Anyone have ICLs with dry eye?

[kymbo71]

I have dry eye and SLK. My doctor just informed me that my eyes will never be healthy enough to do LASIK. I know a lot of you out there are so against LASIK but I have special circumstances. Without going into great detail, I am legally blind in my left eye and need minor correction in my right eye therefore I can not wear glasses due to this condition called anisotropia. For the last 2 years I have been relying only on the vision in my right eye in hopes this SLK and dry eye would get under control enough to get LASIK in my left eye. Well, I was informed that is not an option so my doctor recommend an ICL for my left eye. I was hoping someone has experience with this and can give my any insight.

[Minni]

Wow, that sounds tough.
I'm uninformed - but found confusing anyway what type of blindness you have in eye.
I.E. blind from cataract or whatever.

And if its cataract, I'm wondering whether Prokera can heal a cataract, or does it only help heal post-LASIK.

[kymbo71]

Wow, that sounds tough.
I'm uninformed - but found confusing anyway what type of blindness you have in eye.
I.E. blind from cataract or whatever.

And if its cataract, I'm wondering whether Prokera can heal a cataract, or does it only help heal post-LASIK.

Minni, Thanks for your interest. No I do not have cataracts or any other disease that effects my vision. When I was 5 years old I fell down stairs and my eyes got stuck crossed eyes and this did some damage to my left optic nerve. My vision has always been very bad in my left eye and not too bad in the right eye. I functioned with contact lenses for years but then 2 years ago I developed SLK so I can no longer wear contact lenses which leads to the problem because I can not wear glasses with prescription in both eyes. I have a condition called anismetropia which means my eyes have significant unequal refractive power and spectacle correction causes me to experience a difference in image magnification between the two eyes causing double and even triple vision. Therefore I can not wear glasses. Most people have less the 2 diopters of difference between their eyes, I have over 8 diopters of difference and a ton of astigmastism. I have been wearing glasses with prescription in my right eye only and the left has had no correction. I have adjusted but would love to be able to "see" normally again. Because of the SLK and dry eye, I can not have any refractive surgery either, so I am not left with many options. My doctor is recommending the Implantable Contact Lens for my left eye, but not my right because that eye does not meet the correction needed. I was hoping to get someone on here that has the ICL's and can give me some information. Thanks so much for your reply and interest.

[littlemermaid]

Kymbo, Been thinking of you since you posted and hoping that someone with experience would answer. Ideally, your question would appear to other patients in a Google search so let's double-check keyword spelling? - anisometropia + implantable contact lens ICL + superior limbic keratoconjunctivitis SLK

I'm sure everyone here wants you to be safe. I guess it's about skill and experience on whether they can restore binocular vision with an ICL in the left after all these years (amblyopia, astigmatism since 5yo). Maybe second opinion from a hospital medical ophthalmologist who hasn't got a sales or ego incentive, especially if your questions on risk and outcome are not being answered completely. Time with the Cornea section of Journal of Cataract & Refractive Surgery, PubMed, and ASCRS and ESCRS websites and journals is well spent to learn the doc's perspective. 'I can ... if you like, it's up to you...' is a worry when we are looking for impartial expert medical advice on prognosis for a serious problem. I've just read ICL are more removable than IOL. It's a worry IOL and corneal inlays are marketed cosmetically to young people eg 40yo. A quick search 'US FDA corneal inlay' shows 'patients must be free of ocular surface diseases'. 'World-renowned' sounds funny if we're more interested in outcomes data and long-term results.

There's a question of how they would control the SLK and dry eye inflammation before and after implanting the ICL, and how long that would be expected to last, and maybe ask about different implant techniques rather than just going with his technique and the equipment that practice has. You had a reaction to topical steroid, which wasn't monitored.

I am still wondering whether a super-skilled Optometrist and Orthoptist team really can't use prisms or plano to get you better vision with glasses at least with one eye - why is your right eye with glasses still 20/40? How could you possibly be a lasik candidate?

Would there be strabismus to correct to get an ICL to give binocular vision? Did you get good vision with normal contact lenses before SLK?

It's a worry that you were offered lasik + ICL for a legally blind eye with SLK outside a hospital although I understand 'medical' refractive surgery can be a plan in some cases. I would get more medical opinion on options and your list of doubts before taking any doctor's word - 'if you've bought a hammer, everything looks like a nail'.

Hope you get a reply from someone who's successfully managed an ICL with 2y SLK and the severe dry eye. Are you using long-term anti-inflammatory drops for the SLK? or managing on lubricant drops? Have you still got punctal plugs?

(Re 'we are against lasik', it's the problem that with the cosmetic refractive surgery business, companies have not been open about what's happened to people afterwards, not honest about risks, and advertising is misleading //www.fda.gov/../LASIK/ leading to what the trade are euphemistically calling problems with 'patient expectations' and 'preoperative assessment'. People sometimes can't get restorative and quality-of-life further treatment without taking legal action.)

Here's more info about Kymbo's case http://www.dryeyezone.com/talk/showt...ght=#post90124 The cornea surgeon put you on high-dose steroids, didn't check eye pressure for one month, your IOP (intraocular pressure) doubled to glaucoma risk and SLK seriously worsened. He strangely suggested doing lasik before SLK was resolved, which got you worried. He said your SLK may be helped by the conjunctival resection, but he'd never treated it that bad /emedicine.medscape.com/..SLKtreatment Is the SLK definitely from contact lenses not systemic - has this been tested? Are your eyes feeling better since April? Is he still supportive for the long haul with SLK and ready to answer your questions and work together?

