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Visian ICL successful in surgeon with high myopia
Michael Greenwood, MD, explains why he chose an ICL after delaying refractive surgery for years.
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Michael Greenwood was a very high myope; before his procedure his prescription was out of range for both LASIK and PRK at –13.5 D. Of two choices, Michael selected an ICL, specifically the Visian ICL, because of his increasing intolerance to contact lenses. Although his 1.5 D of cylinder was not corrected, he was still able to obtain better than 20/20 uncorrected vision, better than his preop best corrected visual acuity, partially as a result of excellent surgery and power calculation and partially by eliminating preop minification. We have a powerful arsenal of refractive procedures that can eliminate almost all refractive errors, which will speed our goal of eliminating refractive errors globally in the not too distant future.
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I started wearing glasses in first grade, and the prescription only got stronger as time went on, so I had long desired refractive surgery to become less dependent on my contacts and glasses. However, given the fact that I was highly myopic, LASIK and PRK were not my best options.
When I was in medical school, my optometrist introduced me to phakic IOLs, and I wanted to have them as an option but could never find time to make it work with my busy schedule as I was going through medical school and residency. When I had the opportunity to have it done, to me it was a no-brainer because I knew it would immediately impact my vision and my quality of life, but I did not realize how much of an impact it would have.
My preop refraction was around –13.50 –1.50 × 180 in both eyes. My best corrected vision was somewhere around 20/20– to 20/25+. The reason why I did not think I could ever get to 20/20 crisply was the minification given such a strong refractive error. The procedure I decided to have was Visian ICL (STAAR Surgical). As I mentioned, I was not a candidate for LASIK or PRK due to high refractive error, and so my options were limited to implantable contact lenses or refractive lens exchange. I decided to go for the Visian over other phakic IOLs because I knew this would be a small incision and would also allow for easier removal when the time came for cataract surgery. I had also been told that patients are able to tolerate some minor amounts of astigmatism. Having a larger incision may allow for correction of this, but I knew that I could always have LASIK for any residual refractive error, if needed.
Before refractive surgery I wore soft contact lenses and then hybrid SynergEyes contact lenses and finally mini-scleral hard contact lenses, with which I enjoyed my vision; however, it was difficult to wear them for many hours and I was often wearing them up to 15 hours a day. It was also a pain when it came to traveling, attending conferences, and participating in water sports or any outdoor activity. I was always worried about them getting dirty or lost.
My surgical experience was relatively good. I had no IV sedation, but instead chose to use the MKO Melt from Imprimis. This is something that I have used with many of my patients for intraocular surgery, so I was comfortable having it used on myself. I do not remember much from my surgery other than the scrub tech saying “perfect fold” when the lens unfolded inside my eye. From the perspective of a patient, I understood how anxiety provoking having surgery done could be; however, I was assured by the excellent hands of my surgeon. It was also interesting to be on the other side of the microscope and going through the workup process and the recovery process, hoping that everything was going to be OK. This has since helped me with discussing surgeries with my patients and knowing that although we do surgery day-in and day-out, this is their vision and their eyes and they want everything to go perfectly. This has allowed for a better understanding between myself and patients when discussing various procedures.
My postop refractive outcome was excellent, and although I still have a little bit of cylinder, I am able to see 20/20, which is better than my preop corrected vision. I could have this little bit of astigmatism fine-tuned with LASIK and get to the 20/15 range; however, I am very satisfied with my vision and at this time sitting tight. My outcome was almost immediate, and it truly has been a life-changer. The ability to wake up in the morning and get moving without having to find my glasses or worry about putting in my contacts, or even having the discomfort of having the lenses in my eye in the morning, at nighttime or anywhere in between, has really allowed for freedom that I never understood or expected. When patients undergo refractive surgery, I tell them that there is a burden that will be lifted that they did not know they were carrying, as I truly believe in this.
I would highly recommend refractive surgery to others, and I would recommend this procedure to those who are good candidates for it. If I had to do it all over again, I certainly would, but I would have done it much sooner and made it a higher priority.
- For more information:
- Michael Greenwood, MD, can be reached at Vance Thompson Vision, 3101 W. 57th St., Sioux Falls, SD 57108; email: michael.greenwood@vancethompsonvision.com.
Disclosure: Greenwood reports he is a consultant for Imprimis.