7190 Smoke Ranch Rd, #110
Las Vegas, NV 89128
The eye is an amazing optical device. Like a camera, the eye focuses light into a clear image, which is then changed into electrical signals and sent to the brain for interpretation. Abnormalities in the size and shape of the eye lead to poor vision, which requires glasses or contact lenses for improved clarity.
Scientists and engineers have been working for years, trying to perfect the options for restoring vision without glasses or contact lenses. Currently, the two major categories of vision enhancement include LASIK/PRK and ICL lens implant procedures. LASIK and PRK work externally by reshaping the cornea, ICL implants are placed inside the eye to help focus light rays without glasses or contact lenses. Each procedure has specific benefits and minor risks. Our job is to help educate you on your options and guide your decision making so that you end up with the best possible vision with the safest and highest technology procedure.
Dr. DeBry will work with each patient to make sure they get the best technology for their vision-correction surgery.
The eye works like a camera to focus light and create a clear image. There are two main eye structures that share the job of providing good focus, the cornea, and the lens. The cornea is the window of the eye, much like your car windshield. It is made of living tissue (cells and collagen) that is perfectly clear and shaped with a curved surface. As the light rays enter this curved surface the rays are bent (or refracted), directing the rays closer together and towards the lens. The next structure that light rays encounter is the lens. The lens of the eye is shaped like an M&M candy and is also composed of perfectly clear cells and collagen. The lens also bends the light rays, refracting them towards the posterior surface in the eye, the retina.
The eye is amazing! Your body has it’s own auto-focusing camera system with 3-D technology. Clear vision without glasses requires the eye to be a perfect shape and size with each component of the eye doing its job in the focusing process. Looking around the world at the people you see every day it is easy to realize that we all aren’t born with a perfect shape and size. If your eye is bigger or smaller than average, or if each component of the eye (cornea and lens) doesn’t focus perfectly, your vision will be out of focus. Blurry vision due to focusing problems is called Refractive Error. There are three main categories of refractive error: myopia, hyperopia, and astigmatism.
Myopia, or nearsightedness, is a condition of the eye where the focusing power of the eye does not match the size and shape of the eyeball. People who are myopic generally have an eye that is bigger than average or a cornea that has a higher curvature than average. This results in blurred vision for distant objects. One benefit to being myopic is the ability to see things up close without your glasses or contact lenses.
Hyperopia is caused by an eye that is smaller than average or a cornea that is flatter than it should be. In many people, the auto-focusing ability of the eye is able to help keep an image in focus when the eye is young and healthy. Because of this many hyperopic people don’t need to wear glasses when they are children and young adults. Eventually the auto-focus mechanism ages and blurry vision results, leading to the need for glasses. A hyperopic person can’t see well in the distance or up close without glasses or contact lenses.
Astigmatism is a focusing problem of the eye related to the shape of the cornea. A normal cornea is perfectly round like a basketball. With astigmatism, the eye develops with a slightly oval shape like a football. Astigmatism is corrected with glasses or contact lenses. Almost everyone has a small amount of astigmatism. Astigmatism can be treated with LASIK and PRK. The ICL surgery at this time is limited in the ability to correct significant amounts of astigmatism.
There are three main methods of surgically treating refractive error. Since the cornea and lens are the two eye structures that focus the light, they are the main structures commonly treated to improve vision. Laser technology can be used to reshape the cornea (LASIK and PRK), and surgical procedures can be done to replace the existing lens (Refractive lens exchange) or simply insert a new lens (Visian ICL).
Monovision is an option to help people in their 40’s and older to avoid wearing reading glasses. As the eye ages, it loses its ability to focus on items within 18-24 inches. This aging change is called presbyopia. One method to treat presbyopia, monovision, is to use your dominant eye for distance activities (driving, TV) and the other eye for close activities (reading, computer). This is commonly done with contact lenses for people in the mid-40’s and older. If you are in your 40’s and are considering LASIK, PRK, or an ICL implant, monovision may be beneficial for you. If you have not tried monovision, before having a permanent surgery we recommend working with your optometrist in a monovision contact lens trial to make sure you can adjust to it. Benefits of monovision include less need for reading glasses. Some people have difficulty tolerating the different focus between the two eyes and reduced depth perception.
Dr. DeBry often works closely with your optometrist planning your refractive surgery. Your optometrist may help make some of the initial measurements on your eye to achieve an accurate power selection. The optometrist may also see you for some of the post-operative visits. You have the choice to decide which doctors will participate in your pre- and post-operative care. If your optometrist provides some of these services they will be paid accordingly based on the services they provide. We may elect to have you pay separate payments to our clinic and the optometrist. Please see the co-management consent form located later in this book for more information.
