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THE VISIAN IMPLANTABLE CONTACT LENS
by DR. SCOTT L. JABEN
FREQUENTLY ASKED QUESTIONS

Who are candidates for VISIAN ICL?
What is the track record of the VISIAN ICL?
What material makes up the VISIAN ICL?
What if your vision changes?
What is involved in the VISIAN ICL procedure?
Exactly where is the VISIAN ICL placed in the eye?
Can the VISIAN ICL dry out or get dirty like a contact lens?
How long does the VISIAN ICL stay in my eye?
Can the VISIAN ICL be seen by the naked eye?
Can the VISIAN ICL be felt once it is in place?
Will I need glasses after surgery? If so, why?
Are there other options if I need glasses after VISIAN ICL surgery?
What is the cause of presbyopia (loss of near vision over the age of 40)?
What is monovision?
Why do I need YAG lasers before VISIAN ICL surgery?
When will the YAG laser procedure be performed?
What should I expect with the YAG lasers prior to VISIAN ICL surgery?
What complications can occur after VISIAN ICL surgery?
Are there other complications particular to VISIAN ICL surgery that can occur?
Why might the VISIAN ICL surgery not be completed on the day of surgery?
Why would a VISIAN ICL need to be removed?
What has been Dr. Jaben's experience with the VISIAN ICL?
How do I find out if I am a candidate?


Who are candidates for VISIAN ICL?
If you are between 21 and 45 and nearsighted, you are an excellent candidate for Visian ICL. Persons outside of this age range can also qualify. It is preferable that you have had no previous ophthalmic surgery or history of ophthalmic disease such as glaucoma, iritis, or diabetic retinopathy (see the Are You A Candidate page on this site for more details).

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What is the track record of the VISIAN ICL?
Extensive research and development preceded the introduction of Visian ICL. It is now being used by more than 70,000 patients worldwide. The satisfaction rate among patients is extremely high--above 99% (FDA US Clinical Trial). The Visian ICL provides excellent and stable outcomes; over 80% of all eyes receiving a Visian ICL in the FDA US trial achieved 20/40 vision or better.

What material makes up the VISIAN ICL?
The Visian ICL is made of Collamer, an advanced lens material that is highly biocompatible. Collamer does not cause a reaction inside the eye and contains an ultraviolet filter that provides
protection to the eye.

What if your vision changes?
Visian ICL offers treatment flexibility. If your vision changes dramatically, the lens can be removed and replaced, or another procedure can be performed at any time. With Visian ICL, you can wear glasses or contact lenses if necessary. Visian ICL does not correct or prevent presbyopia (difficulty with reading in people over 40), but you can add reading glasses if needed.

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What is involved in the VISIAN ICL procedure?
One to two weeks prior to surgery, Dr. Jaben will use a laser to make two small openings in the iris of each eye to allow fluid to pass between the lens and the front chamber of the eye. The actual Visian ICL procedure typically takes approximately 15 minutes and is very similar to modern small incision cataract surgery except that the human lens is not removed or touched. The Visian ICL procedure is performed on an outpatient basis (please note that someone will have to drive you to and from your YAG procedure appointment and your ICL surgery). Normally, very little discomfort is associated with this procedure. A light topical or local anesthetic is administered and a mild sedative may be given. Eye drops or oral medication may be prescribed. You will be checked by Dr. Jaben after surgery on the same day approximately 3 to 4 hours following the procedure and you will need to return on the next day for a one-day follow-up visit.

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Exactly where is the VISIAN ICL placed in the eye?
The Visian ICL is placed in the posterior chamber, behind the iris and in front of the eye's natural lens. The Visian ICL does not touch any internal eye structures and stays in position without stitches.

Can the VISIAN ICL dry out or get dirty like a contact lens?
No. The Visian ICL avoids problems experienced with traditional contact lenses. It is designed to remain in place inside your eye and without maintenance. A routine, annual visit with your eye doctor is recommended to make sure everything is fine.

How long does the VISIAN ICL stay in my eye?
The Visian ICL is intended to remain in place in the eye without maintenance. Should it become necessary, the lens can be removed surgically and usually the eye will return to its normal state.

