Intacs vs ICL: Your Essential Guide to Keratoconus Treatment Options

The decision between Intacs and ICL treatment is vital if you have keratoconus. This progressive eye condition affects about 265 people per 100,000. The cornea takes on a cone shape that leads to poor vision and blurriness, which affects your quality of life. People of all ages can develop this condition, but it mostly appears in those aged 10 to 25 years.

Keratoconus gets worse without treatment and causes more serious vision problems. Modern treatments like Intacs (corneal implants) and ICL (Implantable Contact Lenses) show great promise to fix refractive errors and enhance vision quality. Research reveals that ICL treatment delivers better uncorrected and best corrected distance visual acuity after surgery. The treatment approach sometimes combines different methods to get the best results for various keratoconus types. The management of keratoconus keeps improving with new developments like corneal crosslinking that helps stabilise the cornea. This piece will guide you to understand which option suits your condition and vision needs best.

Understanding Keratoconus and Treatment Goals

What is keratoconus and how does it affect vision?

Keratoconus is a condition where your cornea thins and weakens over time, making it bulge outward like a cone. This happens because the supporting collagen fibres become weak, which makes the cornea unstable. Most people develop this condition in their teens or early twenties, and it usually affects both eyes, though one eye might be worse than the other.

Recent studies show keratoconus is more common in the UK than we once thought. White Europeans have a rate of 1 in 1,750, while Asian populations show higher numbers at 1 in 440. Family history plays a big role too – more than 20% of cases run in families.

Your vision becomes distorted as your cornea changes shape. You might notice:

• Blurred and cloudy vision
• Multiple or ghost images
• Light sensitivity (photophobia)
• Poor night vision

The irregular surface of your cornea makes it hard for light to focus on your retina. This creates an irregular astigmatism that regular glasses can’t fix.

Why early intervention matters

Getting treatment early can make a huge difference in your long-term vision. Young patients need help fast because their condition tends to get worse faster. Vision gets worse as the cornea continues to change shape. Regular glasses stop working effectively. Some patients might need a corneal transplant if scarring develops. Finding keratoconus early helps prevent complications from refractive surgery that could trigger corneal ectasia. Doctors find it challenging to spot keratoconus before symptoms appear. The numbers jump up in certain groups – to name just one example, people with astigmatism over 2 diopters have a 14.1% chance of having keratoconus or its early form.

Goals of keratoconus treatment: stability, shape, and clarity

Today’s keratoconus treatment wants to stop the condition from getting worse while improving vision. This approach helps your eyes now and protects them for the future. The first step is to stabilise your cornea and stop it from getting thinner. Corneal Collagen Cross-linking (CXL) works well as the first treatment choice for progressive keratoconus. CXL creates extra bonds between collagen fibres to make your cornea stronger, which stops the condition from getting worse in most cases.

Next comes fixing your vision. Glasses might work if your case is mild. As things progress, special contact lenses – especially rigid gas permeable or scleral lenses – often give better results. Some patients might need surgery like Intacs (intrastromal corneal ring segments) to flatten their cornea and make contact lenses more comfortable. Patients with scarring or very thin corneas might need a corneal transplant (keratoplasty). Getting treatment early through cross-linking and proper vision correction helps many patients avoid needing a transplant.

Precision Vision London creates custom treatment plans based on your cornea’s unique features, how far the condition has progressed, and what you need to see better. This gives you the best chance for good vision now and healthy corneas in the future.

How Intacs Work for Keratoconus

Intacs give keratoconus patients a new surgical option to improve their vision without needing corneal transplants. These small, curved polymethylmethacrylate (PMMA) implants are a less invasive option that has gained traction since getting FDA approval for keratoconus treatment.

Mechanism: Reshaping the cornea with ring segments

Intacs act as spacer elements between the collagen fibres of corneal tissue. They create an arc-shortening effect that flattens the central corneal area. Unlike laser procedures that remove tissue, these semi-circular ring segments reshape the existing cornea mechanically. The flattening effect after implantation relates directly to segment thickness and inversely to the corneal diameter at the implant site. Thicker segments and smaller diameter placement give better flattening results.

Our specialists at Precision Vision London use advanced femtosecond laser technology. This creates precise channels within the corneal stroma—about two-thirds through its depth—where we insert the segments. The technique gives more uniform tunnel depth and results in a safer, more predictable procedure.

