TREATMENTS

PHAKIC LENS IMPLANTS

This is a procedure whereby an artificial lens is implanted into the eye in front of or behind the pupil. The eye's own natural lens is left undisturbed.

This technique is used in patients who wish to eliminate the need for glasses or contact lenses and whose refractive error is so large that it falls beyond the scope of laser surgery. It is possible to enhance one's result with laser surgery should a small residual refractive error be present.

Phakic Lens Implants: ARTISAN®/ARTIFLEX® lenses

An ARTISAN®/ARTIFLEX® lens is a "contact lens" that is implanted in the eye. Therefore, you will no longer be dependent on spectacles or contact lenses.
This special lens is one of the most modern methods of refractive surgery and is being used more and more on a worldwide level.
The objective of this leaflet is to inform you about an ARTISAN®/ ARTIFLEX ® implantation.

ARTISAN®/ ARTIFLEX® lenses
Nowadays people from all around the world prefer not to be dependant on spectacles or contact lenses. They face problems while wearing these or they feel that they no longer fit in a modern lifestyle. For these people refractive surgery could be a solution.

The ARTISAN®/ ARTIFLEX® lens is one of the most modern techniques of refractive surgery. This lens is a reliable, well performing alternative for the popular laser treatments.

What is an ARTISAN® or ARTIFLEX® lens?

An ARTISAN®/ ARTIFLEX® lens is an implantable lens that is implanted in the eye by an eye surgeon. The lens will stay there permanently and therefore you will be able to see clearly all the time; your glasses or contacts will not bother or limit you any longer. It seems as though you have no "refraction problem" any more. The lens needs no maintenance and can stay in your eye for the rest of your life.
The lens is available for nearsightedness (-1 to –23,5 diopter) and farsightedness (+1 to +12 diopter);
 
If you should need to replace the lens for any reason, this can be done without any problem in most cases. The lens can be implanted in patients between 18 and 60 years of age, who meet certain conditions. The lens is available for shortsightedness (-3 to –23,5 diopter) and long-sightedness (+1 to +12 diopter); the cylinders (astigmatism) can also be corrected with the ARTISAN® lens. The ARTISAN®/ ARTIFLEX® lens offers no solution for presbyopia (the need for reading glasses after age ± 42 to 45 years) except for the use of monovision (where one eye is corrected for distance / zero and the other for near vision / -2.00).

The treatment with ARTISAN®/ ARTIFLEX® lenses
The ARTISAN®/ ARTIFLEX® lens is a small "contact lens" that’s not placed on, but in the eye. The lens is positioned in the anterior chamber in front of the iris. It will stay here for the rest of your life.

Only a specially trained surgeon can do the treatment. First you are given a general anaesthetic after which a small incision is made in your cornea. The lens is inserted through this opening in the anterior chamber. When the lens is positioned exactly in front of the pupil it is fixed to the iris with two clips on each side of the lens.

After the treatment you will be able to see immediately (blurry initially) but your vision is at its best after about one to three weeks in most cases. The treatment takes ±30 minutes and with the standard care before and after the surgery the total stay at the hospital is about two hours.

The second eye is often treated when the wound in the first eye has healed; this would usually be two to three weeks after the first eye.

The ARTISAN® / ARTIFLEX® lens is a unique product
The lens is developed by Prof Dr Jan G.F Worst, eye surgeon from The Netherlands. He’s the founder of this unique method to attach a lens in the eye with two clips on the Iris.
The clips are meant to fixate the lens and they’re attached when the lens is centralized in front of the pupil where it remains permanently. The Iris will not be damaged in any way although a triangular incision is made at the 12h00 position to avoid high pressure from building inside the eye. If necessary the lens can easily be detached to be replaced or removed. 

The lens material
The ARTISAN® lens is made of Perspex (PMMA), an artificial material that’s completely accepted by the human body. This became clear when pilots of the 2nd  World War walked around for several years with pieces of this material in their eyes due to shattered cockpits.

The ARTIFLEX® lens is partly made of a flexible material.

The development of the ARTISAN®/ ARTIFLEX® Lens
The unique fixation concept was introduced in 1978 by Prof. Dr Worst under the name “Worst Iris Claw Lens” and used in cataract patients to replace the opaque natural lens. The ARTISAN® lens was implanted worldwide in hundreds of thousands of eyes.

