INTACS
What INTACS Are and How They Work
INTACS are very thin, curved pieces of medical-grade plastic that look like small arcs or semicircles. Our eye doctor places them in the outer part of your cornea, where they stay in the tissue. They are so small that most people cannot see them when looking at your eye.
The material is biocompatible, which means your body typically accepts it without problems. Each segment measures only a fraction of a millimeter thick, making them lightweight and comfortable once they settle into place.
When your cornea bulges outward, light entering your eye bends incorrectly and your vision becomes blurry or distorted. INTACS work by adding support and volume in the mid-peripheral corneal stroma to flatten and regularize the central cornea. This helps light focus better on the retina at the back of your eye.
The ring segments do not fix the underlying condition, but they can improve the shape of your cornea enough to make glasses or contact lenses work better. Many patients notice clearer vision within a few weeks to months after the procedure.
INTACS come in different thicknesses and arc lengths so we can match them to your specific corneal shape. Thicker segments create more flattening, while thinner ones make gentler changes. We may place one segment or two, depending on where the steepest areas are located.
- We choose the segment size based on detailed corneal mapping
- Segment placement depends on where the bulge is most severe
- We can adjust or replace segments later if your condition changes
- Some patients need only one segment, while others benefit from two
When INTACS Can Help Your Vision
Keratoconus causes your cornea to thin and bulge into a cone shape, making your vision blurry and distorted. INTACS work best when keratoconus is in the mild to moderate stage and the primary goal is to improve visual function or contact lens fit. If the bulging has not advanced too far, the segments can flatten the cornea enough to improve your vision and help contacts fit better.
It is important to understand that INTACS are mainly used to improve vision quality and contact lens tolerance, not to stop keratoconus from getting worse. If your condition is progressing, we typically recommend corneal cross-linking first to halt progression. INTACS may then be considered to improve visual function, either after cross-linking or sometimes in combination with it.
We often consider INTACS when you have trouble tolerating contact lenses or when your corrected vision is not as clear as you need. The goal is to make glasses or specialty contact lenses work better for you.
Sometimes vision problems develop after laser eye surgery, especially if the cornea becomes too thin or develops an irregular shape. This condition is often called corneal ectasia. INTACS can help by reshaping the cornea and reducing distortion, which may improve blurry vision or problems with glare and halos at night.
If corneal ectasia is progressive, corneal cross-linking is usually recommended first to stabilize the cornea and stop further weakening. INTACS may then be considered for vision rehabilitation when appropriate.
We evaluate each case carefully because not everyone with post-LASIK issues is a good candidate. Your cornea must still be thick enough to safely place the segments.
If you find yourself needing new glasses every few months because your prescription keeps changing, your cornea may be getting steeper or more irregular. It is important to determine whether this is due to active progression of an underlying condition or to the irregular shape itself.
If progression is confirmed, cross-linking is usually the treatment used to slow or stop worsening. INTACS may improve the optical shape but does not reliably stop progression on its own. When progression has been halted or ruled out, INTACS can help regularize the corneal shape and may reduce how much your refraction fluctuates.
More stable vision makes daily life easier. Understanding the cause of your changing prescription helps us recommend the right treatment.
A very steep or irregularly shaped cornea can make contact lenses spin, slide, or fall out. INTACS flatten the cornea so that specialty lenses fit more securely and stay in place. You may still need contacts after the procedure, but they should be more comfortable and give you clearer vision.
- Segments reduce the extreme steepness that prevents good lens fit
- Lenses center better on a flatter corneal surface
- You may graduate from rigid lenses to softer specialty lenses
- Some people find they can wear lenses for longer periods each day
Corneal transplant surgery is a bigger operation with longer recovery and possible complications. INTACS may delay the need for a transplant by improving your corneal shape enough to restore functional vision. In selected patients, this delay can be substantial, though some patients still progress over time and later need a transplant.
We view INTACS as a way to buy time while keeping your own corneal tissue. If your condition eventually requires a transplant, the segments can usually be removed first.
