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The Surgery

Pre-operative testing

The best visual results from an ICL procedure require accurate measurements to determine the perfect size and power of lens implant. The FDA also has specific criteria that must be met to ensure good results from the procedure. To complete all of these tests more than one visit to the office may be required. Your optometrist may also help collect the required measurements for the procedure. The following tests are typically required

It is best that these measurements be done without a contact lens being worn for at least several weeks. Contact lenses worn for many years can actually change the shape of the cornea. If you wear contact lenses we recommend that you stay out of them for a few weeks and wear only glasses until the measurements can be completed. If it is very difficult to go without contact lenses, then the surgery can still be done, however, there is a slightly higher chance that the lens implanted will not be the right size and strength for your eye. Since you will have this lens for 30 years or more, it is probably worth a few weeks of inconvenience without your contacts to get the best eye measurements.

Choosing Bilateral Surgery

You have the choice to do both ICL implants on one day or separate the two surgeries into two different days. The safest option is to do the eyes on two different days. This allows Dr. DeBry the opportunity to assess the outcome of the first surgery before the second procedure. Based on the first procedure, small adjustments in lens size or power can be made prior to the second eye being done. However, many people have scheduling constraints with work or family responsibilities that make it difficult to take extra days off to do the surgeries on different days. If you choose to have the surgeries done on the same day we will have you sign an extra consent form acknowledging this choice. The risk of a severe bilateral problem such as an infection is very rare. Plan on your vision being blurry for the first day or two while the eye is healing from the procedure. We recommend you don’t plan any important meetings or travel for at least a few days after the procedure to allow your vision time to improve.

Where to have the surgery

An ICL implant can be done in our in-office surgery suite or in the operating room at an outpatient surgery center (ASC). An ICL surgery is similar to a trip to the dentist to have a cavity filled, it takes around 15 minutes and there is mild discomfort. Most patients can tolerate this just fine with a mild sedating pill (relaxing medication) and anesthetic eye drops. If you do not have a high level of anxiety we recommend the surgery be done in the office. This option will save you $1500 per eye compared to the ASC. If you have significant anxiety that might require an anesthesiologist and IV sedation, we are happy to arrange the procedure in the outpatient surgery center. The final results of the surgery will be the same at either location.

What is a peripheral iridotomy, and why is it required with the Visian ICL implant?

The Visian ICL implant is placed behind the iris, the colored portion of the eye. The eye is filled with fluid, and this fluid is continuously circulating within the eye. This fluid must move through the pupil, passing through the area that is now occupied by the lens implant. It is possible that the lens implant blocks the flow of fluid. The peripheral iridotomy creates a very small opening in the iris, allowing fluid to easily pass around the lens implant. This prevents a blockage in fluid flow, which could lead to dangerously high eye pressures. The iridotomy can be done before the surgery using a laser or during the surgery making small incisions. For most people, this small opening in the iris has no visual symptoms. A small percentage of people may notice a line of light or glare coming through the new iridotomy opening.

What to expect on the surgery day for in-office surgery

When you arrive at the office you will be given a sedating pill (relaxing medication) and several sets of eye drops that dilate the pupils. Once the dilation has set in, an anesthetic gel will be applied. This whole process takes around one hour. During this time we will also check your blood pressure and a quick urine pregnancy test if you are a female of childbearing potential. Once the pill has started to relax you and the eyes are dilated and anesthetized, you will be brought back to the surgery room. We have a very comfortable bed to lie on. A few monitors will be applied to help us monitor your pulse rate and blood pressure. The skin around the eye will be cleansed with an antiseptic (Povidone Iodine) and a thin drape applied over your face to keep the surgical area sterile. You don’t have to worry about blinking because a small wire is used to keep the eyelids open. During the procedure, you will be asked to stare straight ahead into the fairly bright microscope light. You will likely feel some burning and pressure for short times during the procedure, which takes around 10 minutes. After the procedure, your eye will be covered with a clear plastic shield.

If you have chosen to have bilateral surgery, the second eye treatment is done as a completely separate procedure. You will leave the operating room, the room will be wiped down, and all new sterile supplies opened. Once the equipment is set up and ready, you will go back into the OR and have the second eye done. Treating each eye as a completely separate procedure lowers the risk of a rare but severe event such as an infection affecting both of your eyes.

What is different with a procedure in the ASC?

For a procedure done in the ambulatory surgery center, there are a few minor differences. Because you will be getting a stronger sedating medication you will need to be fasting. This means no food or drink for at least 8 hours before your procedure. You will also need to have an IV placed in your arm to allow the anesthesiologist to give you the sedating medications in your vein. As mentioned previously, there is an extra cost for these services.
 






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