Phakic intraocular lens treatment in Izmir is a treatment for refractive errors in which an additional artificial lens is implanted inside the eye without removing the eye's natural lens. It may be considered particularly for people with high myopia, certain types of hyperopia or astigmatism. It may be an alternative when laser surgery is considered unsuitable because of corneal thickness or corneal structure. Phakic lenses are implanted inside the eye and differ from externally worn contact lenses. As the natural lens is preserved, age-related changes in the lens and its near-focusing ability remain important after surgery. Since the procedure requires a small corneal incision, it cannot be said that the cornea is not treated at all. Suitability for treatment and the expected visual outcome are assessed using individual eye measurements.
What Is a Phakic Intraocular Lens?
The term phakic means that the eye's own natural lens remains in place. A phakic intraocular lens is implanted to provide additional optical correction in an eye where the natural lens has not been removed. The lens helps light focus more appropriately on the retina. The procedure differs from the natural lens replacement performed during cataract surgery. While the natural lens is removed during cataract surgery, it is preserved during phakic lens treatment. The existing ability to focus at near distances may therefore initially continue in young adults. However, age-related presbyopia or the development of cataracts later in life is not completely prevented.
What Are the Types of Phakic Lenses?
Phakic lenses are classified into different groups according to where they are implanted inside the eye and the refractive error they correct. Posterior chamber phakic lenses, known as ICLs, are placed between the iris and the natural lens of the eye. Anterior chamber phakic lenses are positioned in front of the iris and may use different support mechanisms depending on their design. The condition of the endothelial cells on the inner surface of the cornea is particularly important with anterior chamber lenses. With posterior chamber lenses, the distance between the lens and the natural lens, as well as the circulation of intraocular fluid, is assessed. The lens design that may be used varies according to the anatomy of the eye, the approved indications for the lens and the existing refractive error. Not every type of phakic lens may be available in the same way in every country or healthcare institution.
Spherical phakic lenses are primarily designed to correct myopia or suitable forms of hyperopia. A toric phakic lens may be used to correct astigmatism accompanying these refractive errors. Correct placement of the toric lens on the appropriate axis and maintenance of this position affect the visual outcome. The power and size of the lens are determined using measurements of the internal structures of the eye as well as the spectacle prescription. Selecting a lens of a suitable size for the individual is important, but no lens guarantees a perfect fit or freedom from glasses in every eye. Some lens designs may have a central opening to support the flow of intraocular fluid. When selecting a lens type, intraocular safety limits are considered as well as correction of the refractive error.
When Is ICL Considered?
ICL is a posterior chamber phakic lens option that may be considered particularly for people with moderate or high myopia who are unsuitable for corneal laser procedures. Toric designs may be considered when astigmatism is also present. A thin cornea or the need to remove a large amount of tissue with laser treatment may lead to consideration of a phakic lens. However, having a thin cornea alone does not indicate sufficient suitability for ICL. Anterior chamber depth, angle structure, endothelial cell density and the condition of the natural lens should also be examined. The dioptre range within which the lenses may be used varies according to the model, approval conditions and individual measurements. It is therefore not possible to state that a single prescription range applies to all phakic lenses.
ICL surgery is considered for adults whose refractive error has remained stable for a certain period. The appropriate age range is determined according to the approved characteristics of the lens model to be used and the clinical assessment. A high spectacle prescription that affects daily life, difficulty using contact lenses or a corneal structure unsuitable for laser treatment may be considered during the decision-making process. Surgery is not essential if adequate and comfortable vision can be achieved with glasses or contact lenses. Expectations should be assessed separately in people whose vision remains limited even with glasses because of amblyopia, retinal disease or another cause. A phakic lens does not eliminate amblyopia or vision loss originating from the retina. The decision to proceed with surgery should be made by considering the person's visual needs together with the risks of an intraocular procedure.
Who May Not Be Suitable?
