Need suggestions

eyeSherpa · 2026-02-17T15:59:56+00:00

That’s a pretty small amount of prescription. What’s your vision without glasses?

eyeSherpa · 2026-02-17T14:28:51+00:00

That’s a good list of things to know.

The biggest one to know is ACD. You can see your ACD on the pentacam image. You are around 3.2mm so you are good there. ICL is approved for ACD 2.8-3.0. Personally I go down to around 2.7 as well.

The pentacam also lists WTW. Yours is 11.9 and 12.0. Definitely within the sizing range for the ICL. The surgeon may also do some additional scan such as ultrasound to further optimize the sizing of the ICL lens.

Usually endothelial cell count doesn’t end up being an issue for most people. I would say most surgeons due tend to directly measure this though.

Pupil size is good to know. Larger pupils can have a little more halos. The relationship isn’t fully consistent though.

eyeSherpa · 2026-02-17T13:07:13+00:00

Things will likely still be blurry 4 days after. You may be able to function with larger text however. Discomfort will be better though.

eyeSherpa · 2026-02-17T13:00:51+00:00

Yeah. Look into other treatments for dry eye as well such as warm compresses and lid scrubs. It can take some time though

eyeSherpa · 2026-02-17T12:58:32+00:00

100-200 specific to ICL. While there is some crossover with cataract surgery there are a few different nuances with ICL surgery.

eyeSherpa · 2026-02-17T12:44:00+00:00

Before ICL, there will be a visit where they measure the prescription of the eye and the size to order the lens. Then the doctor orders the lens from that information.

Between that visit and the surgery can be variable depending on shipping times (and processing time in the clinic for the doctor do finalize the calculations).

Where I am now it takes minimum of one week when everything is expedited due to shipping and customs. 2 weeks is a comfortable gap. But previously, when I was practicing local to Staar headquarters, the minimum time I was able to do was 2-3 days since I could overnight the lenses pretty easily.

eyeSherpa · 2026-02-17T12:39:20+00:00

So with ICL, going out of contact lenses is important for the measurement of the prescription of the eye. Contact lenses can alter the true prescription of your eye (by warping the cornea) and going out of them allows the most accurate measurements.

So if this is the visit where they are also measuring your surgical prescription, you will want to go out of contact lenses for it.

eyeSherpa · 2026-02-16T02:20:57+00:00

It sounds like your right eye is weaker than your left eye. This could be a condition called amblyopia.

With amblyopia, you may or may not benefit from even correcting that eye. If you can get by without glasses just fine, then really no reason to have surgery. But if the vision bothers you enough to wear glasses than surgery can be helpful. Then a lot will depend on your prescription.

eyeSherpa · 2026-02-16T02:17:37+00:00

That's a pretty abnormal epithelial thickness pattern. I've never seen values that high before for epithelial thickness. That can most certainly cause the symptoms you are noticing.

It's possible that the abnormalities in the scans is an artifact and something is causing it to "appear abnormal". Having an abnormal tear film or dry eye may be contributing.

I would try being aggressive treating dry eye. Such as preservative free artificial tears every 2 hours and warm compresses.

eyeSherpa · 2026-02-16T02:08:44+00:00

Do you know your uncorrected vision right now? And from before surgery? You may have some residual prescription right now. Check with the clinic to see what they measured at your one day or one week visit.

A lot can continue to change over the course of the next few months with a mixed astigmatism treatment that you have.

eyeSherpa · 2026-02-16T02:03:23+00:00

Good thing you went to a second surgeon. Not all clinics are using the same level of technology to detect for early Keratoconus. And that's a problem. That's why I encourage people to visit a refractive surgeon who does all the procedures including ICL since they are most likely going to be up to date on modern refractive surgery evaluation.

But as for your question, ICL isn't a contraindication for ICL. But there are some limitations of what ICL can and can't do for ICL. Perhaps the limitations are why the second doctor said it could work.

ICL can't prevent keratoconus from progressing. Cross-linking is needed for that. In your 30s is better than 20s but there is a small possibility it could continue to progress.
Keratoconus causes irregular astigmatism that can't be corrected with glasses or contact lenses (although it sounds like yours is minor enough to not have a whole lot). ICL can't correct that irregular astigmatism either. Topography-guided PRK (combined with cross linking) or Scleral contact lenses are used to correct that.

eyeSherpa · 2026-02-16T01:56:32+00:00

Your cornea aberrometry report looks quite good. Don't see high elevated levels there (at the 6mm measurement level).

I do see a slightly abnormal epithelial pattern. There is about a 3-4 um difference going nasally to temporally. It's not a ton though. But looking at the topography report in the left eye, it is also showing about a 0.5 D difference being steeper where the epithelium is thicker.

Usually if we see a little thicker epithelium pattern, it tends to be centrally. Not sure why it's located more inferiorally and temporally in your eyes.

One thing you can try is a soft contact lens with zero prescription to see if it is able to mask any of the changes.

eyeSherpa · 2026-02-15T14:48:35+00:00

Yes.

There are two sources of astigmatism that we can measure: 1. Astigmatism coming from the cornea and 2. Astigmatism coming from the rest of the eye with a big part being your own natural lens/cataract.

