Integrating phakic IOLs in a private practice

The implantation of IOLs in the eye has been part of cataract surgery practice for many years; however, it is only in more recent years that these implants have become available for refractive correction. To date, the resulting vision outcomes have been impressive. In fact, most refractive surgeons believe phakic IOLs will become the procedure of choice for certain forms of refractive correction. Because patients are wary of the perceived invasive nature of this procedure, however, phakic IOLs still have a long way to go in the race to gain patient popularity and trust.

The pioneers of intraocular implants, Barraquer, Strampelli, Dannheim and Choyce, conducted the first ever trials using anterior chamber refractive lenses to correct high myopia in the 1950s. Unfortunately, because of imperfections in IOL design, complications ensued and the development of phakic implants was abandoned. It was not until the 1980s that development of these lenses was resurrected.

Since then phakic IOLs have come a very long way and the concept of a phakic IOL is gaining popularity in the field of refractive surgery. The accuracy of refractive implants in restoring vision is now an acknowledged fact amongst surgeons and is regarded highly because the insertion procedure offers a method of correction that is removable, predictable, rapidly healing and does not permanently alter the shape or structures of the eye.

Mertens is an advocate of the phakic lenses and believes that more needs to be done to change perception, "IOL implantation for refractive correction is a very elegant, five-minute procedure. A refractive practice should offer not only laser surgery, customized laser treatments, conductive keratoplasty, refractive lens exchange, but also phakic IOLs."

The technique

The results so far

Of Mertens' ICL/TICL patients, 76% of eyes have achieved 20/20 uncorrected visual acuity (UCVA) within 24 hours of surgery. In his experience, two eyes have required laser treatment subsequent to the procedure and one TICL required realignment as a result of incorrect placement at the time of surgery.

Mertens has yet to observe lens opacities, possibly because of the use of methylcellulose behaving as a viscoelastic agent.

"Good candidates for phakic IOL implantation are patients with thin corneas, dry eyes, forme fruste keratoconus and all myopes >-8 diopters. The refractive surgeon should consider the use of these implants more seriously for the correction of refractive error. So far, the benefits of this procedure speak for themselves and it is up to us to educate our patients and address their concerns," concludes Mertens.

Erik L. Mertens, MD, FEBO is Director and Ophthalmic Surgeon at the Antwerp Eye Centre in Belgium. He is a consultant to STAAR Surgical. He can be reached by e-mail: