I have a central corneal thickness of 470 in both eyes, (too thin for LASIK?). Do You Recommend ICL or PRK For Thin Corneas?

Question

I am 28, have a prescription of -3.0 (right) and -2.0 (left).  I have been to two separate eye clinics and one advises PRK and one ICL. The surgeon recommending ICL says they believe my corneas are too thin even for PRK and that ICL would be much safer. ICL does sound like the more pleasant option but is twice the price! Any advice?

Farzad Yaghouti, MD · Answer

Your case falls in the grey zone for PRK procedure. Even though the residual cornea after your treatment would be above 250 Micron (the lowest number which is considered to be a safe and within the standard of care), some physicians consider any cornea less than 500 micron at a higher risk for destabilization following any type of corneal thining procedure and advise against them.  ICL is an intraocular procedure that in my opinion has a much higher risk of long term serious complications than does PRK. So I would not recommend ICL.

Michael K. Tracy, MD · Answer

With corneas as thin as yours, I would be reluctant to recommend LASIK or PRK. Using the standard Randleman criteria, you would be classified as "high risk" for LASIK and "unknown risk" for PRK. If you are determined to have a procedure, in ICL may be your best option. But waiting until you are 30 to have anything done would reduce your risk into the "moderate" category for LASIK and also give us time to find safer alternatives. Until then, I prefer glasses to contact lenses. Given your low prescription, you do not even need to wear your glasses all the time if you can function without them.

Jay Bansal, MD · Answer

Your prescription is considered low in both eyes and based on the calculations alone, you might still qualify for LASIK although there are more factors to consider than just the corneal thickness and the prescription.  An irregular topography would be a red flag for potential post-LASIK problems. 

	ICL provides better vision for patients with high prescriptions but since your prescriptions are low, the vision would be very similar.  Since ICL is an intraocular surgery, it would be difficult to argue that it is safer than LASIK or PRK and would probably not be more pleasant.

	ICL is certainly more expensive, but cost should be secondary to safety, comfort, and vision quality.

	If several surgeons are recommending ICL over LASIK or PRK, I would certainly lean in favor of an ICL but make certain that you have a full understanding of why they are making that recommendation.

Christopher Starr, MD · Answer

According to my calculations you are looking at a residual stromal bed of about 360 microns in the right eye and about 380 microns in the left eye, which is well above our accepted standards for safety. That being said, your 470 micron cornea is significantly thinner than the average cornea and it is possible that one of your doctors saw other abnormalities (possibly on the topography test) that were concerning.

Christopher Coad, MD · Answer

Really depends on other factors too such as topography. In the US, the Visian ICL is only approved for -3.00 to -15.00 dioplers with less than 2.5 dioplers of astigmatism and the reduction of myopia from -15.00 to -.20.0 dioplers. Therefore Visian ICL may not be an option for your left eye.

I have a central corneal thickness of 470 in both eyes, (too thin for LASIK?). Do You Recommend ICL or PRK For Thin Corneas?

Answers (9)

Answer: Laser Vision Correction For Thin Corneas

Answer: Laser Vision Correction For Thin Corneas

Answer: Visian ICL vs PRK for thin corneas

Answer: Visian ICL vs PRK for thin corneas

Recommended reading

Everything you need to know about PRK Laser Eye Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.

I have a central corneal thickness of 470 in both eyes, (too thin for LASIK?). Do You Recommend ICL or PRK For Thin Corneas?

Answers (9)

Answer: Laser Vision Correction For Thin Corneas

Answer: Laser Vision Correction For Thin Corneas

Answer: Visian ICL vs PRK for thin corneas

Answer: Visian ICL vs PRK for thin corneas

Browse related questions

Recommended reading

Everything you need to know about PRK Laser Eye Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.