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Life Without Glasses

Dr. Robert Maloney believes that a well-informed patient is key to successful vision correction surgery. He wants to be sure that you fully understand what you can expect from your procedure you choose.

He wants to help you care for and preserve your eyesight in the best way possible. Here, you can find the information that you need to help you make informed choices about health care for your eyes.

Potential Complications with ICL Surgery

The ICL has some definite safety advantages over other procedures. It is removable, unlike other procedures. It doesn’t make the eyes drier. It usually offers better night vision than LASIK or PRK. It also offers sharper quality of vision than these two procedures. However, just as all surgical procedures carry risks, so does the ICL procedure. However, when ICL surgery is performed by an experienced surgeon, the risk of complications is quite low.

I’ve listed both the rare and serious complications and the less rare and mild ones. Although this list is not exhaustive, it includes the complications that you need to know about in order to be comfortable with proceeding with surgery.

Undercorrection

Undercorrection means that your nearsightedness wasn’t fully corrected by the ICL, so you are still a little bit nearsighted. A slight undercorrection will not seriously affect your vision and is often desirable in patients over forty to help with their reading vision. If the undercorrection is enough to cause significant blurring of vision, your surgeon will recommend an enhancement procedure for you.

Overcorrection

Overcorrection means that your nearsightedness was corrected more than intended, leaving you farsighted. Farsightedness can make it harder to see clearly up close. As with undercorrections, a significant overcorrection can be treated with an enhancement procedure.

The most common enhancement procedure done after ICL surgery is LASIK, and it is usually performed three months after the ICL procedure. LASIK can easily correct small amounts of residual nearsightedness, farsightedness, or astigmatism. If LASIK is a good enhancement procedure for patients after ICL surgery, you may wonder why the surgeon doesn’t do LASIK in the first place. The reason is that LASIK is good for small or moderate corrections, but not good for the high corrections where the ICL shines.

Presbyopia

Loss of close vision is a natural part of aging. As discussed earlier, we call this process presbyopia. Presbyopia occurs slightly sooner with the ICL. Normally, people with excellent vision get reading glasses at age forty-five. If you are corrected for excellent distance vision with the ICL, you will need probably need reading glasses at the age of forty-two or forty-three. This happens for optical reasons that are beyond the scope of this book. If you are over the age of forty, monovision with the ICL may be an excellent option for you.

Nighttime Halos and Starburst

As described earlier in this book, halos occur when you are in a dark environment and look at a small bright light, such as a headlight or a streetlight. Halo is the glow that surrounds the light. Starburst is little spiky rays of light that emanate from the light source. Everyone has some degree of halos and starburst at night, even if they haven’t had refractive surgery. Look carefully at a headlight or streetlight tonight so you understand what I’m talking about.

The ICL generally offers better night vision than LASIK. However, the ICL can still cause an increase in halos and starburst around lights at night. When the pupil dilates at night, it is larger than the diameter of the ICL. The light that enters the eye through the pupil outside the edge of the ICL will cause halos. These symptoms can be bothersome in dim-light conditions, such as driving at night. My personal experience is that patients like great vision much more than they are bothered by the halos. On the occasions that patients have mentioned that they have more halos after surgery, I have offered to remove the ICL to restore their night vision to its preoperative state. Not once in my career has a patient taken me up on the offer. What I hear instead is, “No way! I don’t want my vision to go back to the way it was.”

As described earlier, the peripheral iridotomy is a tiny hole that is made to allow fluid to flow from the back of the eye to the front of the eye. A small amount of light can pass through this hole and create starburst, particularly at night. For this reason the hole is intentionally made very small, to minimize the amount of light that enters, and is placed, if possible, under the upper eyelid, so that the eyelid blocks the entrance of light.

Increased Eye Pressure

A rare complication of the ICL is a sudden rise in eye pressure. This may happen in the first week after surgery when fluid can’t flow from the back of the eye to the front through the iridotomy. If this happens you will feel a strong aching pain in your eyeball or in the area around the eye. It feels like a sinus headache. You may also experience nausea. If you have an aching pain or nausea in the first week after surgery, it is important to contact your doctor, even if it is the middle of the night. The doctor will be able to relieve the pain very quickly. Don’t wait because it will just get worse.

A sudden rise in eye pressure can occur in two situations. The first situation is if the iridotomy is not big enough. Fluid can’t flow through it, and the pressure rises. This is easily treated by enlarging the iridotomy with the laser in the doctor’s office. The second situation is if the ICL is too big for your eye. The ICL comes in different sizes. We measure your eye carefully prior to surgery to determine the correct size, but it is not an exact science. On rare occasions the ICL is too big. In this case the overlarge ICL pushes on the peripheral iridotomy and closes it. This situation is treated by removing the ICL and replacing it with a smaller lens.

Cataract

Cataract is a haziness that develops in the natural crystalline lens of the eye. It is a natural part of aging, like gray hair. Everyone gets a cataract if they live long enough. Highly nearsighted people—those who are candidates for ICL surgery—often get cataracts in their sixties or seventies. Cataracts are easy to treat with cataract surgery. In this operation, the hazy natural lens is removed and replaced with a clear synthetic lens.

The ICL slightly increases your chance of getting a cataract earlier in life, but the chance is small. In the FDA study of the ICL, approximately 1 percent of eyes with the ICL needed cataract surgery each year. If you develop a cataract after your ICL surgery, the ICL is removed as the first step in the cataract surgery, and the new synthetic lens is chosen so your nearsightedness is still corrected after the cataract surgery.

Rare Complications

Infection inside the eye can occur after ICL surgery, but is extremely rare. It is a feared complication because an infection inside the eye can damage vital tissues. None of the 526 eyes that had surgery in the large FDA study of the ICL developed an eye infection. Careful surgeons use a technique that minimizes the risk of infection. This involves doing the ICL procedure under very sterile conditions, sterilizing the eye carefully before surgery, and using antibiotics in the eye at the end of surgery to prevent infection.

If your eye does become infected, it will likely occur during the first forty-eight to seventy-two hours after the ICL surgery. This is why it is important for the first week after surgery to avoid any contact with substances that carry bacteria, such as old eye makeup, hot tubs, and swimming pools. It is also essential to go to all of your follow-up visits, even if everything seems fine.

Any surgery can result in loss of vision. Fortunately, this is extremely rare with ICL. Our practice has never had a patient lose his or her vision from ICL surgery, and no patients in the large FDA study lost vision from the ICL.

Frequently Asked Questions about ICL Surgery »

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