent visual outcomes, and are suitable for a broad range of patients, including those with high focus errors.

If you’re considering phakic IOLs or want to explore your options for vision correction, schedule a consultation with me, Gold Coast ophthalmologist, Dr Nick Andrew. I am fortunate to be experienced in both ICL and Artiflex lens surgery and I can help you select the best treatment to transform your vision and improve your quality of life.