Physician shares his personal experience with Intacs implantation

Postoperatively, UCVA is 20/20 in both eyes with 0.25 D of sphere and 0.25 D of cylinder at approximately the same axis as preoperatively.

Issue: December 1, 1999

ByWilliam L. Soscia, MD

As a resident in ophthalmology with both a great personal and professional interest in refractive surgery, the idea of using PMMA intrastromal corneal ring segments intrigued me when I first read about them 3 years ago. As a graduate of West Point and a veteran of the Persian Gulf War, I am by necessity a student of military history. Reading about these PMMA intrastromal corneal ring segments re minded me of the story of how Harold Ridley chose the material for the first IOL. He decided to use PMMA after he realized that this airplane canopy material remained inert in the corneas of World War II pilots of the Royal Airforce. If refractive surgery, instead of cataract surgery, was on the mind of Dr. Ridley, perhaps Intacs (KeraVision, Fremont, Calif.) would have been developed and approved for use decades ago.

As an ophthalmology resident who became progressively myopic in my late 20s, glasses initially were foreign to me. After awhile, I gradually became used to them for indoor activities. Having always led a very active lifestyle outside of work, I ventured into the world of contact lenses for my physical and outdoor activities, which include mountain biking, running, weightlifting and skiing. Despite not having the time to perform these activities as much as I would like, I found glasses and contact lenses to be incompatible with my performance. After 4 years of trials with at least two dozen types and sizes of contact lenses, I made the decision to have refractive surgery performed.

I feel compelled to briefly review my own reasons for having refractive surgery because many non-emmetropic ophthalmologists are often asked why they have not had a refractive procedure performed on themselves, particularly when they are performing these operations on others. Human nature dictates that it is tougher to market a refractive surgery practice if the surgeon wears Coke bottle glasses. However, no patient, even an ophthalmologist, should have refractive surgery unless they strongly desire it for their own personal reasons and they have an understanding of its limitations. Initially, I was very skeptical about having someone operate on my eyes, knowing that my profession requires excellent vision and stereopsis. When I finally came to the conclusion that glasses and contact lenses clearly interfered with my quality of life, I aggressively researched the various options available to me.

Options explored

--- The Intacs intrastromal ring segments in the eye of Dr. Soscia.

Of the available refractive surgery procedures available to me, I narrowed it down to laser in situ keratomileusis (LASIK) or Intacs. I based this decision on uncorrected visual acuity (UCVA), predictability of refractive effect and maintenance of best spectacle corrected visual acuity. My decision to have Intacs over LASIK was based on the following two advantages: the Intacs procedure does not involve ablating the central visual axis; and Intacs are removable and initial data indicates that the refractive effect is reversible. The latter reason leaves open the option for monovision once I become presbyopic. Also, LASIK technology continues to improve at an astronomical pace with options such as customized ablations being available in the near future. With the potential reversibility of Intacs, this also would be an option for me if necessary.

Outcomes

So, what is the bottom line? On June 4, I had the Intacs procedure performed by Maureen Lundergan, MD, associate professor of ophthalmology at the University of Utah. Preoperatively, my refraction was –3.00 + 0.50 x 070 in the right eye and –2.75 + 0.25 x 103 in the left eye. Postoperatively, I am extremely happy with my UCVA of 20/20 in both eyes with 0.25 D of sphere and 0.25 D of cylinder in both eyes at approximately the same axis as preoperatively. For me, the procedure was painless, and I had almost 20/30 vision 5 minutes after the procedure. Some patients have reported fluctuating vision, dry eyes and glare or halos. Of these, the only side effect I had was dry eyes, which lasted approximately 3 weeks.

In conclusion, the Intacs procedure was an excellent decision for me. I have put them to the test at an 11,000-ft elevation with my mountain bike, in the weight room and on the track. They have clearly outperformed the rest of my body. I believe that Intacs are an outstanding option that has been added to the armamentarium of the refractive surgeon. Presently, they have Food and Drug Administration approval only up to –3 D of sphere and less than +1 of cylinder. Trials are currently under way for higher levels of myopia and astigmatism, as well as hyperopic segments. Based on the current research, as well as my own personal experience, I believe Intacs will have a strong future in refractive surgery.

For Your Information:

William L. Soscia, MD, can be reached at Moran Eye Center, University of Utah, 3044 E. Brighton Court, Salt Lake City, UT 84121; e-mail: W.L.Soscia@m.cc.utah.edu. Dr. Soscia has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.

For more information on the Intacs intrastromal corneal ring segments, contact KeraVision Inc., 48630 Milmont Drive, Fremont, CA 94538-7353; (510) 353-3000; fax: (510) 353-3030.