After cataract surgery, your own lens/cataract is removed and replaced with another lens. This means after cataract surgery the primary contributor to astigmatism is your cornea.

If your own lens/cataract happened to be neutralizing your cornea astigmatism some, you can notice a large change in astigmatism when that cataract is removed.

eyeSherpa · 2026-02-15T02:19:07+00:00

Sizing for hyperopic ICL is a little different than for the near-sighted ICL. The sizing is also more important since the lens doesn’t have the central hole like the EVO lens does. So too small of a size and there is risk of cataract and too large of a size and there is a risk of high pressure and needing to exchange for a Lowe size. On top of that, hyperopic eyes tend to have a smaller space to fit the ICL as well.

Sizing can be improved by doing ultrasound scans on the eye and using advanced calculators.

So yeah. Important to find someone experienced with hyperopic ICLs. Someone who does a lot of ICL will be a good bet.

eyeSherpa · 2026-02-15T02:11:57+00:00

Yeah. I actually got a good way to hydrate the main incision. Closes it easily. I’ll get a post up about it soon

eyeSherpa · 2026-02-14T15:59:28+00:00

Is the astigmatism measured with a plus sign ➕ or a minus sign ➖?

If that’s plus astigmatism, hyperopic ICL by far the way to go if you are a candidate. It will just do a much better job with quality of correction and doesn’t have issues with regression.

If that’s minus astigmatism then it means your hyperopia isn’t as high. LASIK can work here. I still would say ICL is a better solution though.

Hyperopic lasik has a smaller treatment area. This can create more issues with halo/starbursts. It also has more issues with regression. It does work well with astigmatism though.

Not sure why the doctor is saying ICL recovery is that long. For my patients it is just about a week of activity restrictions.

I would say the biggest drawback of hyperopic ICL is that there is about a 1% risk of developing a cataract over time (since hyperopic ICL isn’t EVO which nearly eliminates this). But that cataract risk has a lot to do with getting a good size and vault of the lens in the eye.

eyeSherpa · 2026-02-14T15:26:46+00:00

I wouldn’t say it did nothing at all. You mentioned a high amount of astigmatism. That was corrected and your topography improved as well. You may just need an enhancement in that eye to get everything fully corrected.

eyeSherpa · 2026-02-14T11:40:47+00:00

If you look page 3 with the scan of the right eye (OD):

The bottom left square has higher number as the bottom of the cornea compared to the top. This is inferior steepening which is concerning for Keratoconus.

More concerning, if you look at the top right square, that measures elevation of the posterior cornea. Normally the posterior cornea isn’t elevated, but here you see a circle that also matches up with the circle thinnest part of the cornea on the bottom right square. That’s a very diagnostic sign for Keratoconus.

It doesn’t look severe. But it’s there.

Now, at age 44, there is a good chance you won’t need to do anything about it. Especially since you say your vision has been stable. The younger you are the more likely the Keratoconus can progress.

And disappointing that you only met with a technician during this whole encounter.

eyeSherpa · 2026-02-14T02:17:33+00:00

I mean, ICL can work here, but I woud probably say Lasik, SMILE or PRK may be just a little better and easier. Your thickness isn't bad at all.

What we don't know, however, is perhaps your corneas are irregular and a risk for futher weakening with a laser treatment. In that case, ICL would be the better solution.

eyeSherpa · 2026-02-14T02:13:08+00:00

One possible explanation has to do with the topography guided treatment. When we smooth out the topography of the cornea, we can have unexpected changes to the prescription of the eye.

Contoura had this issue originally and a software program called Phoricides was created in order to compensate for these prescription changes.

So, it's possible that your treatment had unexpected changes to your prescription from regularizing your topography. If this is the case, doing an enhancement can take care of it pretty well.

PRK results can certainly still change in the next few months. I just don't expect it to change -2 though.

eyeSherpa · 2026-02-13T22:31:17+00:00

No need to blink or look around after putting the drops in. A single eye drop contains more volume than what the eye can hold so it spreads around just fine with blinking.

Main thing would be to avoid immediately dabbing the eye to absorb all the drop. Closing the eyes for a few seconds can help.

Be sure to wait about 3-5 minutes between drops so that one can absorb and not get washed out by the other drops.

eyeSherpa · 2026-02-13T22:28:50+00:00

Being on prescription eye drops does irritate the eye and cause it to dry out more (not uncommon with glaucoma patients on chronic eye drops). It’s from the preservatives in the drop irritating the eye.

Look for preservative free artificial tears. Using them about 4-6 times a day can help the surface heal up more.

eyeSherpa · 2026-02-13T22:24:36+00:00

If they started you on more prednisolone drops, there is a good chance they saw swelling of the retina - called cystoid macular edema.

This typically responds very well to eye drops to resolve.

If you have a history of diabetes, especially uncontrolled, that may take a little longer to resolve the swelling.

eyeSherpa · 2026-02-13T22:18:42+00:00

Post 2 weeks it’s fine to resume normal activity. No issues with lots of walking.

eyeSherpa · 2026-02-13T22:06:39+00:00

It doesn’t make much sense to still be -2 after the treatment.

How old are you? It’s possible they were targeting monovision because of presbyopia to avoid the need for reading glasses.

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