Can the VISIAN ICL be seen by the naked eye?
No. The Visian ICL is positioned behind the iris where it is invisible to both you and observers. You enjoy a cosmetic appearance that is natural. Only someone examining your eye with special ophthalmic equipment will be able to tell that vision correction has taken place.

Can the VISIAN ICL be felt once it is in place?
The Visian ICL is not noticeable or felt after it is been properly positioned. It does not attach to any structures within the eye and stays in position without the aid of stitches.

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Will I need glasses after surgery? If so, why?
The goal with most patients is to use the Visian ICL to correct vision so that one is not dependent on glasses. In most cases this is the result. If you are over 40 years of age however, then glasses or contact lenses may be needed for the management of presbyopia (see question below regarding presbyopia and monovision). If you have a significant amount of astigmatism pre-existent to the procedure, and since Visian ICL at present does not have any correction for astigmatism, then corrective lenses may be needed. A form of the Visian ICL to treat astigmatism is presently under investigation by the FDA and may be available in the US within the next 12 to 24 months.

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Are there other options if I need glasses after VISIAN ICL surgery?
It is possible in the case of residual corrective error such as nearsightedness, farsightedness or astigmatism, that additional treatment with excimer laser such as LASIK can eliminate the need for glasses other than for near vision. If needed, additional laser treatments are not included in the original fees. Dr. Jaben will discuss this possibility with you during the evaluation process. If the corrective error after surgery is too great, then Visian ICL exchange surgery may be indicated for removal of the initial Visian ICL and replacement with a second of a different power.

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What is the cause of presbyopia (loss of near vision over the age of 40)?
The exact cause of presbyopia continues to be debated. Some think it has to do with an increasing rigidity of the proteins and fibers in the natural lens of the eye that gradually increases with age naturally. Some feel it has something to do with changes in the internal eye muscles and spatial changes of the internal eye structures. Regardless, it is an inevitable vision change that all humans will experience. While there is not an ideal form of treatment, much interest and research continues. Visian ICL surgery does not treat presbyopia if already present or prevent presbyopia from occurring naturally.

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What is monovision?
This technique has long been an option for contact lens wearers who have developed presbyopia. One eye, usually the dominant eye, is fitted for distance and the other eye, usually the non-dominant eye, is fitted for near. Some brains readily adapt and are not bothered by the disparity between the two eyes, while other brains do not adjust at all and never are able to overcome the imbalance created by this technique. It seems to be either an all or nothing phenomenon for most. This same approach can also be applied to patients undergoing Visian ICL surgery and attempting to deal with presbyopia. Generally it is useful to try this with a contact lens before surgery to determine if the patient will be able to accept this system. Reversal of monovision with Visian ICL is possible with additional surgery, but it is best to try contact lenses preoperatively to see if you are a good candidate. If you would like to try this, our contact lens department can help.

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Why do I need YAG lasers before VISIAN ICL surgery?
The lasers are used before surgery to make 2 tiny openings in the iris of each eye. A combination of the argon laser and YAG laser is used to make these openings. They are called iridotomies and they are critical to the control of the eye pressure inside of the eye after surgery (see questions about Visian ICL complications). There are possible complications that can occur with these laser procedures and are described in the Visian ICL Informed Consent document (located on this site) which you must read and sign; however, this YAG laser for iridotomies is a standard procedure used for some forms of glaucoma.
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When will the YAG laser procedure be performed?
Usually the YAG laser procedures will be performed 1 to 2 weeks prior to the Visian ICL surgery and usually on both eyes on the same day. The are no additional fees for the YAG laser treatment; it is included in the Visian ICL fees.

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What should I expect with the YAG lasers prior to VISIAN ICL surgery?
There is no preparation prior to the procedures. Someone will need to drive you home afterwards. There may be some irritation and blurry vision for several hours and possibly for part of the next day. You may not want to make important plans for the day following the procedures. Dr. Jaben may give you a bottle of eye drops to use for a few days and a prescription for pain medicine if needed.

