Refractive Solutions: Understanding the Differences between LASIK and ICLs
LASIK, ICL, IOL, PRK, LASEK … These days the choices for vision correction can look more like an eye chart and less like solutions for nearsightedness, farsightedness, and astigmatism. At a time when there are so many variations on refractive eye surgery, it can be difficult to find the one that's right for you.
If you are confused about which procedure may be most beneficial to you, the best place to start may be to consider the differences between two of the most popular methods of correcting refractive errors: LASIK and phakic IOLs (often referred to as implantable contact lenses or ICLs).
LASIK – Should You or Shouldn't You?
Laser-Assisted in Situ Keratomileusis, usually referred to as LASIK, has emerged as the best-known and most commonly performed treatment for refractive errors. In LASIK, a laser is used to reshape the cornea, thereby correcting varying degrees of nearsightedness, farsightedness, and astigmatism. As with any procedure, there are positives and negatives to this type of vision correction.
There are several variations on the LASIK procedure, including custom wavefront LASIK, IntraLase® LASIK, Epi-LASIK, and others. To determine which, if any, of these are best for you, speak with your doctor.
What People Like about LASIK
The vast majority of patients who have undergone LASIK achieved at least 20/40 vision while more than half regained 20/20 vision. Results such as these, along with the fact that many patients have been able to achieve complete freedom from corrective eyewear, have made LASIK a popular vision correction solution.
In addition, many people choose LASIK because, in most cases, the procedure itself is quick (usually less than 15 minutes) and relatively painless. Also, improvement in vision is usually noticed within a day or two and continues as the eye heals over the next six months.
Some Issues with LASIK
Although LASIK is a generally safe and effective option for most people with refractive errors, it is not right for everyone. Some people are simply not good candidates for the procedure; others are apprehensive about the possible outcomes associated with the procedure.
LASIK surgery is not recommended for patients who:
- have thin corneas
- suffer from severely dry eyes
- have any of several existing eye diseases/disorders
- have had changes in their prescription within the last year
- are under 19 years of age (although patients 21 years old or older are preferred)
- are pregnant
Some people do not choose LASIK because they are concerned about risk factors and possible results of the surgery. One of the biggest issues is the fact that LASIK surgery permanently alters the eye. If a patient is not satisfied with the results, the procedure cannot be reversed.
In general, LASIK patients with extreme degrees of myopia (nearsightedness) and/or astigmatism do not achieve the same level of corrected vision as patients with moderate or mild degrees of these refractive errors. Because they may still need to rely on glasses or contacts after the surgery, patients with high degrees of nearsightedness may decide against LASIK.
ICLs – Are They Right for You?
Currently, there are two FDA-approved phakic intraocular lenses (often called implantable contact lenses) available in the United States: the Visian ICL™ (Implantable Collamer® Lens) and the Verisyse™ phakic IOL. Although they involve different implantation techniques, both ICLs work in conjunction with the eye's natural lens to restore clarity of vision.
What Makes ICLs So Great
One of the primary benefits of implantable contact lenses is that they can be used to treat nearsighted patients who may not qualify for LASIK due to having dry eyes or thin corneas. Patients with high levels of myopia are also better candidates for ICLs than for LASIK since LASIK cannot adequately correct severe myopia.
Although there are differences between the Visian ICL™ and the Verisyse™ phakic IOL, both offer higher clarity of vision than LASIK. Additionally, patients achieve the optimal results of ICL implantation immediately, unlike the gradual improvement after LASIK surgery.
Another compelling reason for choosing ICLs over LASIK is that ICLs can be removed if the patient is not satisfied with the results or if the prescription strength of ICL is not correct.
Why ICLs May Not Be the Right Choice
Currently both ICLs are only approved to treat myopia (nearsightedness). Because of this, patients with hyperopia (farsightedness) or myopia with a moderate to severe level of astigmatism may not be good candidates for the implantable contact lenses.
Implantation of phakic IOLs is not recommended for patients who:
- are under 21 years old or are over 45 years old
- do not have the proper anterior chamber depth (will be determined during exam)
- are pregnant or nursing
- have had a recent change (within the last year) to their corrective lens prescription
Although it should not be the main factor, cost will most likely play some part in the process of deciding between LASIK and ICLs. It is important to realize that the prices of both options can vary widely according to geographic location, equipment used, the experience of the surgeon, and many other factors. Because of this, patients are encouraged to "shop around" but not to select a surgeon by price alone. Your vision isn't something that you should necessarily trust to the lowest bidder.
LASIK procedures typically cost between $1,000 and $5,000, with an average price of $2,000. These prices may or may not include additional fees and supplies needed, so be sure to ask your eye surgeon what is covered in a quoted price.
The cost for implantation of the Visian ICL™ or the Verisyse™ phakic IOL can range from about $1,500 to almost $5,000. The typical ICL implantation cost is about $3,500. In most cases, this price includes the cost of the actual lens and fees for the surgeon and the facility. As with LASIK, it is important to request a breakdown of the total cost for the procedure.
LASIK and ICLs – A Final Look
Implantable contact lenses and LASIK surgery both offer the promise of freedom from glasses and contacts. In most cases, both treatments deliver on that promise.
When deciding between LASIK surgery and ICL implantation, it is important to remember that, as with all surgical procedures, they both have risks associated with them. Some shared risks include overcorrection, undercorrection, infection, and the possibility of some level of refractive error will remain.
As part of your decision making process, it is important to discuss both options in detail, preferably with more than one surgeon. Be sure to ask any questions you may have about the surgical procedures, the results, and the risks associated with LASIK surgery and ICL implantation. After all, your vision is not something to take lightly.
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