Safe placement of a phakic lens may not be possible in eyes with insufficient anterior chamber depth. A narrow intraocular angle may increase the risk of the lens adversely affecting fluid circulation and intraocular pressure. A low endothelial cell count or deterioration of cell structure is important for the long-term health of the cornea. Lens selection is assessed more carefully in endothelial diseases such as Fuchs corneal dystrophy. A different surgical approach may be required instead of a phakic lens that preserves the natural lens in people with a significant cataract. The procedure may be unsuitable or may need to be postponed in patients with uncontrolled glaucoma, active uveitis or an eye infection. Suitability is determined by assessing all structures of the eye, not solely the spectacle prescription.
Continued changes in the refractive error may cause the selected lens power to become insufficient in the future. Hormonal changes during pregnancy and breastfeeding may temporarily affect the spectacle prescription and ocular surface. Progressive keratoconus, a history of retinal tears or previous eye surgery also require individual assessment. The retinal structure should be examined in detail before surgery in people with high myopia. The risks of intraocular surgery should be considered separately in people who have useful vision in only one eye. Immune system disorders, uncontrolled diabetes and medicines that affect wound healing may change the timing of treatment. The presence of these conditions does not mean that every phakic lens is definitively unsuitable, but it does require an individual decision.
How Are Preoperative Measurements Performed?
Before surgery, visual acuity, spectacle prescription and whether the refractive error has remained stable according to previous measurements are assessed. Anterior chamber depth and the structure of the intraocular angle are examined to determine whether the phakic lens can be safely positioned. Corneal endothelial cells may be assessed using specular microscopy to measure cell density and structure. Corneal diameter and anterior segment imaging help determine the size of the lens to be used. When necessary, the anterior part of the eye is examined in detail using optical coherence tomography or ultrasound biomicroscopy. Intraocular pressure, the transparency of the natural lens and a dilated retinal examination are also included in the assessment. The required measurement limits for the anterior chamber and endothelium may vary according to the lens model, measurement method and the patient's age.
People who use contact lenses may be asked to stop wearing them for a certain period to ensure the reliability of some measurements. The length of this period is determined according to the type of contact lens used. Previous eye surgery, retinal problems, medicines being used and general health should be disclosed during the examination. Blood-thinning medicines should not be stopped without consulting the doctor managing the treatment. Whether fasting is required is determined according to the anaesthesia or sedation method to be used. Since short-term blurred vision may occur after surgery, it is advisable to arrange transport in advance. During preparation, the possible benefits of the lens, as well as the need for additional surgery and long-term follow-up, should be assessed.
Is Iridotomy Necessary for Every Patient?
Iridotomy is a procedure that aims to assist the circulation of intraocular fluid by creating a small opening at the edge of the iris. It may be necessary before or during surgery with some older phakic lens designs. Routine iridotomy may not be required with some newer posterior chamber lenses that have a central opening. The need for iridotomy is determined according to the design of the lens to be used, the anterior chamber structure and the characteristics of intraocular fluid flow. It therefore cannot be said that iridotomy will necessarily be performed before every ICL operation. Similarly, the presence of a central opening does not mean that the risks of increased intraocular pressure or pupillary block have been completely eliminated. The necessary preventive approach is assessed together with the individual's eye measurements and the selected lens model.
How Is ICL Surgery Performed?
ICL surgery is generally performed under topical anaesthesia or another suitable local anaesthetic method. After the eye and surrounding area have been prepared with an antiseptic solution, a small incision is made at the edge of the cornea. A viscoelastic substance may be used to protect the intraocular tissues and create a working space. The foldable phakic lens is inserted into the eye through this incision. The supporting sections of a posterior chamber lens are placed behind the iris, positioning the lens in front of the natural lens. If a toric lens is used, it is aligned with the axis of astigmatism. At the end of the procedure, the position of the lens and the circulation of intraocular fluid are assessed.
Adequate removal of the viscoelastic substance used is important in managing the risk of increased intraocular pressure during the early period. The incision is usually capable of closing on its own, but a different approach may be used when necessary. The duration of surgery varies according to the anatomy of the eye, the type of lens and the surgical conditions. Whether both eyes are operated on the same day or on different dates depends on individual planning. After the procedure, intraocular pressure and lens position are checked at specified intervals. Since the natural lens remains in place, it is not removed as it is during cataract surgery. Findings arising during or after surgery may require changes to the follow-up plan.