Pellucid marginal degeneration causes thinning and bulging along the lower part of the cornea. INTACS can help flatten this area and improve vision. Other less common corneal conditions that cause irregular shape may also respond to segment placement.
We use corneal mapping to decide if your specific pattern of thinning or bulging is likely to improve with INTACS. Each case is different, so careful evaluation is important.
When INTACS Is Not the Right Choice
When keratoconus has progressed to a severe stage, the cornea may have deep scars or be too thin and steep for INTACS to work safely. Scarring blocks light even if we flatten the cornea, so your vision may not improve enough to make the procedure worthwhile. In these cases, we may recommend corneal transplant instead.
We check carefully for scars during your evaluation. If we see signs of advanced disease, we will discuss other options that are more likely to help.
Placing INTACS requires a certain amount of corneal thickness to create the tunnel where the segment sits. If your cornea is too thin, the procedure could weaken it further or cause complications. We measure corneal thickness at multiple points to make sure it is safe.
- Thin corneas are at higher risk for problems during and after surgery
- We will not proceed if measurements fall below safety thresholds
- Other treatments may be safer for very thin corneas
Any active infection in the eye must be treated and cleared before we can perform INTACS surgery. Placing segments while infection is present can lead to serious complications. Severe dry eye also needs to be managed first, because the procedure can temporarily make dryness worse.
We will treat these conditions and wait until your eyes are healthy enough for surgery. This may delay your procedure by a few weeks or months.
If your vision is stable and you are happy with how specialty contact lenses work for you, there may be no need for INTACS. Surgery always carries some risk, so we only recommend it when the benefits clearly outweigh those risks. Continuing with lenses is often the best choice when they are working well.
We will talk with you about your goals and help you decide if surgery makes sense for your situation. There is no rush to have INTACS if your current approach is meeting your needs.
INTACS are designed to help irregular astigmatism caused by corneal bulging or thinning. If your astigmatism comes from a different source, such as the natural shape of a healthy cornea or issues inside the eye, INTACS will not help. We need to identify the true cause of your vision problems before recommending treatment.
Our evaluation includes tests to determine where the irregular shape is coming from. This helps us avoid procedures that are unlikely to improve your vision.
How We Evaluate You for INTACS
We use a special camera called a corneal topographer to create a detailed map of your cornea. This map shows us exactly where the steepest and flattest areas are located. The colors on the map help us see bulging and irregular zones that might respond to INTACS.
Corneal mapping is painless and only takes a few minutes. You simply rest your chin on a support and look at a target while the camera takes measurements. We review the images with you so you can see what we are seeing.
We measure how thick your cornea is at many different points using a device called a pachymeter. This tells us if you have enough tissue to safely create the tunnel for the segments. Thickness measurements are critical for deciding if INTACS is safe for you.
- The test is quick and does not hurt
- We may use ultrasound or light-based technology to measure thickness
- We need certain minimum thickness values to proceed
- We compare thickness in different zones to find the safest placement
We check how well you see with your current glasses or contact lenses and also without any correction. This gives us a baseline to measure improvement after INTACS. We also test for glare, halos, and other visual symptoms that affect your daily life.
Knowing exactly how your vision is now helps us set realistic goals for what INTACS can achieve. We want you to have a clear picture of what to expect.
We examine your cornea under high magnification using a slit lamp microscope. This lets us see scars, areas of thinning, blood vessels, and other features that might affect the procedure or your results. We also check the rest of your eye to make sure there are no other problems.
A thorough exam helps us spot any reason INTACS might not work well or could cause complications. We take the time to look at every detail before making a recommendation.
If you wear rigid gas permeable or scleral contact lenses, you may need to stop wearing them for a period before your evaluation. Contact lenses can temporarily change the shape of your cornea, which can make measurements less accurate. We will tell you how long to go without lenses before your testing.
This break from lenses helps ensure that the corneal maps and measurements reflect your true corneal shape. Accurate measurements are essential for planning the right treatment and predicting results.
