Intacs Surgery for Keratoconus

What are Intacs for Keratoconus?

Intacs is the U.S. trademark name for intrastromal corneal ring segments (ICRS) set into the cornea’s mid-layer. These micro-thin, semi-circular rings help resolve vision problems caused by keratoconus, a progressive eye disorder.

Individuals with keratoconus experience thinning and bulging of the cornea, which causes the cornea to develop a cone-like shape over time. The dramatic reshaping of the cornea can impact everyday activities like driving and reading. 

If an individual is a good candidate, the FDA-approved Intacs can be inserted to remodel and support the cornea. The eye procedure does not take any longer than 20 minutes approximately and includes the following steps:

• The ophthalmologist places topical anesthetic eye drops on the surface of the eye and uses a clamp to prevent the eye from blinking. 
• On the corneal surface, the ophthalmologist makes a small incision either manually or with a laser. 
• The ophthalmologist then proceeds to place a centering guide on the eye for stabilization purposes before inserting the Intacs.
• Then, the ophthalmologist creates a tunnel near the outer edge of your cornea for Intacs placement. The Intacs implants are then inserted into the tunnel on either side of your cornea.
• Once completed, the ophthalmologist closes the cornea opening with a suture to begin the recovery process.  

However, like any type of eye surgery, side effects and risks are possible. It is best to consult an eye doctor for further guidance on all potential procedures or treatment options for keratoconus. 

Keratoconus is a rare eye disorder that affects approximately 1 in 2,000 people. Both men and women of any ethnicity can develop the disease. 

Pros and Cons of Intacs

There are advantages and disadvantages of having Intacs placed in the eye. 

Some of the benefits of Intacs include:

• Non-invasive procedure. As will be discussed later, individuals with keratoconus have different treatment options. One possible choice is a corneal transplant. However, unlike Intacs, a corneal transplant is invasive and requires replacing a part of the cornea with donor tissue. With Intacs, an eye surgeon only helps give structural support to a weakened cornea to improve vision. 
• Short recovery time. The Intacs procedure does not result in an extended recovery period like other surgeries, e.g., corneal transplant. Within a little time, individuals with Intacs can begin to notice visual improvement. 
• Permanent. Once the ophthalmologist places the Intacs, individuals do not need to worry about maintenance or replacement. Using Intacs can offer a long-lasting solution. 
• May be used for myopia and astigmatism. For individuals with a low degree of myopia (nearsightedness) or astigmatism, Intacs can be a suitable option to treat such refractive errors. 

However, Intacs can have some drawbacks, such as:

• Not as effective at halting disease progression. Like crosslinking (another treatment option for keratoconus), Intacs can help stabilize keratoconus. However, it is not as effective as crosslinking. 
• Costs. Intacs can be expensive for some individuals, with prices ranging between $1,500 to $2,500 per eye. Nonetheless, insurance companies often offer coverage in most cases. 

How Long Do Intacs Last?

Intacs do not require maintenance or replacement. That said, individuals can have Intacs inserts as a permanent solution.

Conversely, individuals can have Intacs removed, if necessary. 

How Much Does Intacs Surgery Cost?

Intacs implantation will differ in costs depending on multiple variables, including:

• If a laser is used
• The eye surgeon’s expertise and experience
• Special discounts, financing, or payment plans 
• The individual’s functional vision and other relevant or existing eye or medical condition
• Facility fees, pre-op and follow-up visits, or medications
• Location of the ophthalmology clinic 
• Screening eye exam

On average, individuals can expect to spend between $1,500 and $2,500 per eye in Intacs surgery.  

Is Intacs Covered By Insurance?

For the most part, yes. Many leading medical insurance companies provide coverage for this type of surgical procedure.  

Intacs have received Food and Drugs Administration (FDA) approval under a Humanitarian Device Exemption (HDE). The ocular medical device has an FDA classification code (Category III CPT 0099T), which means insurance companies can set the value to be paid. 

Alternative Treatments for Keratoconus

Other treatment options are available if individuals do not want to pursue Intacs surgery for the treatment of keratoconus. Here is a list of some example treatments:

• Contact lenses. In early-stage keratoconus, an eye doctor may prescribe soft contact lenses or glasses to help with vision correction. In later stages, individuals may need to wear rigid gas permeable contact lenses to improve visual acuity. However, contact lenses may not be enough in more severe cases, and corneal transplant surgery may be a more suitable option. 
• Corneal transplant surgery. This transplantation is an invasive ocular procedure that requires the removal of some part of the corneal surface. To replace the missing section, the eye surgeon will insert donor tissue. The healing process is much longer than in Intacs surgery. 
• Corneal cross-linking (CXL). This non-surgical procedure is one of the latest treatments for keratoconus. Unlike Intacs, which helps address vision problems, CXL stops the progression of eye disease. CXL takes no longer than an hour and aims to reinforce the shape of the cornea through the formation of new bonds among collagen fibers in the stroma (thickest layer of the cornea). It is important to mention that CXL does not reverse eye damage that has occurred due to keratoconus. CXL is ideal for individuals who have received a recent diagnosis of keratoconus or are in progression still. 

The FDA has only approved one cross-linking method by Avedro, Inc. The approach sends ultraviolet light to the eye and uses eye drops with vitamin B2 (riboflavin). An eye doctor removes the central epithelium (the top layer of the cornea) to ensure that the eye drops penetrate the cornea.   

If you suffer from keratoconus and do not know which treatment is most suitable for you, speak with your local eye doctor and discuss all the risks and benefits of each option.