The indications were extended; from cataract to near- and farsightedness. In 1986 an ARTISAN® lens was implanted in an eye to correct nearsightedness, without the presence of cataract. The natural lens that normally is removed in cataract patients remained in the eye. It was a great success and the name was changed from WORST IRIS CLAW into ARTISAN®. In 1992 an ARTISAN® lens was developed for farsightedness and in 1999 a ptoric lens was developed that could correct astigmatism as well.

The safety and efficacy of the ARTISAN® lenses was and will always be controlled in the most accurate way. A significant number of clinical trials are finalized in Europe and the USA of which the results are so positive that they were published in several ophthalmic journals.

The ARTISAN® lens is being implanted everywhere in the world for the correction of nearsightedness, farsightedness and astigmatism.

The ARTIFLEX® lens is the latest model based on the ARTISAN® Iris Claw principle. Because of its foldable optic the ARTIFLEX® lens is suitable for small incision surgery, resulting in quick visual recovery. The lens is available for the treatment of Myopia.

Why choose ARTISAN® / ARTIFLEX®  lenses?
With an ARTISAN® / ARTIFLEX® lens in your eye you:

  - have no problems with steamed up glasses

  - have no irritations caused by dry air, sand or dust

  - won't spend time on maintenance (as with contact lenses)

  - won't be afraid of losing your spectacles.

Why this kind of refractive surgery specifically?
Other kinds of refractive surgery also offer the above-mentioned advantages. Why do people who wear glasses or contacts often choose the ARTISAN® / ARTIFLEX® :

The procedure is reversible
When desired the lenses can always be replaced or removed. In this process the   central part of the cornea that is responsible for a clear vision, remains untouched.

Proven: safe and effective
The ARTISAN® / ARTIFLEX® lenses have been subject of extended research. The results proved without exception that the lenses are safe and effective in the    treatment of refractive disorders.

High refraction correction
The lens has an enormous range. This means that people with high refractive errors (+12 to -23,5) and/or cylinders can profit from this kind of refractive surgery too.

Considerations
ARTISAN® / ARTIFLEX® lenses can improve the quality of life of people who wear spectacles or contact lenses. Still it's extremely important that you consider a couple of things, before taking the final decision. We have listed a few items for you: 

  - Conditions

  - Risks

  - Results

Conditions
You are a candidate for ARTISAN® / ARTIFLEX® lenses when you meet the following conditions:

  - Your refractive error is between: -3 and –23,5 diopters with or without cylinder error +1 and +12 diopter with or without cylinder error.

  - You’re between 18 and 60 years of age.

  - You’re in good health.

  - You don’t have other eye diseases.

  - Your refraction has been stable for at least one year.

  - You are not pregnant or breast feeding.

  - You are convinced you want to undergo this procedure.

If you meet these conditions you are a candidate for the pre-examination. Here you will learn whether your eyes are suitable for the ARTISAN® or ARTIFLEX® lenses.

Risks
In every medical intervention there is a small risk factor to consider. This also applies to the ARTISAN® or ARTIFLEX® lens where there can be complications in spite of the best intentions to offer a flawless treatment. Because we are dealing with a healthy eye, apart from the refraction, it is essential that you consider the risks before making a decision.

The risks could be:

  - Infection

  - Temporary elevated eye pressure

  - Dislocated Artisan Lens

Most of these complications can be treated post-operatively, but this is not always the case. Your quality of vision can get worse. Your consultant can inform you about the risks.

The results after a  ARTISAN® / ARTIFLEX® lens implantation
The objective when implanting an ARTISAN®  or ARTIFLEX® lens is to make you totally independent of your glasses. But as with all kinds of refractive surgery this will not always be the case. In the end the required diopter will be between 0 and 1. There can be several reasons for this; the diopter can be affected for instance when suturing the incision. With a diopter between 0 and 1 you will not be limited in daily life; you won’t be dependant on your glasses or contact lenses anymore. A slight correction might be needed if you demand a high level of visual acuity in your job or while driving or your result can be fine-tuned with laser treatment.

Cases of glare or halo’s in the dark.
After an  ARTISAN®  or ARTIFLEX®  implantation you might be bothered by glare or halos at night. People who wear glasses or contact lenses are familiar with this phenomenon. It has to do with rays or light that reflect on the rim of the lens. Because the pupil is larger in the dark, these reflections sometimes enter the eye. The majority of people adapt to this after a while and don't consider it to be a problem.