Distance Between the Lens and the Natural Lens
The space between a posterior chamber phakic lens and the natural lens of the eye is called the vault. An appropriate distance is important to prevent the lens from touching the natural lens and to maintain balance among the intraocular structures. A very low distance may increase proximity to the natural lens and affect the risk of cataract development. A very high vault may narrow the anterior chamber angle and increase intraocular pressure. The appropriate range is assessed according to the lens model, the anatomy of the eye and imaging measurements. It is not possible to state that a single micrometre value is mandatory for every patient. The position of the lens and its relationship with the natural lens may be re-examined during follow-up using anterior segment imaging.
Recovery After Phakic Lens Surgery
Blurred vision, mild stinging and light sensitivity may occur during the first hours or days after surgery. The duration of these symptoms may vary according to the eye's healing response and the drops used during the procedure. Vision may recover quickly in some people, while stabilisation of clarity may take longer in others. The corneal incision, intraocular pressure and lens position are monitored during the recovery process. The use of prescribed antibiotic, anti-inflammatory or lubricating drops is determined individually. The same medicines or follow-up days are not required for every patient. Returning to daily life and driving should be assessed according to visual acuity and examination findings.
During the initial period, it is important not to rub the eye and to protect it from impact. The time for returning to swimming pools, the sea, saunas, makeup and strenuous physical activity varies according to the healing of the eye. Increased intraocular pressure may sometimes cause symptoms during the early period and requires monitoring. Severe pain, an intense headache, nausea, significant redness or a sudden reduction in vision are not expected. Newly developed flashes of light, numerous floaters or the sensation of a curtain in the visual field may also require urgent examination. The occurrence of these symptoms does not necessarily mean that there is a serious problem, but they should be assessed without delay. Follow-up dates are arranged according to the lens type and the clinical condition of the eye.
Possible Side Effects and Risks
Phakic intraocular lens surgery carries certain risks, as do other intraocular procedures. Increased intraocular pressure, intraocular inflammation, infection and corneal oedema may occur. A reduction in endothelial cells may affect the cornea's ability to remain transparent over the long term. Positioning of the lens too close to the natural lens or age-related changes may contribute to cataract development. Rotation or displacement of the lens, or an inappropriate lens size, may alter the visual outcome. The risk of retinal tears or retinal detachment is assessed separately, particularly in people with high myopia. No lens design guarantees that these complications will be completely prevented.
Halos, glare, starbursts or reduced contrast may occur around lights at night. Rotation of a toric lens away from its axis may reduce the effectiveness of astigmatism correction. Impaired circulation of intraocular fluid, pigment dispersion or an increase in pressure caused by the drops used may require additional treatment. A serious intraocular infection may rarely develop and require prompt intervention. If the lens power differs from the expected result, glasses or contact lenses may still be required. Some problems may require repositioning, replacement or removal of the lens. It should be remembered that every additional intraocular procedure carries its own risks.
Intraocular Pressure and Endothelial Monitoring
Monitoring intraocular pressure after phakic lens surgery is important for both early and long-term follow-up. Increased pressure may develop because of retained viscoelastic substance used during surgery, impaired intraocular fluid flow or medicines. The cause of the pressure increase is determined through examination findings. Pressure-lowering drops, medicines or another procedure may be used when necessary. The same pressure-lowering medicine does not need to be routinely given to every patient. The lens vault and intraocular angle may also be assessed using anterior segment imaging. The frequency of follow-up varies according to the lens model and the risk of increased intraocular pressure.
Corneal endothelial cells form an important cell layer that keeps the cornea transparent. These cells may naturally decrease over time, and additional loss may occur after intraocular surgery. The type of phakic lens, anterior chamber depth and lens position are assessed in relation to the endothelium. Monitoring cell density with specular microscopy may help identify long-term changes. Endothelial cell loss does not progress at the same rate in every patient. If a significant reduction is detected, the suitability of leaving the lens inside the eye may be reassessed. Regular follow-up is necessary to evaluate not only the spectacle prescription but also the long-term health of the cornea.
Can a Phakic Lens Be Removed?