Ideal candidates for Intacs

A full assessment helps identify suitable candidates for Intacs implantation. Good candidates typically meet these criteria:

• Corrected distance visual acuity below 0.9 on the decimal scale
• Contact lens intolerance
• No central corneal scarring or leucoma
• Corneal thickness of at least 450μm at the implantation site
• Keratometry readings not exceeding 58D for standard Intacs
• Clear central corneas
• Age over 21 years

Newer Intacs SK might help patients with more advanced keratoconus. These feature an inner diameter of 6.0mm versus the standard 6.8mm, and an oval cross-section instead of hexagonal. Such design changes make them a better option for severe cases or patients with thinner corneas.

Expected visual outcomes and limitations

Clinical studies show real improvements after Intacs implantation. Most patients see a reduction in keratometric readings between 3 and 5 diopters. This leads to better uncorrected and corrected visual acuity.

One complete study showed uncorrected visual acuity improved from worse than 20/200 to better than 20/60 after implantation. The average corneal astigmatism decreased from 3.34D to 1.97D. Another study found that 72% of eyes gained at least 2 lines in uncorrected visual acuity. About 45% improved by 2 or more lines in best-corrected visual acuity 9 months after surgery.

Studies show 70-80% of patients noticed better uncorrected and best-corrected vision. Vision improvements come in part from reduced higher-order aberrations, specifically asymmetric aberrations like coma.

Note that Intacs mainly improve corneal shape but don’t stop disease progression. That’s why at Precision Vision London, we often suggest combining Intacs with corneal collagen cross-linking to reshape and stabilise the cornea.

Risks and reversibility of Intacs

Intacs have an excellent safety profile, but some risks exist. Surgical challenges might include segment decentration, wrong tunnel depth, or segment asymmetry. These issues are rare now with femtosecond laser technology.

Uncommon post-surgery complications can include:

• Ring segment extrusion or migration
• Corneal neovascularisation
• Corneal haze
• Infection (about 2-3% of cases)
• White deposits around segments (histopathologically identified as fatty acids without visual impact)

The ability to reverse this procedure is one of its best features. If complications occur or results aren’t satisfactory, we can safely remove the segments. Research shows that after removal, visual, refractive, and topographic variables usually return to pre-surgery levels within 1-7 weeks (average 4 weeks). Patients find comfort knowing this procedure won’t permanently change their corneal structure.

Our specialists at Precision Vision London carefully assess each patient’s unique corneal characteristics before suggesting Intacs. This ensures the best outcomes through personalised treatment planning.

How ICL Surgery Addresses Refractive Error

Patients looking for alternatives to Intacs will find Implantable Collamer Lenses a great option to manage keratoconus-related vision problems.

What is an Implantable Collamer Lens (ICL)?

An Implantable Collamer Lens consists of a soft, flexible biocompatible implant made from collagen copolymer material with a refractive index of 1.452. These lenses don’t reshape the cornea. They work by adding a corrective lens inside your eye while keeping your cornea’s structure intact. The lens material blocks UV rays, which helps protect your eyes.

Precision Vision London uses the Visian ICL, which has a plate haptic configuration. The lens features a central convex/concave optical zone and a forward vault design that reduces contact with your natural lens. This design helps position the lens perfectly in your eye and will give a better visual outcome while protecting your eye’s health.

ICL placement and how it improves vision

Surgeons place the ICL in the posterior chamber, right behind your iris but in front of your natural crystalline lens. This placement creates a layer of aqueous humour that keeps it separate from your natural lens. The ICL starts working right away to fix refractive errors by teaming up with your eye’s natural focusing system.

Patients see remarkable improvements in their vision. Research shows patients reached a median uncorrected distance visual acuity (UDVA) of 20/25 during follow-up visits. About 40.6% of patients achieved 20/20 vision. The median spherical equivalent typically drops from about -7.875D before surgery to -0.3125D after. The median manifest refractive cylinder usually decreases from 3.00D to 1.125D.

Suitability for keratoconus patients

ICL treatment works best for keratoconus patients who:

• Have stable, non-progressive keratoconus
• Are between 21-40 years old
• Show contact lens intolerance
• Have an anterior chamber depth of at least 3mm
• Have a clear central cornea
• Show keratometric values ≤52.00D

ICL implants work to correct vision quickly and reversibly while keeping your cornea intact. Our specialists at Precision Vision London carefully check these criteria to see if you’re right for this procedure.

ICL vs glasses and contact lenses

ICLs beat traditional vision correction methods in several ways. You get continuous vision correction without dealing with daily insertion or removal. Many patients notice better night vision and less glare after the procedure.

Keratoconus patients benefit because ICLs don’t cause dry eye symptoms since they don’t touch the eye’s surface. This helps patients who don’t deal very well with contact lens discomfort or intolerance—a common issue with keratoconus.

