lens replacement

[Fordy]

After a consultation with optical express, I was offered the option of lens replacement similar to that of a cataract operation. This would last a lifetime, but being private came with a price tag of about £5,000.Does anyone know the success rate of this? would be interested to hear your opinions .I have KC in my left eye to about -7 but would have the same procedure in both.

[Andrew MacLean]

Fordy

I'd not allow any such interference with my eye on the basis of a single consultation with a commercial concern. Have you discussed this possibility with your hospital ophthalmologist? Are they suggesting that the procedure will improve, cure or treat your keratoconus?

I know it can be tempting to jump at any glimmer of light, but maybe you should pause a moment.

We'd be able to comment better if you were able to tell us the name of the procedure that has been proposed.

All the best

Andrew

[Lynn White]

Hi Fordy... Andrew

I am not quite sure which procedure was suggested to Fordy - Lens exchange or phakic implant. Both these procedures are being offered more and more in the private sector.

Lens exchange: exactly the same as a cataract operation and implant but done BEFORE you get a cataract. The eyes natural lens is broken up and removed and a plastic lens is inserted back into the eye. This procedure is very well known and understood and has been done millions of times all over the world (due to the fact everyone eventually gets cataracts!) It has also been regularly done for people who want refractive surgery but have high prescriptions. The downside to this is that if you are young, you immediately lose the ability to focus at near as they have not yet perfected focussing implants. For someone who is older and already uses reading glasses its not such a problem.

Phakic Lens Implant: this procedure leaves the natural lens in place but inserts another thin lens in front of it. Often used to correct high levels of astigmatism. I have seen some complications from this from procedures done about 10-15 years ago (yes it has being going along time!) due to reactions against the materials used for the implant - this has been addressed by the implant manufacturers but there is still a small risk of an adverse reaction. However, if a problem does arise, the implant can be removed.

My thoughts about using this for KC is really that you have to be sure you have stopped progressing otherwise its a waste of money! This is why many surgeons offer this procedure combined with CXL. Have your CXL, wait around a year to stabilise and then correct your prescription with phakic implant. Very useful for people who can't tolerate or get on with any form of contact lens.

Having said all that... I am currently dealing with a patient who had phakic implants 15 years ago for straight short sightedness. On one of her eyes, the incision area on the superior cornea has become raised and caused distortion that is exactly like PMD (Pellucid Marginal Degeneration) so I am now fitting her with contact lenses!

There are risks with any procedure. You will not find good long term stats about implants for KC in the UK as it is not done that much here. However, in some European countries where there are no NHS hospital clinics and thus contact lenses are harder to get hold of, the phakic implant route is used a lot. The known complications of phakic surgery are:

possible development of cataracts
possibility of affecting the endothelium layer in the cornea
raised pressure in the eye (which can be treated)
visual symptoms such as glare
the implant may need to be repositioned if its not quite right first time
occasionally you may end up over or under corrected

What I would ask Optical Express about is whether you have any Higher Order Aberrations that may not be corrected by the implant. If you have a lot of ghosting and multiple images in glasses, it is likely you have a high level of coma and unless they are able to correct that at the same time, you will still have this after the implant.

Lynn

[Fordy]

The treatment that was suggested was Refractive lens exchange.

There are a number of companies offering this, all with a high price tag.

Thanks for your help and advice, it is much appreciated.