Your goals matter to us. We ask what you hope INTACS will do for you, whether that is being able to wear contact lenses again, reducing how often your prescription changes, or avoiding a transplant. Understanding your priorities helps us give you honest advice about whether this procedure is right for you.
Typical goals are improved best-corrected vision and better contact lens fit, not eliminating glasses or contacts entirely. We also discuss risks, recovery time, and costs. We want you to feel informed and confident about your decision.
The INTACS Procedure and Recovery Process
We will give you instructions on which medications to stop or continue before surgery. You should arrange for someone to drive you home, because your vision will be blurry and you will not be able to drive safely. Wear comfortable clothing and avoid wearing makeup or lotions on your face.
- Follow any fasting instructions if intravenous sedation is planned, though many patients have topical anesthesia only and do not need to fast
- Bring your insurance information and identification
- Plan to rest at home for the remainder of the day
- Have your prescribed eye drops ready at home
We numb your eye with drops so you will not feel pain during the procedure. Using a special instrument or a femtosecond laser, we create a small tunnel in the corneal stroma at a planned depth in the mid-peripheral cornea. We then carefully slide the INTACS segment into the tunnel and position it correctly. The entire process usually takes less than 30 minutes per eye.
You may feel pressure during the procedure, but it should not be painful. We keep your eyelids open with a gentle holder, and you will be asked to look at a light. Once the segments are in place, we close the entry incision, sometimes with a small suture depending on technique.
Your eye will likely feel scratchy, watery, or sensitive to light for the first few days. Vision may be blurry initially as your eye adjusts to the segments. We will prescribe antibiotic and anti-inflammatory drops to prevent infection and reduce swelling.
Most people can return to desk work and light activities within a few days, but you should avoid rubbing your eyes, swimming, or strenuous exercise for at least a week. Avoid eye rubbing long-term, especially in keratoconus, because rubbing is associated with worsening. We will schedule a follow-up visit to check your healing.
INTACS do not create instant results. Your cornea needs time to settle into its new shape, and vision continues to improve over several weeks to months. Some people notice better vision within a few weeks, while others take three to six months to see the full benefit.
Be patient during this time and keep all your follow-up appointments so we can monitor your progress. We may adjust your glasses or contact lens prescription as your vision stabilizes.
You will need to use antibiotic and steroid eye drops for a few weeks after surgery. Follow the schedule we give you carefully to prevent infection and control inflammation. Steroid drops are used as directed and may require pressure checks in some patients. You may also need lubricating drops if your eyes feel dry.
- Wash your hands before putting in drops
- Do not touch the dropper tip to your eye or any surface
- Wear sunglasses outdoors to protect your eyes from bright light
- Avoid dusty or dirty environments while healing
Contact our office immediately if you develop sudden vision loss, severe pain that does not improve with over-the-counter medicine, discharge that is thick or colored, or redness that gets worse instead of better. Also call right away if you notice increasing light sensitivity with worsening pain, a sudden increase in glare or halos with decreased vision, a visible or protruding segment, a new white spot on your cornea, or any trauma to the eye. These could be signs of infection or other complications that need prompt treatment.
We would rather hear from you about something minor than have you wait with a serious problem. If you cannot reach us promptly, seek urgent eye care or emergency evaluation. Do not hesitate to call if you are worried about how your eye is healing.
Risks and Possible Complications of INTACS
Most patients experience some temporary side effects after INTACS placement. These usually improve over the first few weeks to months as your eye heals and adjusts to the segments. Common temporary issues include:
- Foreign body sensation or feeling that something is in your eye
- Sensitivity to light and glare
- Halos around lights, especially at night
- Fluctuating or blurry vision during the healing period
- Dry eye symptoms
- Mild discomfort or pain
While most patients do well, INTACS can have serious complications. Some of these may require additional treatment or removal of the segments. Possible serious complications include:
- Infection of the cornea, including bacterial or fungal keratitis
- Extrusion or erosion of a segment through the corneal surface
- Migration of a segment from its intended position
- Corneal melting or thinning around the segment
- Scarring or haze in the cornea
- Perforation of the cornea during channel creation
- Worsening of best-corrected vision
- Induced or increased astigmatism
- Need for segment removal or replacement
- Need for corneal transplant
Outcomes with INTACS depend on many factors, including your corneal thickness, the location and severity of the bulge, the presence of scarring, and how advanced your condition is. Some patients achieve significant improvement in vision and contact lens tolerance, while others see only modest benefit. Many patients still need specialty contact lenses after INTACS to achieve their best vision.
