Phakic IOL Implantation: A Complete Guide

Introduction to Phakic IOL Implantation

Phakic Intraocular Lens (IOL) Implantation is a revolutionary vision correction procedure designed for people with high myopia (nearsightedness), hyperopia (farsightedness), or astigmatism who may not be suitable candidates for LASIK or PRK. Unlike traditional cataract surgery, this procedure preserves your natural lens while implanting a supplementary lens inside the eye to correct refractive errors.

The term "phakic" comes from the Greek word "phakos," meaning lens, indicating that your natural lens remains intact. This makes Phakic IOLs an excellent option for younger patients or those with thin corneas. The lenses are made of biocompatible materials (like Collamer or silicone) and are placed either in front of or behind the iris, depending on the type.

Many patients achieve 20/20 vision or better after the procedure, reducing or eliminating dependence on glasses or contact lenses. If you’ve been told you’re not a candidate for laser eye surgery, Phakic IOLs might be the perfect solution for you.

Who is a Candidate for Phakic IOL?

Phakic IOLs are ideal for individuals who:

Have high refractive errors (-8.0 to -20.0 diopters of myopia or +4.0 to +10.0 diopters of hyperopia).
Have thin corneas, making LASIK or PRK unsafe.
Are aged 21-45 (though older patients may qualify if they don’t have cataracts).
Have stable vision (no significant prescription changes in the past year).
Have healthy eyes (no glaucoma, severe dry eye, or retinal issues).

However, you may not be a candidate if you have:

History of eye infections or inflammation (uveitis, iritis).
Abnormally small anterior chamber depth (<2.8 mm).
Pregnancy or uncontrolled autoimmune diseases.

A comprehensive eye exam, including corneal topography and endothelial cell count, will determine your eligibility. Your surgeon will discuss alternatives like ICL (Implantable Collamer Lens) or refractive lens exchange (RLE) if Phakic IOL isn’t suitable.

Types of Phakic Intraocular Lenses

There are three main types of Phakic IOLs, categorized by their placement in the eye:

Anterior Chamber Angle-Supported IOLs – Placed in front of the iris and held in place by the angle where the cornea and iris meet. Example: Artisan/Verisyse lens (rigid PMMA material).
Anterior Chamber Iris-Fixated IOLs – Also positioned in front of the iris but clipped to the iris tissue for stability. Example: Artiflex lens (flexible silicone).
Posterior Chamber IOLs – Placed behind the iris and in front of the natural lens. Example: Visian ICL (Implantable Collamer Lens), the most popular due to its vaulted design and biocompatibility.

Each type has pros and cons. Posterior chamber lenses (like ICL) are often preferred because they reduce risks of corneal endothelial cell loss and glare. Your surgeon will recommend the best option based on your eye anatomy and refractive needs.

Procedure: Step-by-Step Breakdown

Phakic IOL implantation is an outpatient procedure taking about 15-30 minutes per eye. Here’s what to expect:

Pre-Operative Testing – Detailed measurements (corneal thickness, anterior chamber depth) ensure proper lens sizing.
Anesthesia – Numbing eye drops or mild sedation keeps you comfortable.
Incision – A tiny (2-3 mm) corneal incision is made for lens insertion.
Lens Placement – The folded IOL is inserted and positioned in front of or behind the iris.
Adjustment & Closure – The surgeon ensures proper alignment; stitches are rarely needed.

Most patients report minimal discomfort, though you may feel slight pressure. Vision improves within 24-48 hours, with full stabilization in a few weeks. Both eyes are usually treated on separate days to ensure safety.

Benefits of Phakic IOL Over Other Vision Corrections

Phakic IOLs offer unique advantages compared to LASIK, PRK, or RLE:

Reversible – The lens can be removed if needed (unlike corneal reshaping in LASIK).
Preserves Corneal Tissue – Ideal for thin corneas where LASIK isn’t an option.
Wider Correction Range – Treats extreme myopia/hyperopia beyond laser capabilities.
Quick Recovery – Most resume normal activities within a day.
UV Protection – Some lenses (like Visian ICL) include built-in UV filtering.

Unlike cataract surgery (RLE), Phakic IOLs retain your natural lens, preserving accommodation (near vision) in young patients. However, LASIK may still be preferable for mild to moderate corrections due to lower cost and invasiveness.

Risks and Possible Complications

While Phakic IOLs are safe for most, potential risks include:

Glare/Halos – Temporary night vision disturbances (usually resolves in weeks).
Cataract Formation – Rare, but posterior chamber lenses may increase risk over time.
Endothelial Cell Loss – The inner corneal layer may thin slightly (monitored via annual exams).
Infection/Inflammation – Extremely rare with proper post-op care.
IOL Misalignment – May require repositioning (1-2% of cases).

Choosing an experienced surgeon minimizes risks. Pre-operative screening ensures the anterior chamber depth and endothelial cell count are sufficient to support the lens long-term.

Recovery and Post-Procedure Care

Recovery is typically fast and comfortable with these guidelines:

First 24 Hours – Rest with protective shields; avoid rubbing eyes.
Medications – Antibiotic/anti-inflammatory drops for 1-2 weeks.
Activities – Avoid swimming, heavy lifting, or makeup for 1 week.
Follow-Up – Visits at 1 day, 1 week, and 1 month post-op.

Most patients achieve functional vision within a day, though fine-tuning may take weeks. Minor dryness or light sensitivity is normal. Contact your surgeon immediately if you experience severe pain or sudden vision loss.

Success Rates and Long-Term Results

Studies show 90-95% of patients achieve 20/40 vision or better (driving standard), with many reaching 20/20. The Visian ICL boasts a 99% patient satisfaction rate in clinical trials.

Long-term, Phakic IOLs:

Remain stable – No degradation over decades (unlike laser corrections that may regress).
Require monitoring – Annual eye exams track endothelial cell health.
Can be updated – Lenses may be replaced if your prescription changes significantly.

If cataracts develop later (due to aging), the Phakic IOL can be removed during standard cataract surgery.

Frequently Asked Questions (FAQs)

Q: Is Phakic IOL surgery painful?

A: No—numbing drops ensure a painless procedure. Mild irritation may occur post-op.

Q: How long do Phakic IOLs last?

A: They’re designed to be permanent but can be removed if necessary.

Q: Can I have MRI scans with a Phakic IOL?

A: Yes—modern lenses (like ICL) are MRI-compatible up to 3 Tesla.

Q: Are both eyes treated on the same day?

A: Usually no—surgeons often space procedures 1-2 weeks apart for safety.

Q: Will I still need reading glasses after Phakic IOL?

A: If you’re under 40, likely not. Presbyopia (age-related near vision loss) may still require readers later.

Phakic Intraocular Lens (IOL) Implantation: A Complete Guide