Phakic IOLs: aiming for a place in the heart of surgeons

Could phakic IOLs some day emerge as the dominant refractive surgical approach, particularly considering the past problems with early innovations? This is a difficult question to answer but one that has been debated over recent years.

Although Europe has earned a reputation as being the centre for worldwide phakic IOL innovation and clinical experience, the widespread acceptance of these lenses has still been slower than expected, with phakic IOL implantations accounting for only a tiny percentage of overall refractive surgery procedures.

Make no mistake, there are many advocates of phakic IOLs and, in some practices across our continent, the avoidance of corneal surgery and the inherent risks associated with corneal procedures, has made phakic IOLs emerge as the treatment of choice. Indeed, in most studies that compare phakic IOLs with LASIK for the treatment of high myopia, results show that phakic IOLs produce better quality of vision than LASIK.

One other explanation, therefore, could be that IOL implantation requires elective intraocular surgery, in contrast to LASIK, which is an in-office procedure. Naturally, intraocular surgery performed in an operating room becomes a big barrier for adoption of a technology, particularly when there is an alternative for most patients. It is also true to say that patients certainly are more attuned to LASIK surgery owing largely to the broad public press coverage that it receives. Because the press tends to trivialize LASIK, most patients believe it is less invasive and much less dangerous than implanting a lens in the eye. Consequently, it is viewed by many as an acceptable approach to ametropia correction.

Furthermore, although the more modern designs seem to have a favourable safety record, follow-up and long-term success remains to be defined for some.

Notwithstanding these reasons, many do predict phakic IOL use will continue to show steady growth, primarily in younger to middle-aged patients with high myopia who are high-risk candidates for clear lensectomy because of the risk of retinal detachment and who still have substantial capacity for accommodation.

Because fine-tuning of with corneal refractive procedures is often necessary after lens implantation, the surgeons adopting this technology are those who are comfortable performing both laser vision correction and intraocular surgery. As this group of surgeons grows, as we gather more safety and efficacy data and as research and development continues to spawn improved lens models, a natural growth in phakic IOL procedure volumes will follow.

In this section, we show you which phakic IOLs are currently available across Europe and we also ask the experts what they think of these lenses in practice.