INTACS cannot reverse keratoconus or other corneal conditions, and they do not prevent further progression. We choose candidates carefully and set realistic expectations, but results can never be guaranteed. If you do not achieve the improvement you hoped for, we can discuss removing or replacing the segments or exploring other treatment options.
Other Treatment Options for Corneal Irregularities
Corneal cross-linking is a procedure that uses ultraviolet light and riboflavin drops to strengthen the bonds in your cornea. This can stop keratoconus and similar conditions from getting worse. Cross-linking is the primary treatment for halting progression, and some patients may experience modest improvements in vision or refraction as well.
Many patients have cross-linking done first to stabilize the cornea, and then consider INTACS or other vision-improving treatments later. We may recommend both procedures in a planned sequence.
Rigid gas permeable lenses, scleral lenses, and hybrid lenses are specially designed to fit irregular corneas. They vault over the steep areas and create a smooth front surface so light focuses correctly. Many people get excellent vision with these lenses, especially if the cornea is not too advanced.
- Scleral lenses are larger and rest on the white part of your eye
- They are often more comfortable than smaller rigid lenses
- A specialty lens fitter works with you to find the best design
- Lenses can be a good long-term solution without surgery
If your cornea is too scarred or thin for INTACS or contact lenses to work, a corneal transplant may be the best option. During a transplant, we replace part or all of your cornea with healthy donor tissue. Recovery takes longer and there are more risks, but vision improvement can be significant when other treatments have failed.
We view transplant as a last resort and only recommend it when necessary. Advances in transplant techniques have made the procedure safer and more successful than in the past.
Sometimes the best approach is to combine treatments. You might have cross-linking to stop your condition from getting worse and INTACS to improve the corneal shape. After INTACS, you might still use specialty contact lenses for the sharpest vision. We will design a treatment plan that addresses both stability and vision quality.
Combining treatments can give you better results than any single approach alone. We discuss all your options so you understand the benefits of each part of the plan.
Frequently Asked Questions
Yes, INTACS can be removed if they do not improve your vision or if you develop complications. Removing them allows your cornea to return close to its original shape, though it may not go back exactly to where it was before. This reversibility is one advantage INTACS have over some other procedures.
Most people still need some form of vision correction after INTACS, but glasses or contact lenses usually work better than they did before. The goal is often to make your vision correctable rather than to eliminate the need for glasses entirely. Many patients are happy with clearer, more stable vision even if they still wear contacts.
INTACS are designed to stay in your cornea permanently unless we need to remove or replace them. They do not dissolve or break down over time. Some people keep the same segments for many years, while others may need adjustments if their condition changes.
Coverage varies depending on your insurance plan and your diagnosis. Many insurers cover INTACS for keratoconus or corneal ectasia after refractive surgery, but you may need prior authorization. We recommend checking with your insurance company before scheduling the procedure to understand your out-of-pocket costs.
We usually treat one eye at a time to reduce overall risk and allow you to function better during recovery. Treating one eye first also lets us see how well you respond before proceeding with the second eye. We typically wait several weeks to a few months between eyes.
If keratoconus or another corneal condition continues to worsen after INTACS, we may recommend corneal cross-linking to halt progression. In some cases, we can replace the segments with thicker ones or add additional segments. If progression is severe, a corneal transplant might eventually become necessary.
Getting Help for INTACS
If you are struggling with blurry or changing vision due to keratoconus or another corneal condition, we can evaluate whether INTACS or other treatments might help. Schedule a consultation with our eye doctor to discuss your symptoms, undergo a thorough examination, and learn about all your options for clearer, more comfortable vision.