Research proves ICLs are safe and work well. Studies show a safety index of 0.77 four years after surgery, which proves they remain stable long-term. After 4 years, 82.5% of eyes stayed within ±0.50D of the planned correction, and 97.05% stayed within ±1.0D.

You can remove ICLs if your vision needs change in the future. This reversibility gives them an edge over permanent corneal procedures, especially since keratoconus tends to get worse over time.

Visual Outcomes: Intacs vs ICL Over Time

The largest longitudinal study comparing Intacs and ICL treatment options for keratoconus gives us informed insights about eye care decisions based on objective visual outcomes.

Uncorrected Distance Visual Acuity (UCDVA) improvements

Clinical data shows both treatments improve UCDVA by a lot, though the results differ in scale. Patients using Intacs typically see their UCDVA improve from worse than 20/200 before surgery to about 20/50 after. ICL patients show much better results, with UCDVA reaching 20/32 or better in many cases.

Studies over four years prove ICL works better than Intacs for uncorrected vision. The ICRS (Intacs) group improved from 0.65 LogMAR to 0.41 LogMAR. The TICL group achieved far superior results, moving from 0.82 LogMAR to 0.10 LogMAR. This means ICL patients can usually handle daily activities without glasses, while Intacs patients often need extra correction.

Best Corrected Distance Visual Acuity (BCDVA) comparison

Both treatments prove safe, though they affect best corrected vision differently. ICL shows better BCDVA outcomes in all studies. Four-year data reveals BCDVA improved from 0.15 LogMAR to 0.09 LogMAR in the TICL group. The ICRS group barely changed, moving from 0.37 LogMAR to 0.33 LogMAR.

About 87% of toric ICL patients saw improvement of at least one line in BCDVA. Studies at Precision Vision London back these positive results, with many patients seeing better than they could before surgery.

Spherical equivalent and astigmatism correction

These treatments differ substantially in refractive correction. ICL corrects both spherical equivalent and astigmatism better:

• Spherical Equivalent: Intacs reduce SE from about -3.88D before surgery to -1.04D after. ICL patients often reach near-perfect vision, dropping from -8.57D to -0.73D after four years.
• Astigmatism: ICL corrects astigmatism better, with four-year data showing reduction from -4.83D to -1.00D. Intacs only managed to drop from -6.25D to -4.98D. This means ICL patients deal with fewer astigmatism symptoms.

Predictability and stability over 4 years

Stability is vital for keratoconus patients. UK clinical data shows 82.5% of ICL patients reach refraction within ±0.50D of target, and 97.05% hit within ±1.0D. Intacs results vary more and are nowhere near as predictable.

Both treatments stay mostly unchanged after the original correction. ICL maintains more consistent results throughout follow-up periods. Intacs patients might see slight changes over time.

Precision Vision London’s detailed assessment helps find the best treatment for optimal visual outcomes based on your keratoconus patterns and vision needs.

Safety, Risks, and Long-Term Considerations

Both treatments have excellent safety profiles. Learning about specific risks and what it all means will help you make an informed decision about your keratoconus management approach.

Surgical risks: infection, inflammation, and regression

ICL surgery shows an outstanding safety record. About 95% of patients report satisfaction with their outcomes. Clinical data shows ICL has a safety index of 1.15. Only 0.2% of eyes lose two or more lines of corrected distance visual acuity. Modern techniques and proper protocols keep infection rates extremely low.

Intacs procedures can sometimes lead to complications. These include segment migration that might cause corneal melting, infections in 1-3% of cases, and corneal deposits. Aqueous leakage during incision creation happens rarely but might need suturing. Femtosecond laser technology has substantially reduced these risks.

Effect on corneal biomechanics

Clinical data reveals Intacs reshape the cornea by redistributing corneal stress. This happens through shortened corneal lamellae, which changes the pattern of progressive decompensation. The mechanical reshaping doesn’t change the cornea’s intrinsic properties.

ICL implantation doesn’t change corneal biomechanics in normal or keratoconic eyes. This makes ICL especially valuable when you have thin corneas or mild keratoconus because it preserves corneal integrity.

Reversibility and retreatment options

These treatments stand out because they’re reversible. Doctors can safely remove Intacs. Visual and topographic variables usually return to their original levels within 1-7 weeks. ICLs can also be removed or exchanged if your vision needs change.

Progressive cases might benefit from combining Intacs with collagen cross-linking. This approach provides reshaping and stabilisation benefits. At Precision Vision London, we look at each case individually to determine the best approach.

Post-op care and follow-up needs

ICL surgery aftercare requires antibiotic and anti-inflammatory drops. You’ll need eye protection while sleeping at first and should avoid swimming for two weeks. You’ll have follow-up appointments on day 1, week 1, month 1, month 3, and month 6. After that, you’ll need annual check-ups.