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What complications can occur after VISIAN ICL surgery?
The complications, in general, are the same as for modern small incision cataract surgery since the procedures are so similar. Some of the more serious complications that may affect your vision in 2% of cases are:
- infection
- bleeding
- internal inflammation (iritis)
- swelling of the cornea or retina
- detachment of the retina
- loss or decrease in vision

Call Dr. Jaben or the CEENTA doctor on-call immediately if you have any of the following symptoms after surgery:
- pain not relieved by non-prescription pain medication
- loss or decrease in vision
- redness in or around the eye
- nausea, vomiting or excessive coughing
- injury to the eye

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Are there other complications particular to VISIAN ICL surgery that can occur?
INTRAOCULAR PRESSURE (pressure inside the eye) - because of the gel-like substance used for the procedure and the location of the Visian ICL in the eye, a major concern is always the eye pressure after surgery. The laser openings made prior to surgery are critical for the prevention of elevations in pressure. If these close at any time after surgery, the holes will need to be reopened with the laser. The eye pressure is checked 3 to 4 hours after surgery on the same day by Dr. Jaben in his office. If the pressure in your eye is elevated, it may need to be lowered with medicines or a release of fluid. The pressure will be checked again at your one-day postoperative appointment.

CATARACT - these may occur at the time of surgery in a very rare situation; if so, the surgical team is prepared to remove the cataract at the same surgery in a standard fashion and replace the natural lens with an artifical monofocal implant like the standard lenses used for cataract surgery. In this situation, a Visian ICL would not be needed. Cataracts may occur of course at any time after Visian ICL surgery naturally. The incidence of visually significant cataract formation in the FDA US study after Visian ICL surgery was 1.4%. Without any previous surgery, the incidence of cataract formation in highly nearsighted persons is somewhat higher than the general population. The treatment for cataract after Visian ICL surgery is handled in the standard fashion for modern day small incision cataract removal but only after the Visian ICL is removed which is accomplished at the same time as the cataract surgery.

GLARE - a small percentage of Visian ICL patients probably around 5% or less will experience more glare and halos at night than they experienced prior to Visan ICL surgery.

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Why might the VISIAN ICL surgery not be completed on the day of surgery?
For the following reasons: (1) the pupil does not dilate widely enough to safely perform the procedure, in which case the surgery is canceled and rescheduled for another day; however, Dr. Jaben will check your pupil dilation during the evaluation process to avoid this problem; (2) the Visian ICL ordered does not properly fit in which case the initial lens will be removed and the surgery rescheduled for another day with a different lens; and (3) a cataract develops during Visian ICL surgery (please refer to the question regarding Visian ICL complications).

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Why would a VISIAN ICL need to be removed?
The following reasons could be indications for Visian ICL removal: (1) if the Visian ICL power needs to be changed for better vision focus and clarity; (2) if the Visian ICL becomes decentered; (3) if the space between the VIsian ICL and the human lens is either too wide (usually because the Visian ICL length is too long) or if the space is too narrow (usually because the Visian ICL length is too small); (4) for other eye diseases that might develop naturally such as cataract; or (5) because of patient preference.

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What has been Dr. Jaben's experience with the VISIAN ICL?
The Visian ICL was approved for use in the US by the FDA in December 2005. Dr. Jaben completed his formal training in July 2006 and began implanting the Visian ICL in November 2006. Interest in the technology continues to grow both in the region and in the entire US. The similarities between Visian ICL surgery and modern standard small incision cataract surgery have made the transition into this surgery very smooth for most accomplished eye surgeons. Dr. Jaben has performed in his 25 year career over 27,000 cataract and excimer laser surgeries. Dr. Jaben and his staff have developed a protocol for screening interested Visian ICL patients to determine both anatomical and psychological candidacy for the Visian ICL procedure. If you are interested in proceeding with a complimentary screening exam for Visian ICL surgery, please see the next question and/or refer to the Make an appointment tab on this site or the Contact Us page.

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How do I find out if I am a candidate?
Please contact KARON PETTY, Refractive Surgery Coordinator for Dr. Scott Jaben, to make an appointment to learn more about Visian ICL surgery and to find out if you are a candidate. Her contact numbers are listed on both the Make an Appointment tab and the Contact Us page on this site. She can also be reached at 704-295-3777 or kpetty@ceenta.com.

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copyright Scott L. Jaben, M.D.