The procedure
 

  - You have a consultation with a consultant and learn all about the implantation.

  - With the aid of a clinical examination it is determined if you are suitable for a lens implantation

  - Special tests are performed (Endothelial Cell Count / IOL Master measurements).

  - You sign a consent form

  - You receive the treatment

  - You return within the following year for a number of check ups

Pre-examination around an ARTISAN®/ ARTIFLEX® implantation.
To determine whether your eyes are suitable for a lens implantation your eyes will be screened thoroughly. A so called pre-examination is of great importance in order to avoid possible risks so in this way you can take a well thought out decision.

It’s important to remove:

  - Soft contact lenses one week prior to the examination

  - Hard lenses two weeks prior to the examination

What can you expect from such a pre-examination?
During this examination you’ll be invited to tell the doctor about the condition of your eyes and your health in general. Then the desired correction will be determined very accurately after which some additional measurements will be performed like: the length of your eye, your pupil diameter and your eye pressure. It is also important to have a "close look" at your eye with the slit lamp in order to carefully characterize possible disorders. Not only superficially but also inside the eye. This test is painless but your eyes can be somewhat irritated afterwards.

When all the appropriate information is analyzed the consultant will make the final decision as to whether your eye is suitable for a lens implantation. 

Informed consent
If your eyes are suitable for a lens implantation and you are convinced to have this treatment then you will be asked to sign a consent form. The declaration will state that you:

  - Give permission to have this treatment and that this is your free will

  - Have been informed sufficiently concerning the treatment

  - Have been informed sufficiently about the possible risks and the advantages and disadvantages of lens implantations

After signing this consent you can make an appointment to have the first eye treated.

The treatment
A treatment with ARTISAN®/ ARTIFLEX® lenses will only happen if the pre-examination shows that your eyes are suited for this and if you meet the other conditions.

It is a day treatment where we will treat one eye at a time. A nurse will meet you when you arrive. The nurse puts drops in your eyes in order to reduce the pupil size and he/she will explain the procedure with you and help you to prepare for surgery.

After you are asleep under general anesthesia, a little cut is made in the sclera / cornea through which the lens is inserted in the anterior chamber. When the lens is right in front of the pupil it is attached to the Iris. A little fold of Iris is pushed into the clips of the lens. In this way the lens will stay in its place. The small incision is sutured and the surgery is over.

After the procedure, which lasts about 30 minutes, the eye is covered with an eye patch and you are  taken to the recovery room. A nurse again looks after your well being and will inform you of what you should and shouldn't do until the next day when you come back for the first check up.

The following day you will have the first check up
The day after the treatment you’re allowed to take off the eye patch yourself. After this you will be asked to put some eye drops in the eye so that the consultant is able to do his check up in a clear eye later that day. You will be able to see with the eye immediately but your vision of course will not be perfect.

Rules after the treatment
You can go about your daily life again if and when you feel able to. One or two days of rest should be sufficient before getting back to your activities.
In order to let the eye heal properly and to avoid complications it’s important to follow certain rules for the first few days after the treatment:

  - For up to 1 week after the treatment you should sleep with an eye patch, in order to avoid rubbing your eye and to avoid contact with any bedding materials.

  - You should put drops in your eyes for the first three weeks after the surgery to avoid inflammatory reaction.

  - For the first few days after the surgery you should avoid doing things that increase the pressure on your eye. 

  - For the first few days after the treatment you will receive tablets and drops to avoid any increased eye pressure.

  - You are not allowed to wear make up the first week after surgery.

  - You are not allowed to go swimming for the first 2 weeks after surgery.

The end calculation
About 6 weeks after the implantation your sight will reach the optimum level. Your consultant will check your vision at this stage and decide whether further laser surgery is necessary to further fine-tune your vision.

After check-up
During the first year after the treatment some post check-up will take place. If you need more check-ups than the standard, this is possible.

Refractive Surgery
The ARTISAN® or ARTIFLEX® lens implantation is one of the most modern methods of refractive surgery. It’s a safe and effective way that is being used worldwide. But there are other treatments available. If you consider other surgical methods for replacing glasses then it's important to know the advantages and disadvantages of the more commonly used techniques.

At this moment in time the LASIK and PRK/LASEK solutions are also very popular. These are techniques whereby the curvature of the cornea is modified with a laser.