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Laser eye surgery is the most well-known and most commonly performed mode of refractive surgery, audit for around 70% that the surgical volume in ~ our smile Eyes facility in Munich, Germany.1 Laser vision correction has been commonly marketed internationally for the past 2 decades, and the basic public is acquainted with the term and also the concept.

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Less famed to the public is lens-based refractive surgery, which contains refractive lens exchange and also phakic IOL implantation. In ~ our clinic, this procedures make up 20% and also 10% of ours refractive operation volume, respectively.1 even though lens-based procedures have actually been approximately as lengthy as LASIK, if not longer, they have actually not captured on in the popular consciousness and also LASIK has—perhaps due to the fact that they lack the high-tech zest of gift performed through a laser.

Nevertheless, part patients who pertained to us for refractive surgical procedure are better candidates because that a lens-based procedure 보다 for LASIK. Once I see such patients, therefore, ns am faced with the task of educating them about the rationale because that implanting one extra lens in their eyes. Patients have many questions. What is this procedure I’ve never heard of? Why is it done? Why space you recommending it because that me, instead of the acquainted procedure I have seen advertised because that so plenty of years? This post details the information I give to patients about phakic IOLs, the questions they most regularly ask, and also the answer I provide them. Mine answers space then contrasted with the answers the patients are likely to find on the very first page the a Google find of that same question.

TWO PRINCIPLES

When I think that a patient is a an excellent candidate for phakic IOLs, I start by explaining that there space two an easy principles for just how to exactly refractive error:

Principle No. 1: To take it something far from the eye. In other words, tissue removal, i beg your pardon is what wake up in laser surgery.

Principle No. 2: To add something to the eye. This is what wake up in phakic IOL surgery.

This provides it clear to the patient the there room two various ways to deal with the problem of refractive error. Often, patient express part disappointment as soon as we begin talking about lens surgery since many that them have laser surgical treatment on your minds. When they find out that they space not great candidates because that laser vision correction, this can be a little of a an adverse experience. If you open up the conversation as just described, however, you have the right to turn it into something positive: us are including to your eye, quite than acquisition away. This provides the concept and simple principle that the phakic IOL clean at the outset.

I further explain that one of the factors they space candidates because that phakic IOLs is that their lot of myopic refractive error is fairly high. If we were operating under rule No. 1, we would certainly be removed a many tissue, and, if we remove too much tissue, there will be nothing left to insurance the stability of the eye. This defines the logic behind the choice of this procedure: You can only eliminate tissue to a particular extent, and then you need to choose one more approach. The other method is the use of phakic IOLs.

SETTING EXPECTATIONS

Once I explain those simple concepts, then i introduce and describe the phakic IOL procedure. I tell patients what is involved in the surgery and also what they have the right to expect throughout the experience. Rather than emphasizing the differences in between laser and lens surgery, I try to emphasize the similarities:

• Both actions take around the exact same amount that time to perform, around 10 minutes;• Both procedures are excellent in the outpatient setting; and• Both are done under local anesthesia.

When ns emphasize the common points, patients realize the the differences are not so great as they might have expected.

Whatever the surgical procedure under discussion, even if it is laser or lens, I always start by reflecting patients one eye model. I explain the anatomy and show them whereby the lens, the cornea, and the iris are. Climate I display an man film showing the basic principles and the steps of the procedure. I additionally give patient a directory from the IOL firm to review through.

We use a standardized kind for educated consent, as compelled by our national health and wellness insurance. In enhancement to the form, however, I talk to patients and also tell lock verbally the points they really need to know about the risks of surgery. Phakic IOL implantation is intraocular surgery, which requires other threats than those attributed to outside laser eye surgery.

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I likewise explain that further vision alters can take place after phakic IOL implantation. Cataracts can develop, and also this will more than likely necessitate explantation that the phakic IOL, remove of the cataract, and implantation the a pseudophakic IOL. This is crucial issue and must be made clear, back the breakthrough of cataract seems to be rather low v the recent EVO Visian ICL version (STAAR Surgical). I likewise note the refractive surprise can occur, and this may necessitate exchange the the phakic IOL for a various lens power. Presbyopia is also described, so the patients are ready for the gradual loss of reading vision in your 40s.

The last point I try to emphasize throughout informed consent is that patients may perceive some glare and also halos, especially in the at an early stage postoperative period. This will generally acquire better, however some worries can remain.