Intacs (Corneal Implants)

What are Intacs®?

Intacs® is a brand of corneal implants, also known as intrastromal corneal ring segments or intracorneal ring segments (ICRS). They’re a type of medical device that treats eye disorders like keratoconus. 

Keratoconus is the thinning and bulging of the cornea, the clear front layer of your eye. A normal cornea is dome-shaped, like a ball. People with keratoconus have corneas that bulge outward like a cone.

Keratoconus usually affects both eyes and can cause vision problems, such as:

• Myopia (nearsightedness)
• Astigmatism
• Blurred vision
• Double vision
• Sensitivity to light
• Loss of visual acuity

Intacs flatten the steep parts of the bulging cornea in people with keratoconus, improving vision.

How Do Intacs Work?

Intacs flatten the cornea in people with myopia. This refocuses light rays in the retina to improve vision. The retina is the part of the eye that senses light and sends images to the brain for interpretation.

Intacs are thin, crescent-shaped arcs of clear plastic. They’re made of the same biocompatible material used for intraocular lenses (IOLs) for cataract surgery.

Originally designed to treat mild myopia, Intacs were FDA-approved as a keratoconus treatment in 2004.¹ They were approved to complement existing treatments for keratoconus, such as:

• Scleral contact lenses
• Corneal collagen cross-linking
• Corneal transplant (keratoplasty)

Intacs can improve visual acuity in people with keratoconus who no longer benefit from prescription eyeglasses or contact lenses.

Intacs and Corneal Collagen Cross-linking

Intacs combined with corneal collagen cross-linking effectively treat myopic astigmatism and offer the best outcome for people with progressive keratoconus.³

The corneal cross-linking (CXL) procedure involves using vitamin B (riboflavin) and controlled UV rays to strengthen the corneal collagen fibers.⁴ This flattens and stabilizes the bulging cornea.

Intacs SK

Recently, Intacs SK has been proven effective in correcting higher myopic and astigmatic refractive errors, particularly in those with more severe keratoconus. 

This version of corneal ring segments has a diameter of 6 mm and a round design to minimize glare.⁵ As a result, they're much smaller than standard Intacs, which measure 7 mm in diameter.

Intacs are available in different thicknesses, ranging from 0.25 to 0.45 mm. Intacs SK are available in 0.21, 0.40, 0.45, and 0.50 mm thickness.⁶ 

How Much Does Intacs Surgery Cost?

The cost of Intacs is about $2,000 to $2,500 per eye. Cost may increase or decrease based on your location, the facility, and your surgeon's experience. 

Most insurance providers cover Intacs for treating keratoconus. So, expect to pay less if you have insurance coverage. Talk with your doctor and insurance company to determine the exact cost of the procedure.

Intacs Procedure: What to Expect

The Intacs procedure occurs on an outpatient basis, meaning you'll return home immediately afterward. However, your ability to perform normal functions, such as driving, will be impaired for a few days. Ask someone to drive you to and from the surgeon's office.

Below is what to expect before, during, and after surgery:

Before Surgery

Before surgery, your doctor will ask you questions and conduct examinations to ensure you're fit for the procedure.⁸ The ideal candidate for Intacs:

• Is at least 21 years or older
• Has myopia or astigmatism
• Has mild to moderate keratoconus
• Has had a stable eye prescription for at least a year
• Doesn’t have any underlying health conditions that affect the eyes

If you meet the above requirements, your surgeon will likely recommend surgery.

During Surgery

The surgical procedure takes about 15 to 20 minutes, during which you can expect:

1. Your corneal surgeon will numb your eyes with a topical anesthetic.
2. They place a speculum between your eyelids to prevent blinking.
3. Your surgeon will make a small incision on the surface of your cornea. They may use a laser for this step.
4. They place a centering guide to stabilize your eye and ensure proper alignment for the Intacs. During this time, they gently separate the corneal layers to create room for the insert.
5. Your surgeon places the Intacs insert and closes the incision site with sutures.

After Surgery

Intacs have a low risk for postoperative complications. After surgery, your surgeon will apply eye drops to prevent infection or inflammation. They may also place clear plastic shields over your cornea for protection as it heals. 

You won't feel the Intacs because they're placed beneath the nerve endings. Intacs are also not noticeable to other people unless they look closely.

Your doctor will provide post-op care instructions to enhance your healing process. They will also prescribe pain medications and lubricating eye drops to ease discomfort after surgery.

A follow-up visit is highly recommended so your surgeon can monitor the healing process.

The Intacs procedure is reversible in the case of unsatisfactory outcomes. Once removed, your eyes will return to their preoperative refractive errors.⁹

Who is a Candidate for Intacs? 

Intacs may be right for you if you have a refractive error associated with:

• Keratoconus
• Myopia (nearsightedness)
• Astigmatism

Who Should Not Get Intacs?

Your doctor may advise against getting Intacs if you:

• Are pregnant
• Have an eye health problem that might worsen
• Are taking medications that prevent your eye from healing

What is the Success Rate of Intacs?

Intacs have a success rate of about 90% in cases of progressive keratoconus. When combined with corneal collagen cross-linking, the results are remarkable in nearly all operated eyes.¹⁰

The results of the procedure will depend on the extent of keratoconus: 

• People with mild keratoconus may not need additional vision correction after surgery
• People with moderate keratoconus will need to wear glasses or contact lenses after Intacs

According to a European study, 74% of Intacs recipients achieved a visual acuity of 20/40.¹¹ Only 12% of recipients were dissatisfied with the procedure, requiring removal.

Studies conducted on Asian eyes also support these findings. They found that the Intacs procedure was safe and had positive outcomes among the study population.¹² And, there were no significant complications with Intacs removal.

What are the Risks of Intacs?

Possible risks after an Intacs procedure include:

• Eye infection
• Problems with night vision
• Halos or glares around lights
• Blurry or fluctuating vision

Alternative Treatment Options

Here are six possible alternatives to Intacs:

1. Eyeglasses or soft contact lenses. These correct vision problems in early-stage keratoconus.
2. Gas permeable contact lenses (GP lenses). GP lenses replace the irregular curvature of the cornea with a smooth, uniform refracting surface that improves visual acuity.
3. Piggyback lenses. These are hard contact lenses placed on soft ones to improve comfort.
4. Hybrid contact lenses. These have a firm center with a soft ring around the circumference to increase comfort.
5. Scleral contact lenses. These are placed on the sclera or white of the eye. They cover the cornea without contact to enhance comfort and improve visual acuity.
6. Prosthetic lenses. These are specially designed through 3D imaging to match the exact impression of your sclera. They correct vision like scleral lenses.

Summary

Intacs are also known as intrastromal corneal or intracorneal ring segments (ICRS). They’re thin, clear plastic implants that are inserted into the cornea.

Intacs aim to provide long-term vision correction for people with mild myopia, astigmatism, or keratoconus. People with keratoconus have corneas that are cone-shaped instead of round. Intacs flatten the cornea into a normal shape.

Intacs surgery costs about $2,000 to $2,500 per eye. Insurance companies usually cover Intacs as a treatment for keratoconus.