ICL surgery can sometimes be used with irregular corneas, but the underlying cause and degree of irregularity are crucial.
Challenges with irregular corneas
Irregularity limits potential visual quality.
- ICLs correct spherical and regular astigmatic error, not complex distortions
- Residual irregularity may still require rigid, scleral, or custom lenses
- Irregular patterns may signal early ectasia, making any surgery riskier
- Measurements for ICL sizing and power become less predictable
- Expectations for perfect unaided vision may not be realistic
When ICL might still be an option
Careful selection is essential.
- Stable irregularity after trauma or previous surgery, not active disease
- Combination with corneal surface treatments to improve regularity first
- Desire mainly to reduce prescription strength rather than eliminate glasses
- Extensive counselling about possible need for ongoing contact lenses
- Management in a centre familiar with complex refractive cases
