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Post Visian ICL/Phakic IOL, from severe dry eye to tenuous recovery

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  • Post Visian ICL/Phakic IOL, from severe dry eye to tenuous recovery

    Hi gang,

    After suffering through dry eye for months I'm finally seeing steady improvement. I want to share my story as I haven't seen anything regarding post phakic IOL dry eyes.

    My story begins like many post-vision correction suffers: I grew tired of wearing glasses. Contacts were great, but slowly it became more difficult to wear them, until finally I couldn't use them at all. I tried many brands of contacts, went to many optometrists, but I soon came to the conclusion that my eyes didn't work for contacts anymore. (I never fully pursued why, not did my optometrists pursue this either). It was at this point that I turned to vision correction, which I debated for close to five years.

    In February of this year I had Visian ICL surgery at a major clinic near Philadelphia. I had considered Lasik for years, but I opted for Visian for two reasons: 1) it was, in theory, reversible, and 2) it promised a much lower risk of complications. Visian ICL is a type of Phakic IOL (intra-ocular lens) basically an implanted lens. In my research I found lower rates of complications in particular a promise of lower rates of dry eye. Every doctor I spoke with regarding this procedure repeated the phrase "Visian ICL does not cause dry eye." I searched PubMed and didn't find anything regarding Visian and dry eye.

    The surgery itself was rather painless and really something of magic. Within a day I could see well enough to read, and within two I was 20/20 in both eyes. The quality of vision was excellent, comparable to that which I had on my best contact days.

    But I wouldn't be on the forum if that were the full story. Some time in early May I began experiencing symptoms related to dry eye. It began with slight redness and dryness, which slowly worsened. I met with the surgeon and he repeated the mantra "Visian does not cause dry eye," and prescribed steroid drops and recommended genteel drops during the day. One of the optometrists on his staff inexpertly inserted lower duct plugs--poorly, as I later found out they never stayed. I was angry--mostly on the doctor's insistence that this was unrelated to the surgery--but my eyes remained manageable with drops, at least for the time being.

    My condition quickly got worse. I had to use drops once or twice an hour. I would wake with eyes that were dry and completely bloodshot. I was frightened, scared that I would be like this forever. The surgeon was no help, and kept insisting that the cause of dry eye had nothing to do with the surgery, which seemed patently ridiculous. It was about this time that I found this forum and tried every treatment I could. My treatments varied during this period. I managed and tried to function in my life with a variety of treatments. I first tried drops: genteel, opcon-A (to reduce redness), Theratears, and others. I cleaned my lids and eye margins daily with lid cleansers. Compresses seemed to bring the most relief (especially the rice bag compress, thank you Rebecca!). The nighttime sleep mask didn't help as far as I could tell. There was no consistency to my method; I was operating out of desperation.

    Having had enough, I got out the big guns and sought a dry eye Opthamologist, sometime in August. I saw Maria Rosselson at Chicago Cornea and we worked out the following regimen:

    restasis (2x day)
    lotemax (steroid drop, 2x day)
    azasite (anti-bacterial drop, 2x day)
    Genteel drops during the day
    Omega-3 Oil (1000 mg)
    Opcon (to manage redness, warning: this is unpopular on the board)
    Hot compresses as need
    Plugs in lower ducts

    The azasite ran out quickly and was difficult to apply. Restasis and Lotemax seemed to work great initially, but soon the effects dissipated. My eyes would go through cycles. I would have 3-4 days of eyes that were almost normal, then 3-4 just awful days. The latter was characterized by near constant redness, and feelings of grittiness and dryness. At times I barely wanted to open my eyes, just lie under a hot compress, the only thing that I found consistently helped.

    Seeing little improvement, I decided to see another specialist, Sheridan Lam at DuPage Opthamology, sometime in late September. Dr. Lam examined my eyes carefully and saw signs of chronic meibomian gland dysfunction. He recommended swapping the azasite for doxycycline pill. He seemed to have a clear understanding of MGD, its causes and how to treat it.

    My eyes didn't improve suddenly. In fact, I still maintained the up and down cycles of the past. But my eyes seemed to improve. Every morning I would wake to beet red eyes which I would manage with drops, but soon I noticed going all morning without thinking of my eyes. Later it would stretch into the afternoon before I had to consciously think of my eyes. I want to stress how nonlinear this process was. I would have good days and bad, but every day I kept using the doxycycline, lotemax and restasis. I met with the doctor again and he noted improvements to the meibomian glands. He also added a steroid gel drop to use at night to help with redness. He also plugged the upper tear ducts, noting in the process that the left upper eye duct showed signs that it's been inflamed for a long time.