Phakic intraocular lenses may be surgically removed or replaced with a different lens when necessary. This characteristic differs from laser procedures in which corneal tissue is removed. However, the fact that the lens can be removed does not mean that the procedure is entirely risk-free or completely reversible. Removal or replacement requires another operation inside the eye. This may create a risk of infection, changes in intraocular pressure or other surgical complications. Lens displacement, insufficient vault distance, endothelial cell loss or cataract development may influence the decision to remove the lens. Whether additional surgery is required is determined according to individual examination and imaging results.
What Determines the Visual Outcome?
The visual outcome of phakic lens surgery depends on the initial refractive error and the overall health of the eye. Accurate calculation of lens power and selection of the appropriate lens size are important. With toric lenses, correct determination of the astigmatism axis and maintenance of the lens position affect the result. The achievable level of vision may be limited if retinal, macular or optic nerve problems are present. In people with amblyopia, the lens only corrects the refractive error and does not eliminate the developmental limit of the eye's vision. Some patients may require glasses for certain activities after the procedure. It is therefore not appropriate to provide a fixed success rate or state that complete freedom from glasses will be achieved in every patient.
Can Vision Change Over Time?
The presence of a phakic lens inside the eye does not mean that the spectacle prescription and vision will never change throughout life. The refractive error may change over time or differences may develop in the position of the lens. Presbyopia and cataracts may develop in the natural lens with advancing age. Retinal problems associated with high myopia may occur even when a phakic lens has been implanted. Rotation of a toric lens or changes to the ocular surface may also affect visual quality. These situations are assessed as natural changes in the eye or problems that may develop after surgery, rather than as resistance to treatment. Regular follow-up helps determine the cause of new visual symptoms.
Precautions After Surgery
Prescribed eye drops should be used at the recommended frequency and for the specified duration. Hands should be washed before applying the drops, and care should be taken not to touch the eye with the tip of the bottle. Avoiding rubbing the eyes and protecting them from impact are important during recovery. Protective glasses or an eye shield may be used during sleep when necessary. The time for returning to swimming pools, the sea, saunas and strenuous exercise is determined according to the course of the surgery. Driving should be avoided until vision has become clear, and activities requiring occupational safety should not be resumed. Medicine doses should not be changed based on personal judgement, and treatment should not be stopped early.
Intraocular pressure, lens position, vault distance and the condition of the natural lens are assessed during follow-up appointments. Endothelial cell measurements and retinal examinations are repeated when necessary. Although mild stinging or light sensitivity may occur, increasing pain, significant redness and a sudden reduction in vision should not be considered normal. Blurred vision accompanied by headache and nausea may require assessment for increased intraocular pressure. Flashes of light, new floaters or a shadow in the visual field may require a retinal examination. Follow-up frequency may not be the same for every patient. Long-term monitoring is important to ensure that the lens remains compatible with the intraocular structures.
Phakic Intraocular Lens Treatment in Izmir
When planning phakic intraocular lens treatment in Izmir, the degree of refractive error and suitability for corneal laser treatment are assessed first. Anterior chamber depth, endothelial cell density, intraocular pressure and the condition of the natural lens are examined together. Retinal assessment is an important part of treatment planning for people with high myopia. As the intraocular anatomy of people with the same spectacle prescription may differ, the same lens may not be suitable for everyone. The choice between a toric or spherical lens is made according to the existing degree of astigmatism and eye measurements. Glasses, contact lenses and laser options may also be compared in suitable cases. The decision to proceed with surgery should be made by considering the individual's visual needs together with the risks of an intraocular procedure.
Phakic Intraocular Lens Treatment Prices
Phakic intraocular lens treatment prices may vary according to the type of lens to be used, the refractive error to be corrected and the scope of surgery. When evaluating phakic intraocular lens treatment prices for 2026, it should be taken into account that spherical and toric lenses do not have the same characteristics. Anterior chamber measurements, endothelial assessment, retinal examination and follow-up requirements are also part of the planning process. It is not appropriate to set a standard fee for ICL surgery without an examination. If the two eyes require different powers or different lens characteristics, the scope of treatment may change. Price information alone does not indicate whether the lens is suitable for the eye's structure or the potential surgical risks. Current pricing is assessed after the necessary measurements have been completed and an appropriate treatment plan has been determined.
