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‘Permanent contact lens’ offers alternative to Lasik: Is it right for you?

The EVO Visian implantable collamer lens was approved by the FDA this year. It’s designed to stay in the eye forever without any maintenance.
Maimoona Azeem had been wearing glasses since she was 8 years old. She wasn't a candidate for Lasik so she decided to have lenses permanently implanted to correct her vision.
Maimoona Azeem had been wearing glasses since she was 8 years old. She wasn't a candidate for Lasik so she decided to have lenses permanently implanted to correct her vision.Courtesy Maimoona Azeem
/ Source: TODAY

Like many people who’ve been nearsighted since childhood, Maimoona Azeem was looking for a way to stop wearing glasses and contact lenses.

But there were even more compelling reasons to correct her vision. Azeem, 33, has significant astigmatism — an imperfection in the curvature of the eye — and said she could only wear contacts for a few hours before she would get dry eyes or migraines. Plus, her eyesight was never completely sharp even with glasses or contacts.

Azeem looked into Lasik, but was not a good candidate for the laser eye surgery because her corneas were too thin and her astigmatism was at a level where it could not be corrected.

That’s when her doctor suggested a permanent “implantable contact lens” more formally known as the EVO Visian implantable collamer lens, which was approved by the U.S. Food and Drug Administration in March. It’s designed to stay in the eye forever behind the iris without any maintenance.

Azeem, who underwent the procedure last month at the University of Michigan Kellogg Eye Center in Ann Arbor, called it “life changing.”

“Of course, there are always those last minute jitters,” Azeem, a speech therapist who lives in Toledo, Ohio, told TODAY. “(But) I am so happy… I thought my vision was good with my corrective lenses, but I can see so much better now, things are just brighter, more crisp. It’s beautiful.”

The new implantable lens is a welcome addition to the options people have to correct nearsightedness, said Dr. Shahzad Mian, a professor of ophthalmology at the University of Michigan Medical School and Azeem’s surgeon.

It can correct severe nearsightedness, up to -20 diopters, while doctors generally avoid doing laser corneal surgery like Lasik or photorefractive keratectomy (PRK) beyond -8 or -9 diopters, he noted. A version of the implantable lens can also correct astigmatism.

“This is really going to help a lot of patients who otherwise would not have qualified for refractive surgery,” Mian noted. “They are limited in what they can do without their glasses or contact lenses. So it really is a huge change in their quality of life.”

How do the EVO implantable lenses compare to Lasik?

With laser eye surgery like Lasik, doctors permanently change the shape of the cornea — the clear front part of the eye — to correct vision. The process is irreversible and can lead to complications such as severe dry eye syndrome, according to the Federal Trade Commission.

But with the implantable lens, the insertion surgery doesn’t change the shape of the cornea, so there’s less risk of dry eye, and the procedure is reversible — the lens can be taken out, Mian said.

To insert the lens, he makes a small incision in the cornea, injects and positions the lens in behind the iris — the colored part of the eye — and closes the wound, which generally does not require any sutures. Mian called it “a relatively simple procedure” that takes about 10 minutes or less per eye.

Because the lens is implanted behind the iris and made of clear material, you cannot see the it in the eye.
Because the lens is implanted behind the iris and made of clear material, you cannot see the it in the eye.Courtesy STAAR Surgical Company

The lens is approved for people who are 21 to 45 years old. Singer Joe Jonas is a high-profile patient and spokesperson for the product.

Even though the EVO implantable lens was approved by the FDA this year, an older version has been around since 2006 so the concept has many years of safety data, Mian said. The new lens has a small opening built in, which allows fluid in the eye to move freely. Before this redesign, doctors had to perform an extra procedure to create little holes in the iris to reduce the risk of high pressure in the eye, which was “a burdensome step on the patients,” Mian noted.

The implantable lens is more expensive than laser eye surgery: At Kellogg Eye Center, it costs about $4,500 per eye, compared to $2,300 per eye for Lasik, Mian said.

Potential complications:

As with any surgery, there's a low risk of infection, Mian noted.

There is a risk of developing a cataract, which continues to rise with each year the EVO lens is in the eye, according to the patient information booklet provided by STAAR Surgical Company, the maker of the lens.

Other risks include raised eye pressure, the loss of cells on the surface of the cornea responsible for keeping it clear, and patients experiencing glare and halos after surgery, the booklet noted.

Azeem saw halos after her procedure, which is very common, especially early on, because there’s some swelling and inflammation, Mian said. As that goes away and the lens settles in place over the first few weeks, the halos resolve or people adjust to them, he noted.

What it feels like to have the lens implanted:

For the procedure, the eye is numbed with medication. At Kellogg Eye Center, patients also receive intravenous medication to relax, but that’s not required, Mian said.

Azeem said she felt no pain during her procedure, but remembers seeing different shapes and colors, and noticing cool sensations in her eye.

“I did have awareness of my surroundings, so I was still awake, but I didn’t feel anything,” she recalled.

The procedure to implant the lens takes about 10 minutes per eye.
The procedure to implant the lens takes about 10 minutes per eye. Courtesy STAAR Surgical Company

Patients’ vision won’t be completely clear as they get up from the table — it takes a few hours to a day or so for their vision to continue to improve, Mian noted.

Azeem said her vision was extremely blurry and very sensitive to light at first. It took about three days for her to feel comfortable to drive and return back to work, and a week for her eyes to fully heal during which she had to avoid touching them or wear makeup. She wore eye shields at night to avoid inadvertently touching her eyes during sleep.

After the recovery period, Azeem said she’s now enjoying her crisp new vision.

“It’s such a good experience because since I’ve been 8 and wearing glasses or some kind of corrective lens, I thought my vision was good because I was able to see, but after the surgery… it is literally a new world,” she noted.