lens implantation a Refractive solution for cases that cannot get LASIK

Phakic intraocular lens implantation a Refractive solution for cases that cannot get LASIK

Implanting lenses inside the eye on top of the natural crystalline lens is a safe solution for patients whose eye condition, error measurements,  or corneal imaging preclude them from getting LASIK. These highly specialized lenses correct all errors of refraction (Myopia,  hyperopia, and astigmatism).

Popular mistakes and erroneous beliefs about phakic IOL implantation surgery:

  • The word implantation implies to many that the it is a complicated and lengthy procedure
  • The popular belief that placing this IOL in the eye will prevent the person from praying or practicing sports  
  • The belief that the body will “reject” the IOL

How is the surgery performed?

A simple painless procedure when done  with a skilled doctor and with the proper choice of patients. 

A very small opening is done at the corneal edge measuring 2 mm, through which the surgeon inserts the folded and flexible  IOL. 

The doctor then accurately places the IOL by injecting it  in the correct position either in front of or behind the iris (the colored part of the eye). 

The incision does not require stitches due to its small size.

So, who are the most suitable candidates for this type of refractive surgery?

  1. Patient with thin corneas which cannot perform LASIK, this is because they carry the risk of corneal bulges and deformity if LASIK is done, and these complications severely affect vision and require more complicated and expensive surgeries to correct them. 
  2. Nearsighted persons (Myopes)  with more than -8 D, which cannot undergo LASIK due to their high error measurements because this again would lead to corneal thinning and bulging.
  3. Farsighted persons (hyperopes) with more than +5 D error, unsuitable for LASIK.
  4. Patients seeking LASIK and have cataracts. The cataracts are removed with state-of-the-art technology and the IOL is implanted, relieving them of their symptoms.
  5. After corneal transplant, and stitch removal, and ensuring correct measurements are done, IOLs are implanted for fear of LASIK complications of the transplanted cornea
  6. Keratoconus patients, after corneal strengthening procedure (cross linking) and follow up of error stability.

What are these intraocular lenses made of ?

They are made of an inert flexible  (foldable ) transparent material. Many shapes and designs  have been developed to suit each eye separately depending on the aim of the surgery. Each IOL is composed of two main part

  1.   Central “optical “ zone that acts as the main refractive power of the lens or the lenses in the glasses
  2. Two fixating arms (like the arms of the glasses) to keep it in place.

IOLs can be divided into two main types :

  1. IOL implantation under the age of 40 years :


    Phakic IOLs,  the aim of this surgery is to maintain the eye’s  natural lens (must be clear) which allows us to see near objects through a reflex called accommodation. It may be placed in front of the iris or behind it, and it is easily removed if any problem should occur.  

  2. IOL implantation above the age of 40 years and in eyes with cataract :


    at this age another issue arises which is loss of clear near vision (presbyopia), which requires the patient to used reading glasses, therefore the patient needs two glasses , one for near work, and another for distant vision. In addition, cataracts or opacities that develop in the natural lens with age require removal of the cataractous lens and implanting a clear IOL. There are various types of options available:

  • Monofocal lenses: these correct the distance vision only and glasses will be needed for near vision, and do not correct astigmatism.  
  • Toric IOL: these correct astigmatisms.
  • Multifocal IOLs: these correct distances, intermediate, and near vision, but do not correct astigmatism.
  • Trifocal IOLs: these IOLs correct distance, intermediate, and near vision, and astigmatism. These are individually crafted for each patient and take about 4-6 weeks to make . 

Are there colored lenses that can be implanted in the eye to change the eye color?

We get asked this question quite often, that’s why a clarification is due. The aim of IOL implantation is to correct vision and rid the patient of the glasses or contact lenses . 

they are transparent only and cannot be seen with the naked eye because of their small size and extreme thinness. 

In addition, surgeries that attempt to change the eye color have not been approved by FDA because of the major complications and detrimental effects on the eye. 

What are the investigations required before an IOL implantation?

  1. Corneal topography and thickness map to exclude keratoconus.
  2. Biometry to make sure there are lens measurements for the future.
  3. Measuring intraocular pressure
  4. Checking the retina (fundus examination)
  5. Measuring the patient’s vision

How long does it take to recover after the surgery?

Depending on the skill and experience of the eye doctor (ophthalmologist) the vision should improve next day after the surgery, and each eye is done on a separate session. Complete recovery takes about one month. 

What are the recommendations after the surgery?

  1. Instilling the prescribed eyedrops regularly as explained by your doctor
  2. Avoid scratching the eye for a week after the surgery
  3. Avoid getting water into the eye for the first week 

What  is the price difference between LASIK and IOL implantation?

In some cases , especially if the patient has high errors and a thin cornea, and the doctor recommends IOL implantation, the patient does not go through with it despite its safety , because of the high cost of the surgery  which is in fact the cost of the IOL as compared to the LASIK technology. 

In these cases the patient is advised to keep their glasses or contact lenses,  and not to go after the LASIK offers or cheaper substitutes which will eventually harm the eyes and cause grave complications that will permanently affect the vision and cost much more to reverse.

عن الطبيب

أستاذ طب و جراحة العيون م. طب عين شمس أستشاري جراحات تصحيح عيوب الابصار و المياه البيضاء و القرنية عضو الجمعية الامريكية لعلاج العيون و تصحيح العيون بالليزر زميل المجلس العالمي لجراحة و طب العيون زميل الكلية الملكية لطب و جراحات العيون بأنجلترا

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About the doctor

A consultant specializing in corneal, cataract and Glaucoma Surgery and Refractive surgery in Egypt, Assistant Professor of Ophthalmology – Ain Shams University, Consultant cornea, cataract, and Glaucoma Surgery and Refractive Surgery, Fellow of the Royal College of Physicians and Surgeons of Glasgow, UK.

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