The ICL Decision

I found blogs like this extremely helpful when doing my research on the procedure, so I'd like to share my own perspective as I go through the process. I'm a little behind on starting this, so I apologize that this first post is so long. My hope is that someone may stumble onto it and find it helpful.

Background

I have high myopia, or extreme nearsightedness at -11 and -10.75, so basically I'm blind. The best way I can describe it, is you know that very large big "E" that's usually at the top of the eye chart? I can't even tell there's a letter there if it's the one brought up on the screen. That's 20/400, and there's no real measurement past that, but I've been told that my vision is somewhere around 20/1000. I've been in glasses since I was about 5 or 6, and made the jump to contacts when I was 13 years old. I was probably legally blind by about that time as well. 

Ever since my dad got lasik it was naturally something I was asking about as well. The first time I asked, they told me I couldn't be a candidate until I was 18. When I turned 18, they told me with my eyes I would have to at least be 21. Then of course, when I got close to 21, I was told that I would only have one shot at lasik, and it would be best to wait until I was 25. Eye correction is something that's been on my mind for a long time. It's not that I have dry eyes, or an astigmatism to a level where it makes wearing contacts uncomfortable, I can wear them fine. I can't stand wearing my glasses, but that's mostly because it limits my range of vision, and makes every light glare to where driving at night is very uncomfortable. I've always slept with a digital watch on, because I wouldn't be able to read an alarm clock that was two feet away from me in the middle of the night. I have to place the watch about an inch from my face just to read that.  The real reason I want vision correction is that my day doesn't start when I wake up. It doesn't even start when I put my glasses on because I can't see great through them,so it's really not until I've taken a shower and put my contacts in afterwards that my day actually starts. I've decided that I want my day to start when I open my eyes.

Consultation

I'm a little behind on writing this, so this happened a few weeks back, but it was only about a week after turning 25 that I scheduled a consultation appointment to find out about lasik. My eye doctor had recommended a specific place a couple months before, but with a very specific warning. I was told that with my level of high myopia, they might refuse to do lasik on me, and that I shouldn't argue with them. I could probably find a discount laser eye center that would be willing to do the procedure just to make some cash, but it wasn't ever going to be worth winding up with vision worse than what it was with contacts. It was tough to hear that after all my years of waiting lasik might not be possible.

The day of the consultation I did my best to "steel" myself to the possibility of staying stuck in contacts, which all things considered, really isn't the end of the world. I went through about 30 minutes of different tests, some of which where part of a standard eye exam, and some where things I had never done, like how thick my cornea was. After all of that the doctor came in and told me that if I were his son there is no way he would recommend lasik (well, not a big surprise.) They would have to alter so much from the surface of my eye that it would leave it almost flat, and at night the light would halo so far out that driving would be very uncomfortable. As much as hearing that sucked, he told me there was another option called Visian ICL, or implantable collamer lens, also sometimes called implantable contact lenses. This is basically what it sounds like, they take a contact made from a material called collamer, and insert it into your eye between your iris and your eye's natural lens. The effect is like wearing a contact lens at all times, and almost always produces better vision than lasik. On top of that, the recovery time was only about a day, and I could be back at work the day after. 

Here's where me being a dumb 25 year kid comes in, he went through the various risks, and I listened to them, but all I could really hear in my mind was "you're going to get perfect vision!" What I do remember from that first appointment was that infection is the greatest risk involved, since it's much more of a surgery than lasik and involves something foreign being permanently lodged inside your eye. If that sounds unsettling, that's probably good. The real catch to me, was that it costs about two to three times as much as lasik. I wouldn't say it's unfairly expensive though. The price is high because the lenses themselves aren't cheap, and you need an OR for the procedure, as well as 5 RNs. All of that adds up, which as I would find out, is the main reason people aren't lining up  to get this done instead of lasik. 

The whole thing takes place in three steps. First you have an examination where they determine the prescription for the implants, and make sure that your eyes are healthy enough. Next a week before the actual surgery they perform an iridotomy which is the process of punching holes in your iris with a laser to help your eyes drain better once you get the lens in. Last is the actual procedure where you're under anesthesia, and a little loopy, but you otherwise know what's going on. A couple hours after that I'll come back to have them check the pressure in my eyes to make sure every thing's ok, and I'll be back the following morning to do the same. All said in done, it's only one full day off from work, and a couple other half-days, which I liked. 

