Jennifer was not sure if she was a candidate for Lasik because her prescription for nearsightedness was so strong. But when she learned she was eligible for the procedure, she trusted her eyes to Dr. Sandy T. Feldman. Jennifer feels strongly that undergoing Lasik impacts your life very little when it comes to time and money, but makes a huge impact with respect to the freedom that was hampered by wearing contact lenses and glasses.
Many people with moderate to severe nearsightedness have successfully corrected their vision with LASIK, a popular refractive surgery that uses a computer-controlled laser to reshape the cornea. But not everyone is a good candidate for LASIK, including patients with severe nearsightedness, very thin or irregularly shaped corneas, eye conditions such as keratoconus, or chronically dry eyes. For these patients, implantable lenses—phakic intraocular lenses—provide a life-changing alternative to glasses and contact lenses.
“Implantable lenses function like contact lenses, but they work from within the eye instead of sitting on the surface of the eye,” said Sandy T. Feldman, MD, a San Diego-based physician who is considered one of the top ophthalmologists in the country. “You can’t feel them at all, they are maintenance-free, and best of all, they can permanently correct nearsightedness.”
Dr. Feldman specializes in the use of the FDA-approved Visian Implantable Collamer Lens, which is made of a soft biocompatible material that can be folded and inserted through a small incision. The Visian ICL is implanted behind the iris, in front of the natural lens of the eye. This type of lens does not treat astigmatism and has been known to cause cataracts in a small percentage of people, although recent modifications have decreased the risk of cataracts. The lens is undetectable to the naked eye and can only be seen through a microscope.
Implantable lens surgery is an elective procedure that requires topical drops to numb the eye as well as IV sedation, and typically takes about 15 minutes. Instead of a blade, Dr. Feldman uses an innovative new technology—the femtosecond laser—that allows for a very small and precise incision. Patients can see out of the eye immediately and recovery time is virtually overnight.
“Implantable lenses are a good choice for people who are extremely nearsighted and might not get enough correction with a LASIK procedure,” said Dr. Feldman. “For people who have more moderate nearsightedness, the choice isn’t as clear. It’s important to ask your ophthalmologist to explain the benefits and risks of each surgery.”
Dr. Feldman suggests six key questions to determine if implantable lenses are right for you:
- Is your vision within the accepted range approved for this type of procedure?
- Have you had a comprehensive eye exam to determine that your eyes can safely accommodate implantable lenses?
- Are you between 21 and 40? If you’re outside this age range, you may still be a candidate for an implantable lens; consult your eye doctor.
- Has your eyeglass / contact lens prescription changed in the past year? For vision correction surgeries, you must have stable vision for at least one year.
- Conditions such as cataracts, glaucoma and untreated eye infections generally prevent you from having an implantable lens.
- Are you in good health? Certain conditions—such as Sjogren’s syndrome, rheumatoid arthritis, type 1 diabetes, HIV and AIDS—and certain medications, such as steroids and immunosuppressants, may interfere with healing and final outcomes.
“There are a lot of factors to consider, but the good news is that patients with this kind of implantable lens are usually very satisfied with the quality of their corrected vision,” said Dr. Feldman. “Being able to wake up in the morning and see clearly, without contacts or eyeglasses, can make a huge difference in a person’s quality of life.”
Image credit: afullmer via freeimages
If you have pre existing vision issues, choosing a qualified surgeon for cataract surgery is imperative. Read Spencer’s story in his own words:
By Spencer S. Busby, San Diego, CA
Dr. Sandy T. Feldman and her office really gave me my life back. She helped me fulfill a life-long dream to be able to see clearly without glasses. Having good vision, or any vision at all, is so important, and you tend to take it for granted until you lose, or almost lose it. And that is what happened to me.
In the early 1980’s, I was able to see 20/20 corrected with glasses. But uncorrected, I was about 20/200, with approximately six diopters of myopia/nearsightedness in both eyes. My eyes could not tolerate contact lenses, so I opted to have a 16 incision radial keratotomy (RK) in my right eye and a few years later, a radial keratomileusis in my left eye…..(neither of these eye surgeries were done by Dr. Feldman)…The right eye myopia improved about 50 percent, though I was still nearsighted and needed glasses. However, the left eye operation had complications, with the eye pressure rising to the point of damaging my optic nerve/retina, and forever clouding my central vision and limiting my left eye to hazy images. At the time, my surgeons were unsure of the cause, and followed up with numerous follow-up refractive surgeries to the cornea, including at least three cornea transplants, none of which provided much vision improvement. About five years ago, my left eye was blasted by a racquetball, requiring immediately stitching surgery to save the eye, after the cornea transplant dislodged and the eye opened and pressure dropped. And on top of everything else, the left eye was developing a cataract, further depleting any residual vision.
So I learned to function well with my right eye mono-vision, doing all the things I needed to do—read and work as an attorney, play racquetball, drive, etc. But then my right eye developed a cataract, ultimately dropping my vision to 20/50 corrected with glasses, with the typical cataract vision issues of night glare, starbursts, color dullness, and hazy vision day and night. It was getting dangerous even trying to drive, having a few fender bender accidents and a few near serious accidents….As Dr. Feldman said, it was getting to the point that I had to risk cataract surgery in my only good eye, because I really had no choice but to do it or gradually become more blind. We waited for a year, getting several new prescriptions and glasses to the point where my “good” eye required 10 diopters of correction, and even then, only corrected to 20/50, at which point we elected to proceed with the cataract surgery.
Comparing Dr. Feldman to the many other eye surgeons I have seen all over the world, I would put her in the conservative category. She has plenty of work, such that unless she really believes surgery is warranted, she won’t do it. I personally know of some friends whom she has rejected for LASIK surgery for various reasons, such as corneas which are too thin. And unlike some other surgeons, she never recommended risking additional cornea refractive surgery to my eyes.
To my relief, I elected to have Dr. Feldman perform cataract surgeries (three weeks apart) to both of my eyes. Going into cataract surgery, I was quite nervous, knowing how much was riding on it, given that I could really only rely on my right eye vision to see. I had previous refractive surgeries and cornea transplants, many of which were quite painful. Additionally, my right eye had the risk of complications, given that Dr. Feldman would have to navigate around a 16 incision RK to extract the cloudy natural lens and to implant the replacement lens, but knowing of her extensive refractive experience, I knew she was the one who could respond to any complication, and that experience was called upon when several of my RK incisions opened during the cataract lens implantation and required four sutures. Dr. Feldman immediately implanted three sutures, kept monitoring the eye, and even had me return the next day (on her day off) to add a fourth suture. In terms of pain, there really was none, as the topical anesthesia and IV was sufficient. Interestingly, I had two different anesthesiologists for each cataract surgery….The first one knocked me out and I didn’t remember a thing, whereas the second kept me awake (which Dr. Feldman said she does, so the patient doesn’t wake up with a jolt during surgery). I had seen the surgery on line and really appreciated being awake, but again, did not feel any pain.
Spencer S. Busby, Esq. Spencer S. Busby & Associates