Alternatives to ICL

[two-columns][The risks and benefits of ICL implantation must be set against those for alternative techniques, contact lenses and glasses.

Glasses are risk-free, but the ‘bottle bottom’ lenses required to correct high myopia (short sight) and the thick magnifying lenses to correct high hypermetropia (long sight), can be visually unappealing and also have inherent optical limitations, including reduced visual field, edge distortions, and altered image size.

Contact lenses produce excellent visual correction for most patients, but may be uncomfortable and inconvenient, and long-term usage can be associated with an increased risk of sight threatening infection. Whilst the risk is low, contact lens wearers should bear it in mind when considering implant-based refractive surgical techniques such as ICL implantation.

Alternative surgical techniques for the correction of high myopia include refractive lens exchange (RLE) and anterior chamber phakic lens implantation (ACL)

RLE is exactly the same as cataract surgery. As the name suggests, however, the operation involves the removal of a clear natural lens rather than a cataract. An artificial lens is implanted to correct vision. Loss of the natural lens means loss of the ability to read without glasses (accommodation).

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Accommodation and lens clarity both decline with age in any case, so RLE is often preferred for patients over 50. For younger patients, ICL or ACL implantation are normally preferred, since both techniques preserve natural accommodation and are less likely than RLE to lead to retinal detachment.

][Newer ACLs are flexible and can be folded for implantation through a small incision, as with ICLs. However, the incision is generally slightly larger, and the implantation procedure is more difficult to perform reliably.

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Pupil distortion occurs in around 7% of cases and this may cause ghosting or diplopia (double vision). ACLs are also associated with an increased risk of long-term inflammation and damage to the delicate cell layer lining the back of the cornea (the corneal endothelium), which is vital to corneal clarity.

ACLs do not contact the natural lens and were thought to be less likely than ICLs to cause cataracts, but recent data suggests that ACLs may also affect lens clarity.

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