Like I said, I went home having already made up my mind that I wanted to do it. The only real decision I had to make, was how many kidneys I had to sell to pay for the procedure. My mom was initially on board with it as well, but became concerned after talking to our eye doctor about ICL. What worried her was that they had never seen anyone who had gotten this done. This procedure has only been done on about 300,000 people, despite being approved by the FDA since 2005, which is more than a little unnerving. Initially I was a little upset that my mom had suddenly become worried about this, but now I'm extremely grateful that she brought it up because it led to a long week of research on my part.  

I found out that the biggest long-term risk of ICL was that it could cause cataracts from the lens rubbing up against your natural lens. I also found out that even with this more obscure procedure there are other options. The FDA also approved a different lens in 2004 called the Verisyse (which I still have no idea how to pronounce) which goes in the anterior chamber, or in front of the iris, and has less of a risk of cataracts because it's further away from the lens. It's also been shown to produce less accurate results, and greater halos at night. The other important factor that kept me from pursuing this option was that it requires a much larger incision. The Visian ICL is rolled up and inserted through a pretty small hole, and the Verisyse can't be made any smaller so the incision must be the size of the lens. I would strongly encourage anyone considering this procedure, or anything like it, to do as much research as possible. I trust my doctor, and I don't think he would ever lie to me, but I do think that he answered my questions in a way that always made it sound like strolling through the park. Sure, you might get mugged, but what are the odds of that happening? There are two things I found extremely useful when researching, the first being blogs, like I mentioned at the start of this post. They really help illustrate the experience from someone's point of view who isn't giving a testimony for the company making the lenses (you can find tons of those.) The second was medical case studies, for this I recommend a site like PubMed, which will list most of the studies that have been done, and what side effects they saw. I'm a numbers guy, so I wasn't ever truly happy with these studies, because at most the sample size was 50 people. That said, I wasn't able to find anything that made me super concerned to do the surgery. They all found the potential risks to be no greater than lasik. There is indeed a risk of cataracts, but I couldn't find a case where someone my age developed it within a few years of getting the ICLs. The worst thing I read about was the ghosting, and halo effect at night people were seeing. The blogs all made it clear though, even with the halos at night, everyone said they would do it again in a heart beat.  

Everyone approaches major decisions differently, I usually make a scale in my mind of pros and cons, and see which one outweighs the other. The reason I tend not to write them down is that some factors "weigh" more than others, and if you make a list, all the potential risks would list out a mile long, and on paper the decision would seem obvious. To me, however, the risks are all out-weighed by one simple pro: I am blind, and I would be able to see.

Initial Examination

Every place does this process differently, but I was told to be out of contacts for a week before the next appointment where they would do all the size measurements on my eyes and determine what strength to make the ICLs themselves. That week in my glasses only served to strengthen my resolve for getting the procedure. My mother wasn't with me for my consultation appointment so for the next one I decided to bring her along and drill the doctor with as many questions as she could come up with. I went through mostly the same set of tests as before, but this time it was a more accurate reading because even your soft contacts alter the shape of your eye slightly, and your prescription can change some when you're in glasses for a week. They also measured how many endothelial cells I have in my eyes, since there's a slight risk to them when inserting the lenses, and I'm fine there. The most interesting thing I learned in my second sit-down with the doctor was that this particular eye doctor took part in the clinical FDA study back in 2005 that gave the Visian ICLs their approval. This means that they've been doing this procedure as long as any other place in America has been doing it. Even with that, they admitted to only doing about 2-3 of them a month. Like I said, they aren't really common. One of the listed benefits of the ICLs over Lasik is that if anything goes wrong, they can remove them, where as lasik is irreversible. So we also asked if they had ever done that, and they said that there was one instance where a lady had signs of cataracts before getting the ICLs, and when it worsened she had to get the ICLs removed when they removed her natural lens to perform cataracts surgery. He also mentioned that the worst thing that ever happened was that they had to take a patient back into the OR after the procedure to "burp" the wound, because the gel they use to protect your eyes can sometimes cause blockage before it dissolves naturally. This doesn't sound all together pleasant, but if he felt that the worst thing that happened was having to go back into the OR so they can re-open the wound for a moment, I'd say they are way worse things. We left that appointment with even my mother being satisfied.

The next step is for me to get the iridotomy, which is about an hour long appointment and involves holes poked in my eyes by lasers. I've read a couple different accounts of this process ranging anywhere from the worst pain imaginable to a small pricking sensation, so I really have no idea what to expect...