Intacs patients need protection from UV exposure. Regular monitoring helps track corneal stability and shape. Tell your doctor right away about eye pain, vision changes, or redness to ensure the best results.

Which Option is Right for You?

Your unique eye condition needs a full picture to determine the best keratoconus treatment path.

Mild vs moderate keratoconus: choosing the right path

Glasses or specialised contact lenses provide enough correction for mild keratoconus with minimal corneal irregularity. Intacs become a viable option for patients with K readings below 58D and corneal thickness that exceeds 450μm. Patients with stable keratoconus and keratometric values ≤52.00D respond well to ICL treatment.

Age, progression, and corneal thickness considerations

Your age substantially affects treatment choices. Patients under 25 show rapid progression and need stabilisation procedures. Corneal thickness is vital—Intacs need at least 450μm thickness at the implantation site. ICL procedures require adequate anterior chamber depth (>2.8mm).

When to combine with cross-linking

Combined treatments deliver remarkable results. Studies show that Intacs with subsequent cross-linking stops progression and enhances vision. Research demonstrates that sequential treatment using Intacs, cross-linking, and toric ICL improved uncorrected visual acuity from 0.01 preoperatively to 0.46 after completion.

How Precision Vision London personalises your treatment

Each patient’s keratoconus treatment needs differ. Precision Vision London evaluates your eye health thoroughly to suggest the ideal solution—whether it’s Intacs, ICL, or a combined approach. Schedule your keratoconus consultation today to receive expert, personalised guidance.

Intacs vs ICL Comparison Table

Conclusion

Patients with keratoconus need to think over several factors before choosing between Intacs and ICL treatment. These factors include their specific condition, visual needs, and long-term goals. This piece shows how both options are great ways to get benefits for keratoconus patients, though they work differently and give different results.

ICL treatment shows better visual outcomes in many ways, especially when you have uncorrected distance visual acuity and astigmatism correction needs. The treatment helps most patients achieve vision within ±0.50D of target. This means they can often go without glasses for daily activities. Intacs reshape the cornea effectively and work well with corneal cross-linking to reshape and stabilise the affected area.

Your treatment path depends on several factors. These include your age, corneal thickness, keratometry readings, and how fast the disease progresses. Younger patients whose keratoconus progresses faster might need stabilisation procedures first. Patients with stable disease could opt for ICL to get optimal refractive correction.

Safety matters whatever treatment you choose. Both options are safe and reversible. ICL shows slightly better results with 95% patient satisfaction rates. On top of that, it helps complex cases by combining treatments.

Precision Vision London uses the latest techniques and technologies to manage keratoconus. The core team assesses each patient’s unique corneal characteristics to create personalised treatment plans. You can book your keratoconus consultation today to get expert advice that fits your visual needs and lifestyle.

Living with keratoconus brings challenges. Modern treatment options give excellent ways to improve vision and life quality. Your individual circumstances determine the right approach. Most keratoconus patients can achieve better vision with proper assessment and treatment.

FAQs

Q1. What is the success rate of Intacs for keratoconus? Studies show that approximately 70-80% of patients experience improvement in both uncorrected and best-corrected vision after Intacs implantation. Most patients see a reduction in keratometric readings between 3 and 5 diopters, with consequent improvements in visual acuity.

Q2. What is currently considered the best treatment option for keratoconus? While scleral contact lenses are often considered an excellent non-surgical option, the best treatment depends on the individual’s specific condition. For some, a combination of treatments like corneal cross-linking with Intacs or ICL may provide optimal results. Consulting with a keratoconus specialist is crucial for determining the most suitable approach.

Q3. What precautions should be taken after corneal cross-linking? After corneal cross-linking, it’s important to avoid swimming or using hot tubs for at least 10 days to reduce infection risk. Patients should wait for their doctor’s approval before resuming driving. Most people can return to light work after 4-5 days, but it’s essential to follow your surgeon’s specific post-operative instructions.

Q4. Can Intacs improve vision for keratoconus patients? Yes, Intacs can improve vision for many keratoconus patients. By mechanically reshaping the cornea, Intacs can lead to improved vision, often reducing or eliminating the need for glasses or contact lenses. However, the degree of improvement varies among individuals.

Q5. How do ICL and Intacs compare in terms of visual outcomes for keratoconus? ICL generally demonstrates superior visual outcomes compared to Intacs. Studies show ICL patients often achieve uncorrected distance visual acuity of 20/32 or better, while Intacs typically improve vision from worse than 20/200 to about 20/50. ICL also shows better correction of astigmatism and spherical equivalent refractive errors.