If it was me I would go for 'minimum intervention' for now and prioritise on comfort and maintaining vision in the good eye, maybe consult a sensible ocular surface disorder specialist team in a big university teaching hospital centre. And ask them what they think about his plan from their experience. I'd be thinking it's at least a 40y plan to discuss without rushing.

[kymbo71]

Kymbo, Been thinking of you since you posted and hoping that someone with experience would answer. Ideally, your question would appear to other patients in a Google search so let's double-check keyword spelling? - anisometropia + implantable contact lens ICL + superior limbic keratoconjunctivitis SLK

I'm sure everyone here wants you to be safe. I guess it's about skill and experience on whether they can restore binocular vision with an ICL in the left after all these years (amblyopia, astigmatism since 5yo). Maybe second opinion from a hospital medical ophthalmologist who hasn't got a sales or ego incentive, especially if your questions on risk and outcome are not being answered completely. Time with the Cornea section of Journal of Cataract & Refractive Surgery, PubMed, and ASCRS and ESCRS websites and journals is well spent to learn the doc's perspective. 'I can ... if you like, it's up to you...' is a worry when we are looking for impartial expert medical advice on prognosis for a serious problem. I've just read ICL are more removable than IOL. It's a worry IOL and corneal inlays are marketed cosmetically to young people eg 40yo. A quick search 'US FDA corneal inlay' shows 'patients must be free of ocular surface diseases'. 'World-renowned' sounds funny if we're more interested in outcomes data and long-term results.

There's a question of how they would control the SLK and dry eye inflammation before and after implanting the ICL, and how long that would be expected to last, and maybe ask about different implant techniques rather than just going with his technique and the equipment that practice has. You had a reaction to topical steroid, which wasn't monitored.

I am still wondering whether a super-skilled Optometrist and Orthoptist team really can't use prisms or plano to get you better vision with glasses at least with one eye - why is your right eye with glasses still 20/40? How could you possibly be a lasik candidate?

Would there be strabismus to correct to get an ICL to give binocular vision? Did you get good vision with normal contact lenses before SLK?

It's a worry that you were offered lasik + ICL for a legally blind eye with SLK outside a hospital although I understand 'medical' refractive surgery can be a plan in some cases. I would get more medical opinion on options and your list of doubts before taking any doctor's word - 'if you've bought a hammer, everything looks like a nail'.

Hope you get a reply from someone who's successfully managed an ICL with 2y SLK and the severe dry eye. Are you using long-term anti-inflammatory drops for the SLK? or managing on lubricant drops? Have you still got punctal plugs?

(Re 'we are against lasik', it's the problem that with the cosmetic refractive surgery business, companies have not been open about what's happened to people afterwards, not honest about risks, and advertising is misleading //www.fda.gov/../LASIK/ leading to what the trade are euphemistically calling problems with 'patient expectations' and 'preoperative assessment'. People sometimes can't get restorative and quality-of-life further treatment without taking legal action.)

Here's more info about Kymbo's case http://www.dryeyezone.com/talk/showt...ght=#post90124 The cornea surgeon put you on high-dose steroids, didn't check eye pressure for one month, your IOP (intraocular pressure) doubled to glaucoma risk and SLK seriously worsened. He strangely suggested doing lasik before SLK was resolved, which got you worried. He said your SLK may be helped by the conjunctival resection, but he'd never treated it that bad /emedicine.medscape.com/..SLKtreatment Is the SLK definitely from contact lenses not systemic - has this been tested? Are your eyes feeling better since April? Is he still supportive for the long haul with SLK and ready to answer your questions and work together?

If it was me I would go for 'minimum intervention' for now and prioritise on comfort and maintaining vision in the good eye, maybe consult a sensible ocular surface disorder specialist team in a big university teaching hospital centre. And ask them what they think about his plan from their experience. I'd be thinking it's at least a 40y plan to discuss without rushing.

Thanks for the thoughts and concerns. I am currently being treated by a Dr. Price in Indianapolis, he is a corneal specialist and ocular surface disease specialist. He specializes in corneal transplants and started the Corneal Research Foundation of America. He is internationally known and respected in his field. I do trust him, but because my situation is so unique I am wanting as much information at possible. As far as his profit, I have been paying cash for all visits and treatments. My insurance does not cover him because he is out of state. He has always been fair and reasonable with the costs. I had conjunctiva resection surgery in January 2014. Since then the SLK had returned but now is located in a place that is not treatable with surgery. I have been on blood serum drops for 5 months and they seem to be keeping most of the inflammation under control. My eyes are on most days are tolerable but I know they will never be normal again. At my last visit he told me that my eyes would never be healthy enough to have any refractive surgery but the left eye could be a candidate for the ICL. I go back in 6 months to get more information from him but he wanted more time on the blood serum drops. So I just thought I would try to get my own information in the mean time. As far as my vision, I currently am seeing 20/25 with my right eye corrected only. I function but would like to be able to see out of my left eye also. Maybe I am asking for too much. I will look into more info on the internet, but I really wanted individual experiences with the ICL. I am also 43 years old so that has also brought up questions about the ICL working for me. My doctor suggested the ICL because that would be the only option for me! Thanks for your information and concern, I will take everything you have told me in mind.