Another option for vision correction is an ICL implant. The ICL is a lens implant developed to correct myopia. Although the Visian ICL is often informally named an “implantable contact lens,” in the United States, the acronym ICL stands for “Implantable Collamer Lens.” Collamer is the unique material that the lens is made of. The ICL surgery has some benefits when compared to LASIK or PRK, but also has its own unique set of risks.
The Visian ICL offers unparalleled quality of vision, providing excellent contrast. Two unique factors help explain this superior optical performance. First, the Visian ICL is made of Collamer – a soft, flexible lens material that contains a small amount of collagen – making the lens extremely biocompatible for a lifetime of clear vision. Second, the lens is placed inside the eye, where it continues to focus light accurately without any maintenance required.
The safety and effectiveness of the Visian ICL surgery implantation procedure has been proven with over 125,000 implants worldwide. Unlike corneal refractive surgery (LASIK and PRK), the Visian ICL does not permanently alter the structure of the eye. Instead, the Visian ICL is placed in the eye’s posterior chamber, where it works with the natural lens to correct vision.
Unlike other phakic IOLs, the Visian ICL is foldable. This feature allows physicians to implant the lens using a smaller incision. The small incision procedure is a technique that is familiar to eye surgeons. The Visian ICL requires a 3.0mm (1/8 inch) incision as opposed to the 6.0mm incision required by other FDA-approved phakic IOLs. This smaller incision is seen as less invasive, does not require sutures, and is less likely to cause astigmatism (change the corneal shape).
Although the Visian ICL is meant to stay in the eye indefinitely, it is easily removed by a trained ophthalmic surgeon, leaving the patient’s options open for future treatments. LASIK and PRK permanently alter the eye structures and cannot be reversed if the recipient is dissatisfied or of there are complications.
One amazing aspect of the ICL implant is that many people report that they see better after the procedure than they had ever seen before with glasses or contact lenses. This is related to the quality of the implant material and the location of placement within the eye. The lens actually makes the image a little larger than glasses or contact lenses, which can help you to see small details even clearer. 49% of lens recipients gained one or more lines of best-corrected vision. In other words, if they could see 20/30 with their glasses or contact lenses before the procedure, they improved to 20/20 after the procedure.
Most patients who have had the ICL implant are happy with their decision and feel they had a good outcome from the surgery. In the FDA study of 341 patients, only 1% claimed that they were dissatisfied with the procedure. 97% of patients said they would have the surgery again.
The Visian ICL has been studied in FDA trials and successfully implanted in over 125,000 eyes over the last 10 years. This experience has shown the implant to be very safe and effective. Nevertheless, all medical treatments have potential side effects and complications. Before choosing an elective procedure it is important that you understand these possible problems. Potential problems from the ICL procedure include:
Because an incision is made in the eye and the ICL is implanted through this incision, there is a risk that bacteria could enter the eye and cause an infection. This can occur even with the antibiotic medications used before and after the procedure. The risk of a severe infection is less than 1:1,000.
A cataract or cloudy lens usually develops with aging. You may have heard of older people having cataract surgery. Trauma can also cause cataract development. The ICL surgery is a minor trauma to the eye. In the FDA study the rate of cataract developing that required surgery was only 0.6%. Patients who developed a cataract eventually required another surgery to fix this condition. Most people still end up with good vision without glasses after a successful cataract procedure.
High eye pressure
During the ICL procedure a thick gel is placed inside the eye to protect the delicate eye structures. This thick gel can block the fluid circulation and cause a short-term elevation in the eye pressure. This can usually be treated successfully with eye drops. It is also possible that the ICL can push the iris forward and block the drain of the eye. This may require medications or laser surgery to treat the condition. Your eye pressure will need to be checked later in the day after the procedure to make sure there are no pressure problems developing.
The retina is the thin film that covers the inside of the eye like wallpaper covers a wall. A retinal detachment means the retina peels away from the eye. A retinal detachment usually requires surgery to repair the detachment. Eyes that are myopic or nearsighted usually are larger than normal, which leads to a thinner retina. Being nearsighted is a risk factor for developing a retinal detachment. In the FDA study 3 patients (less than 1%) developed a retinal detachment in the months after the surgery. Because these myopic eyes had risk factors for retinal detachment, it is difficult to tell whether the surgery was a contributing factor in these cases. As a nearsighted person you should have a good retinal exam at least once each year.
