Implanted lens

[mattcox]

I am 39 and have KC in both eyes. I wear a SoClear lens in my left eye which gives me good vision. I had a corneal graft to my right eye 12 years ago which has left me with very poor vision in this eye and I am unable to tolerate any sort of lens in this eye (despite a fantastic contact lens department who have tried everything). I have also had laser and other surgery to the graft to try and improve my vision with little effect.

My consultant is now suggesting an implanted lens to try and improve my vision. Does anyone have any experience of this or know what the procedure is likely to be? I have a follow up appointment to find out more but would like to do some more research first.

I am very reliant on my right eye and on days where I can't wear my lens I struggle to function / work etc so I am desperate for anything that will give me some useful sight in my left eye. My only other option appears to be a repeat graft, which I assume is a last resort.

[Anne Klepacz]

Hi Matt,

Below is a transcript of part of a talk we had from an ophthalmologist at our 2009 conference in Glasgow, who among other things, talked about intraocular lenses. This is now 5 years ago, so I imagine the technology has improved even more since then. The specialist talked about these lenses being used for stable KC, but of course a grafted eye would also fall into that category. Hope this helps.
Anne

Intraocular lenses

Intraocular lenses for KC are an exciting new field as more and more new toric lenses are becoming available. Broadly they can be classed as phakic intraocular lenses, meaning you put in a new lens in addition to the old lens inside the eye, or you can remove the natural lens inside the eye and replace it with a special toric lens which can correct the astigmatism and myopia of KC. These lenses would be suitable for patients who have stable KC. If someone is progressing you cannot use this because it would be like shooting at a moving target. So the KC has to be stable and there should be documented evidence that it hasn’t progressed. But if someone who is stable becomes intolerant to contact lenses then this is a possible option. One treatment doesn’t fit all – it’s a question of trying to find out which stage of KC someone is at, what has happened and how stable it is and then we can consider options.

Phakic intraocular lenses are additional artificial lenses paced inside the eye. They can either be placed in front of the iris (these are called anterior chamber lenses) or they can be placed behind the iris, just in front of the natural lens (posterior chamber lenses). There are two types of anterior chamber lenses; the Artisan was the first one to come out, while the Artiflex is a foldable version of the lens, which goes through a smaller incision and is made of silicon. There is a risk of developing glaucoma because of the lens so we need to create small openings in the iris called iridotomy. This is done by laser before the lens is fitted so that we have additional channels for the fluid to circulate inside the eye. The lens has little hooks at the side and it just gets attached to the iris tissue. The procedure takes 15-20 minutes under a local anaesthetic. It was developed by a Dutch ophthalmologist back in the 70s so we now have 15-20 years of data on the use of the lens. The advantage of the new version of the lens is that it comes with a toric option so not only corrects short sightedness but the astigmatism as well.

The other lens which I have recent experience of is the posterior lens, which is called the implantable colymer lens (ICL). Some people call it the implantable contact lens. All these lenses are custom made and this lens is made by a company based in Switzerland. You take all the measurements from the patient, fax them over and they make the lens, which takes 6-8 weeks. The colymer is a special kind of collagen polymer which is 100% pure and bio compatible, very similar to the natural lens inside the eye. The ICL comes in a toric version as well and I have used it for stable KC patients. This lens sits behind the iris just in front of the natural lens. Since it is made of a polymer material it is foldable and goes through a very small incision 2.75mm in size. We have used this for around 14 patients with stable KC which hadn’t progressed. They were all contact lens intolerant. We presented the results at a conference in the States. The mean vision improved post operatively from 20/400 to 20/30.

The next option would be a psuedopathic intraocular lens where we remove the natural lens and replace it with an artificial lens. And again there are now toric lenses available which not only correct the short sightedness but also the astigmatism. If KC patients develop cataracts, it gives us a great opportunity to correct the refractive error by using a custom made toric lens. There are several companies making these lenses. A company in Sussex can custom make toric lenses to correct up to 9 dioptres of astigmatism. The cataract operation is standard, only the replacement lens is specific.
So all these lenses can be useful for people with stable KC that is not progressing

[mattcox]

Thanks for that Anne, I really appreciate you taking time to post that information for me.

[pbsiakht]

hi there

I have intacs in left eye. Can I still have an ICL inserted? Do you still have to wear contact lenses?

[Kerry Mc]

This has been suggested to me, following my graft, during which my eye had a blood clot, so a stroke, I have no functional vision but I am told this is because my natural lens has moved. The eye appears healthy so once my grafted cornea settles, the plan is to replace by lens with an artificial one.

[Kerry Mc]

Sorry posted twice by accident, tried to delete

[Anne Klepacz]

I hope that works well for you, Kerry.
Pbsiakht, I don't know whether having an Intac would make any difference. But it also depends on whether your KC is stable. If it's still progressing, then an implanted lens wouldn't really work. As for whether a contact lens would still be needed, I guess that's very individual and depends on what prescription is possible on the implanted lens.