    As it stands today, my eyes are good enough that they don't keep me from living a normal life. Some days are still better than others, but I no longer construct my day around my eyes. My eyes are only slightly red in the morning. I'm incredibly grateful for this and want to thank all the doctors that I saw, with the possible exception of the surgeon who operated on my eyes. I owe something to this forum as well, for providing a community of suffers at my lowest points. Thank so much, sincerely.

    There are three takeways from my experience I want to convey to the board:

    TAKEWAY 1: Visian ICL/Phakic IOL can cause dry eye. I might get sued for saying 'cause' but let's back off and say that Visian ICL can lead to dry eye. In conversations with the Dr. Lam it seems my meibomian glands have been in poor shape for some time. Strictly speaking, I had a predilection towards dry eye before the surgery. The surgeon might interpret this as evidence that Visian ICL didn't cause my dry eye, but that seems asinie. Something from or as a consequence of the surgey triggered my dry eye. [/I]The surgeon should have tested my meibomian glands to indicate whether this would likely be a problem.

    TAKEAWAY 2: If I had to guess I would say the doxycylcine pill helped the most. But in general if you are suffering from dry eye, see an opthamologist. If one doesn't help you, go see another. The goal should be to return proper function so that we aren't relying on drops or other aids to manage dry eye. Getting your meibomian glands back to good health is the only way. But I can't disentangle the effect of doxycycline from the restasis or lotemax.

    TAKEAWAY 3: If you are considering vision correction surgery because contacts no longer function well, you are at a higher risk for dry eye post-surgery. Check first with an opthamologist to see if your meibomian glands function. Treat the gland dysfunction first and try to improve your eyes for contacts. Contacts rest on the lipid layer of your eyes. If your meibomian glands don't produce enough oil (lipids) contacts won't be comfortable, and neither will you post vision correction surgery. (I can't prove this point, but this is my not very educated guess.) It's shocking to me--shocking--that with all of the concerns stemming from post-vision correction dry eye, addressing dry eyes pre-surgery is not a standard procedure. Until the medical community addresses this error patients are on their own. (Hopefully you read this before the surgery, but if you're reading this here it's likely post.)

    Thanks everyone! You can't imagine how much I appreciated this board when I was in dire need. I will send updates on my progress, but hopefully I've got this licked. If you have comments on my treatment regimen please reply.

    As a final note, if you are suffering read everything you can. You can beat this! Best of luck to all of you.

  • #2
    Hi dryis,

    Thank you for your story. I've been through a similar experience, but in sort-of reverse order and with slightly other, but not so different conclusions.

    I've always been very short-sighted (in the -11 diopters range) and suddenly in my late 20's I could not tolerate contact lenses any more (after some 17 years of intensive, daily use). I was diagnosed with dry-eye and later MGD by a specialist. To cut a long story short, after roughly 2 years of very slow improvements under the daily regimes discussed here, my eyes felt stable, little to no irritation and just requiring some artificial tears (Liposic and Artelac Splash are the mix that works for me).

    However, I couldn't stand my glasses at anymore, especially with the restricted field of view with my high prescription. Contact lenses were still impossibly to bear for more than 4 hours. I felt that my dry eyes were well managed and stable. When asked, my ophthalmologist suggested that refractive surgery would be possibly (one eye LASEK, implant in the other) and after some more checks, the specialized surgeon suggested to do two Veriflex phakic anterior chamber lenses.

    That was in March, and just a few weeks later I had the procedure done (covered by insurance ). If done properly (with some luck), there is very little impact on the other parts of the eye where DES happens. Both times, when the bandage came off the next morning, the eyes looked perfect, not even red. Overall, one surgery gave perfect results, the other eye had some later complications with the intraocular pressure and the iridectomy.. Anyway, my vision is now 1,0 and I am quite happy with the outcome.

    The dryness of my eyes is now at least as good as before the surgery, actually the weeks of therapy with anti-inflamatory drops (first steroids then diclofenac) improved the overall situation.

    So, here are my conclusions: Implants are possible with DES, if it is well managed. Of course the risks of any operation will be higher than with perfectly healthy eyes. If your eyes are not stable: please don't take the risk and forget about any surgical intervention until they are, even if it takes some time.



    • #3
      Hi dryis,

      I've had a very similar experience to you. I had ICL surgery early this year and have had issues with dry, irritated eyes ever since. I was then was diagnosed with chronic MGD a month ago. I believe I was asymptomatic pre-surgery but somehow the surgery brought about symptomatic MGD. What's helped me the most so far is hot compresses which makes me believe if I can get my MGD under control, my dry eyes should improve. I've heard about Lipiflow and IPL for MGD so keen to give those a go too.

      I would love to hear an update from you with how you're going with your eyes post-ICL surgery. I'm hoping you've made a complete recovery!