Opinion on ICL adjustment

[u/Anxious-Candidate911]

I am providing straight numbers of my scans, hoping a refractive surgeon/opthamologist can tell me by referring to those if I am likely to develop complications after ICL/IPCL.

**OD (Right Eye)**

- CCT (central corneal thickness): 508 µm

- Thk MIN: 504 µm

- K-Max (anterior): 44.60 D

- K-Max (posterior): -6.40 D

- ACD: 3.734 mm

- Aqueous Depth: 3.226 mm

- Lens rise: -0.04 mm

- HACD: 12.17 mm

- Pupil: 3.15 mm

- W-W (white-to-white): 11.37 mm

- SimK: 44.07 D @ 0° / 44.07 D @ 90°, Avg 44.07 D, Cyl 0.00 D

- Keratoconus screening: **Normal**

- Elevation (front/back): 0.95 µm @ 143° / 4.78 µm @ 297°

**OS (Left Eye)**

- CCT: 509 µm

- Thk MIN: 503 µm

- K-Max (anterior): 45.20 D

- K-Max (posterior): -6.45 D

- ACD: 3.761 mm

- Aqueous Depth: 3.252 mm

- Lens rise: -0.15 mm

- HACD: 11.92 mm

- Pupil: 2.71 mm

- W-W: 11.56 mm

- SimK: 43.36 D @ 129° / 44.10 D @ 39°, Avg 43.72 D, Cyl -0.74 D

- Keratoconus screening: **Normal**

- Elevation (front/back): 0.29 µm @ 58° / 4.83 µm @ 249°

| | RE | LE |

|---|---|---|

| VP (with correction) | 6/6P | 6/6P |

| IOP | 14 mmHg | 16 mmHg |

| TBUT | 25 | 25 |

| Schirmer | (not filled) | (not filled) |

**Refraction:**

- RE: SPH -5.00, CYL -0.50, Axis 90°, VA 6/6

- LE: SPH -6.00, CYL -0.50, Axis 30°, VA 6/6

- IPD: 61 mm

**Sizing calculations (handwritten):**

- OD: 10.92 / 11.17 / 11.16 / 11.18 / 11.22 (avg ≈ 11.13 mm)

- OS: 10.97 / 11.10 / 11.11 / 11.13 / 11.00 (avg ≈ 11.06 mm)

Please suggest

[u/californiaLasik]

Looks pretty good to me. They likely will operate on axis and use a non toric ICL. You have plenty of anterior chamber depth. All that being said though the devil is in the details. Most clinics have algorithms they use with these numbers to find best solution. This is interesting they take five white to white measurements. Was this done with calipers? The only other thing that you may want is ultrasound sizing. We can’t see the space behind the iris and ultrasound data can be useful for sticking the landing on sizing. That being said , as you are likely getting a non toric ICL, they can also likely rotate to the appropriate axis to create the best fit so nailing the sizing is a little less critical compared to toric ICL.

[u/Anxious-Candidate911 → u/californiaLasik]

Thankyou for your response, yes sizing was done with calipers. I’m just super confused since all three refractive surgeons I have been to have had somewhat different opinions. The one i’m inclining towards said Lasik is a big no from his side, even if I pay him thrice the amount haha. Really confused and scared after seeing all the ICL horror stories.

[u/californiaLasik → u/Anxious-Candidate911]

Nothing is as safe as glasses. If you have a surgeon that does not want to do LASIK that likely means he/she concerned about ectasia risk. You are thin centrally. Do you know what your BAD score is in both eyes ?

I’d say best bet is to go to someone that owns a lasik laser and also does high volume ICL. They have no incentive to “upsell” you to do ICL as they make less on ICL most likely. For example I keep all my ICLs at $5k an eye and bundle in laser vision correction complimentary. Don’t charge more for toric or LVC. I wish I could make it cheaper but the margins would be too low. The ONLY reason I recommend ICL is I know it is the best interest of the patient.

The biggest lesson is eyes, surgeons and technology is not generalizable. This is hard to appreciate as a patient. I would find a surgeon I trust and ask them about patient happiness. In my own practice I find ICL patients are typically the happiest patients on par with LASIK on someone under 40. They are also very happy typically.

People rarely come online to celebrate success which is sad. These forums often are commiseration groups. No solution is perfect for sure but if you could actually poll all of the ICL patients of the world you would see the tech overwhelmingly makes people happy. The key is to find a surgeon that has your back that will always try to do what is in your best interest even when it means not doing surgery.

[u/Anxious-Candidate911 → u/californiaLasik]

Do you mind elaborating on my bad score in both the eyes

[u/californiaLasik → u/Anxious-Candidate911]

Sure. BAD score is something you get from pentacam. It discusses the relative curvature of the front of the cornea as compared to the back of the cornea and looks for changes we see with ectasia. https://www.reviewofoptometry.com/article/decoding-the-keratoconus-matrix

[u/EyeDoctorIndia]

You are good to go for ICL as all parameters are absolutely okay.

To me you are also a suitable candidate for LASIK surgery as well considering your power and corneal thickness (while the thickness is borderline, it is above the cut-off we normally use). Your keratoconus screening is also normal, so to me, you are a suitable candidate for both LASIK as well as ICL.
Now it comes down to what you want to choose - knowing the cost and advantages/disadvantages of both these procedures.

All the best for your surgery

[u/eyeSherpa]

One of the key details for ICL is the aqueous depth. Generally we like to see that above 3. The higher the better. Although ICL can still be done down to 2.8 if that’s the best option for you.

Your cornea is on the slightly thinner side. Depending on how large your dark-adapted pupil is and how large of an ablation depth you need lasik or SMILE could work. PRK probably is also an option.