Implantable Contact Lenses - Dry Eye & Keratoconus

[SC77]

I am considering having implantable contact lenses. I suffer with chronic MGD and Keratoconus. I wanted to reach out and see if anyone else has had this procedure? How did you get on? Do you still use hot compress etc?

[DryEyeNJ]

It's a terrible idea if you already have MGD. Making a corneal incision to implant the lenses is going to sever corneal nerves, add inflammation, and potentially make your MGD much much worse.

[linguininess]

Is there proof on that? I heard ICLs are "ideal" (and I use that term cautiously) for dry eye sufferers. This honestly has me confused since many top doctors...and I'm talking about top .5% globally here... have said ICLs do not worsen dry eye symptoms. Their main concern for ICL is that it induces early onset cataracts.

[CharlieGreenEyes]

A bit worrying if ICLs are a bad idea for someone with MGD. This procedure was suggested to me by the most recent opthalmologist I saw - and I apparently have very bad MGD....

SC77 - are you considering it for the keratoconus so vision correction more than for the MGD? They were suggested to me not to help my MGD but because I have a very complex vision issues that aren't corrected with glasses - and the MGD has made it too difficult to wear RGP lenses on a daily basis. I understood from the opth that I'd still separately need MGD treatment.

I haven't had a chance to look into the procedure more but I'm planning to find out more at my next consultation - so I'll report back anything I'm told.

[Hokucat]

I guess it comes down to how much one wants to be able to see without glasses or contacts, how bad their vision is, the severity of one's dry eyes, one's level of adversity to risk, and the expertise of and trust in one's doctor. I think it would be helpful to also get the opinions of at least a few trusted dry eye specialists who do not perform the ICL procedure.

I have gone from being home bound for several years due to extremely severe dry eye (MGD/blepharitis), to managable dry eye, and am risk-averse, so personally would not opt to have any elective surgery that could have potential to set me back. It was a depressing, lonely, helpless, and unbearable situation for me to have constant debilitating eye pain.

If one has MGD, likely the tear film is not stable and the nutrients are not at the optimum level, as with normal tears, to protect the eye and help them heal quickly from injuries. So if an incision is made on the cornea, a compromised tear film may prevent the incision from healing, or make it more difficult to heal. Also, with dry eyes, the surface of the eye may already not be smooth, and adding an incision can further disrupt the tear film from evenly distributing over the eye. Like DryEyeNJ says, also your corneal nerves could possibly get damaged from the surgery, but maybe the chances for this are less than with LASIK, since the incision is not as deep (since they lay the contact lens over your natural lens).

There was a very recent post by someone with borderline dry eye, who had the Raindrop lens inlay. The incision is very small with this procedure, but it didn't heal correctly and she has also had other problems since the surgery, like corneal scratches and most of all, constant debilitating pain. Given these types of outcomes, I think those of us in this forum recommending against elective eye surgeries just want you to be careful and safe, especially if you already have dry eyes.