Lens sizing problems
Although several sets of measurements are made prior to ICL surgery, it is possible that the lens selected is smaller or larger than an ideal size. This occurs because of variability within biological systems that is difficult to measure. Problems of this nature that are severe enough to lead to an ICL exchange occur less than 5% of procedures.
A lens implant has the potential to cause glare and halos at night. The normal eye response to darkness is to make the pupil get larger to let in more light. A healthy young person may have a very large pupil in dim illumination. If the pupil gets larger than the implanted lens, some light can hit the lens edge and bounce into the eye causing glare or halos. This same process can also happen with glasses, contact lenses, and LASIK procedures. In the FDA study, some patients reported symptoms of glare and halos related to their vision correction with glasses or contact lenses. After the procedure a few patients noted more noticeable symptoms of glare and halos. It was rare that this was considered severe or bothersome. For example 11% reported noticing moderate or severe glare before the procedure and 14% reported this symptom after the procedure. 20% of patients reported night driving difficulties before the procedure and 16% reported this after the procedure.
Astigmatism means that the cornea, or front window of the eye is shaped more like a football than a basketball. The curvature in one direction is different than the curvature 90 degrees away (perpendicular). Astigmatism causes the vision to be slightly blurry. This can be corrected with glasses or special contact lenses (toric lens). The FDA is currently reviewing approval for a version of the ICL that corrects astigmatism. Until then, astigmatism needs to be treated with special incisions in the cornea (LRI or limbal relaxing incisions). People with large amounts of astigmatism may not be good candidates for the Visian ICL procedure or will need a dual procedure with an ICL and LASIK/PRK.
The ICL is made of a high tech material known as collamer. Collamer is a revolutionary material used exclusively in making STAAR Surgical corrective lenses, including several models of the Visian ICL. Its name comes from the combination of “collagen” and “polymer”. Because it is made with collagen, Collamer is compatible with your body’s natural chemistry. Collamer is easy to implant because it unfolds gently and predictably in the eye. Collamer transmits light very similarly to your natural lens because the material’s characteristics are nearly identical to the human crystalline lens. Collamer offers numerous advantages over other lens materials:
Quality of Vision
Due to its unique anti-reflective properties and high water content, Collamer helps transmit light nearly identically to the human crystalline lens. This means less light is reflected within the eye, leading to sharper, clearer vision; and far fewer occurrences of glare, halos, or poor night vision associated with other lenses or corrective procedures.
Meaning “compatible with your body’s natural chemistry,” biocompatibility is a key advantage of Collamer. The collagen in the Collamer attracts fibronectin, a substance found naturally in the eye. A layer of fibronectin forms around the lens, inhibiting white cell adhesion to the lens. This coating prevents the lens from being identified as a foreign object, and the lens remains unnoticed and “quiet in the eye” indefinitely. What’s more, like the collagen it contains, Collamer carries a slight negative ionic charge. Proteins in the eye also carry a negative charge. As these two negative forces meet each other along the border of the Visian ICL, the charge repulsion pushes away the proteins from the lens, naturally keeping it clean and clear.
Long-term exposure to UV radiation can damage the eyes; longer term or more intense exposure increase the chance of eye disorders including the development of cataracts and some retinal problems. As an added feature, the Visian ICL advanced lens material contains a UV blocker that actually prevents harmful UVA and UVB rays from entering the eye, possibly preventing the development of UV related eye disorders.
The best visual results from an ICL procedure require accurate measurements to determine the perfect size and power of lens implant. The FDA also has specific criteria that must be met to ensure good results from the procedure. To complete all of these tests more than one visit to the office may be required. Your optometrist may also help collect the required measurements for the procedure. The following tests are typically required
It is best that these measurements be done without a contact lens being worn for at least several weeks. Contact lenses worn for many years can actually change the shape of the cornea. If you wear contact lenses we recommend that you stay out of them for a few weeks and wear only glasses until the measurements can be completed. If it is very difficult to go without contact lenses, then the surgery can still be done, however, there is a slightly higher chance that the lens implanted will not be the right size and strength for your eye. Since you will have this lens for 30 years or more, it is probably worth a few weeks of inconvenience without your contacts to get the best eye measurements.
You have the choice to do both ICL implants on one day or separate the two surgeries into two different days. The safest option is to do the eyes on two different days. This allows Dr. DeBry the opportunity to assess the outcome of the first surgery before the second procedure. Based on the first procedure, small adjustments in lens size or power can be made prior to the second eye being done. However, many people have scheduling constraints with work or family responsibilities that make it difficult to take extra days off to do the surgeries on different days. If you choose to have the surgeries done on the same day we will have you sign an extra consent form acknowledging this choice. The risk of a severe bilateral problem such as an infection is very rare. Plan on your vision being blurry for the first day or two while the eye is healing from the procedure. We recommend you don’t plan any important meetings or travel for at least a few days after the procedure to allow your vision time to improve.
