http://search.japantimes.co.jp/cgi-bin/nn20061006f1.html
Friday, Oct. 6, 2006
Lens implant surgery becoming popular
Procedure to fix nearsightedness offers correctable alternative to laser
By KOICHI MIYAGAWA
Kyodo News
A surgery that corrects severe nearsightedness by implanting a lens behind the
cornea is becoming a popular alternative to laser surgery.
An intraocular lens sits under the cornea, attached to the edges of the
iris, to correct nearsightedness. PHOTO COURTESY OF KAZUO TSUBOTA/KYODO
The procedure can correct more severe myopia than lasik surgery can and it can
also be used on people with thin corneas.
Traditionally, intraocular lenses are typically implanted to replace the eye's
natural lens when it becomes clouded by a cataract, but with the new phakic
intraocular lens surgery, the natural lens remains and an implant is slipped
between the natural lens and the cornea.
Kazuo Tsubota, a professor of ophthalmology at Keio University in Tokyo, said
the main feature of phakic IOL surgery is that it can correct a wide range of
nearsightedness.
Phakic IOL surgery was initially developed to correct severe cases of myopia
that cannot be treated with lasik surgery. But Tsubota said the method has also
produced better results than lasik for treating mild nearsightedness.
People who undergo lasik surgery have their corneas' cut with a laser and this
causes some people to see a glare at night when the pupil dilates in the dark.
This doesn't happen to people who have had IOL surgery, as the cornea is not
touched, according to Tsubota.
In phakic IOL surgery, a laser punctures the eye through the iris one or two
weeks before surgery to prevent the pressure inside the eye from dropping
during the procedure. During surgery, under a local anesthetic, a 3-mm incision
is made and a lens is inserted behind the cornea. Two sides of the lens are
then clipped to the edges of the iris to hold it in place.
The surgery takes about 15 minutes, and can be done in a clinic. There are no
stitches needed, as the cut made is tiny -- the soft lens is folded so it can
be inserted into the eye, according to Tsubota.
Immediately after the surgery, the patient must wear protective glasses to
guard the eye from dust and shocks, however, there is little danger of
infection.
With lasik surgery, both eyes can be operated on at the same time, although a
lasered cornea cannot be restored. In phakic IOL surgery, only one eye can be
treated at a time, but the lens can be removed if a problem occurs.
Phakic IOL surgery began in Europe in the 1980s, and has also been approved in
the United States.
The procedure is not covered by Japanese health insurance, and an operation on
just one eye costs between 400,000 yen and 500,000 yen, compared to around
200,000 yen for both eyes in lasik surgery.
At the Minami-Aoyama Eye Clinic in Tokyo, where Tsubota serves as a surgical
adviser, more than 400 phakic IOL operations have been conducted since 1999. On
average, an eyesight of 0.02 diopter before surgery has been improved to about
1.0 diopter, and around 90 percent of patients said they are either very
satisfied or satisfied with the results.
At present, lasik procedures far outnumber the phakic IOL, with 40,000 cases at
the clinic so far, but patients are increasingly choosing phakic IOL surgery,
Tsubota said.
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