Wang Vision Cataract and LASIK Center, Nashville, Tennessee

BY HOLLY CONNER SHARP
Saturday, April 29, 2006

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Twenty-six year-old Alan Judd wore glasses or contacts to correct his all but legally blind eyesight since he was nine. However, on Feb. 28, Judd's world completely changed. Thanks to a new bendable contact lens, Alan is seeing 20/15. For those like Alan who are not LASIK candidates, there is now new hope.

As of December 2005, the STAAR Visian (ICL)T is the second FDA-approved implantable contact lens in the United States, and it's battling the VerisyseT phakic intraocular lens (IOL) for top market share for extremely nearsighted patients. These new ICLs are specifically designed to correct vision for very nearsighted people who are not candidates for laser procedures.

Like Verisyse, the Visian ICL is best for distance correction for people with moderate to high nearsightedness, but the Visian sits behind the iris and requires a smaller incision to implant than the Verisyse. Dr. Jim Loden performed the first Nashville implant this February. The procedure requires a 3 mm incision into the cornea and according to Loden, "often takes less than 10 minutes to perform. Generally, the patients have 80-90 percent vision restoration within the first 24 hours."

Dr. Loden says the ideal Visian ICL candidate is 21-50 years old with -6 myopia and higher. The procedure is completely reversible and can be done in less time than the original implant procedure itself.

"With Visian ICL, there is no altering or removing any eye tissue, so if you don't like it, it can be easily removed," explains Loden.

In laser surgeries, corneal tissue is permanently removed reshaping the eye for better vision. "Patients with high myopia would require too much corneal tissue to be removed making LASIK out of the question, but with Visian these very nearsighted patients have an option," adds Loden.

That was the case for Loden patient Roger Ray of White House, Tenn., whose best corrected vision before the Visian ICL was 20/40. Ray said he was told the LASIK "would require too much scraping of his cornea," so when he learned about the Visian, he was very interested. "I now see 20/20," Ray says of the procedure. Alan Judd notes marked improvement in his eyesight as well; however, he adds, "There was slight discomfort while my eye acclimated to the new lens."

Dr. Ming Wang of the Wang Vision Institute prefers the Visian because it is placed in the posterior chamber of the eye behind the iris, in front of the lens. According to Wang, "This location is preferable to that of the Verisyse because the Verisyse attaches to the iris behind the cornea, which can cause problems with the cornea in younger patients who need to have the lens there for years and years, and in some cases, the back surface of the cornea can decompensate from irritation of the anterior chamber lens."

The Verisyse phakic IOL was the first implantable contact lens approved by the FDA in 2004. The Verisyse is a micro lens made out of PMMA, the same plastic material used over the past 50 years in cataract surgery. The Verisyse lens is placed into the eye behind the cornea and is then clipped to the front of the iris to hold it stable. It has been used in Europe for more than 17 years with over 150,000 Verisyse lenses implanted worldwide. Dr. Peter Arrowsmith, who works extensively with Verisyse implantation in Nashville, says the procedure is $5,120 per eye, including exam and follow-up.

The cost of the Visian procedure (not including any other surgical tests or costs) at Loden Eye Center is $3,500 per eye. According to Wang, the cost at The Wang Vision Institute is $5,000 per eye for all surgical procedures and measurements that are required - the price includes the ultrasound measurements, the laser procedure prior to implantation, the lens implantation and LASIK if needed later. Dr. Stewart Shofner, a refractive surgeon since 1990 in Middle Tennessee who will soon be offering the Visian, says he is impressed and pleased to offer the new Visian technology but is "somewhat concerned about the costs for patients." The Visian, similar to most laser procedures, is not covered by insurance plans.

Herb Stewart, principal and regional manager of STAAR Surgical estimates 60,000 Visian implants have occurred worldwide. Loden claims, "The risk of infection with the Visian ICL is less than one in 2,000 cases and there is only a two in 1,000 risk of getting a cataract." Loden adds that "the ideal patient is without cataracts or preexisting glaucoma."

At press time, the three Tennessee STAAR certified Visian ICL physicians are: Drs. Young Choi (Chattanooga), James Loden and Daniel Bergman (both of Nashville). Herb Stewart notes that several other physicians in Nashville are in the process of receiving complete certification and on-site training.

Finally, just when you thought you had the scoop on the latest implantable contact lens, there's another one just around the bend. Dr. Jeffrey D. Horn of Vision for Life in Nashville is the principal investigator in an ongoing trial for a new Alcon lens. Horn believes the perfect lens is not available yet. He explains, "The Visian may sit too close to the human lens which can lead to cataract formation, while the Verisyse's larger incision may lead to astigmatism along with the unknown, possibly negative effects of clipping the lens to the iris." Horn says the Alcon lens, which is still undergoing phase III testing, requires a small incision, sits in front of the iris and does not require clipping. He adds, "It too is removable and reversible."