An ICL implant can be done in our in-office surgery suite or in the operating room at an outpatient surgery center (ASC). An ICL surgery is similar to a trip to the dentist to have a cavity filled, it takes around 15 minutes and there is mild discomfort. Most patients can tolerate this just fine with a mild sedating pill (Triazolam) and anesthetic eye drops. If you do not have a high level of anxiety we recommend the surgery be done in the office. This option will save you $1500 per eye compared to the ASC. If you have significant anxiety that might require an anesthesiologist and IV sedation, we are happy to arrange the procedure in the outpatient surgery center. The final results of the surgery will be the same at either location.
The Visian ICL implant is placed behind the iris, the colored portion of the eye. The eye is filled with fluid, and this fluid is continuously circulating within the eye. This fluid must move through the pupil, passing through the area that is now occupied by the lens implant. It is possible that the lens implant blocks the flow of fluid. The peripheral iridotomy creates a very small opening in the iris, allowing fluid to easily pass around the lens implant. This prevents a blockage in fluid flow, which could lead to dangerously high eye pressures. The iridotomy can be done before the surgery using a laser or during the surgery making small incisions. For most people, this small opening in the iris has no visual symptoms. A small percentage of people may notice a line of light or glare coming through the new iridotomy opening.
When you arrive at the office you will be given a sedating pill (Triazolam) and several sets of eye drops that dilate the pupils. Once the dilation has set in, an anesthetic gel will be applied. This whole process takes around one hour. During this time we will also check your blood pressure and a quick urine pregnancy test if you are a female of childbearing potential. Once the pill has started to relax you and the eyes are dilated and anesthetized, you will be brought back to the surgery room. We have a very comfortable bed to lie on. A few monitors will be applied to help us monitor your pulse rate and blood pressure. The skin around the eye will be cleansed with an antiseptic (Povidone Iodine) and a thin drape applied over your face to keep the surgical area sterile. You don’t have to worry about blinking because a small wire is used to keep the eyelids open. During the procedure, you will be asked to stare straight ahead into the fairly bright microscope light. You will likely feel some burning and pressure for short times during the procedure, which takes around 10 minutes. After the procedure, your eye will be covered with a clear plastic shield.
If you have chosen to have bilateral surgery, the second eye treatment is done as a completely separate procedure. You will leave the operating room, the room will be wiped down, and all new sterile supplies opened. Once the equipment is set up and ready, you will go back into the OR and have the second eye done. Treating each eye as a completely separate procedure lowers the risk of a rare but severe event such as an infection affecting both of your eyes.
For a procedure done in the ambulatory surgery center, there are a few minor differences. Because you will be getting a stronger sedating medication you will need to be fasting. This means no food or drink for at least 8 hours before your procedure. You will also need to have an IV placed in your arm to allow the anesthesiologist to give you the sedating medications in your vein. As mentioned previously, there is an extra cost for these services.
Once the lens is implanted you will no longer be nearsighted, but the best vision may take up to a week to achieve. For the first day, you should plan on the vision in your surgical eye being blurry. This is due to the medications used before and during the procedure, the bright microscope light, and the postoperative eye drops. The next day the vision should be improved and over the next few days, you will notice additional clarity as the eye heals.
There are two different eye drops that are used to help give you the best outcome from the procedure; a mild anti-inflammatory (Prednisolone) and an antibiotic (Ofloxacin). We ask that you start the drops a few days before the procedure to prepare the eye for the treatment, and continue them for a few weeks after. The detailed dosing schedule is included in the back of this book. Please let us know if you have difficulty buying them or run out of drops after the procedure. Your best results may depend on adequate dosing of the eye drops after the procedure.
Because of the sedating medications used, you will need a driver to take you home from the office or surgery center. You shouldn’t drive the rest of the day until the medications have worn off. If you have bilateral surgery you shouldn’t drive until the vision has cleared to the point where you feel comfortable driving. We ask that you take it easy the first 24 hours and don’t plan any important meetings or events. You should be gentle with your eyes and avoid rubbing them if possible. Dr. DeBry also recommends that you avoid vigorous activity for a few days as you adjust to your new vision. Finally, no swimming with your head under the water is allowed for one week after the procedure. All of your normal daily activities are fine, including showering and bathing.