March 14, 2019 by
Photography by Bill Sitzmann

Brian Leising could barely see his cell phone screen without glasses or contacts. Leising, 45, was severely nearsighted and had astigmatism until this past year—now, he has perfect vision. He is one of more than a dozen patients in Omaha who, since December 2018, have undergone permanent contact lens implant surgery to correct both nearsightedness (medically known as myopia) and astigmatism. Dr. Lance Kugler, physician CEO of Kugler Vision, represents one of 10 practices in the country to be selected by the manufacturer as a test market for the product.

The idea was to work out any kinks in the procedure with a small test market of ophthalmologists. The procedure was offered to a broader range of ophthalmologists within a few weeks.

“Everybody who has had the surgery is now seeing 20/20 or better,” Kugler says. “They tell us, ‘It’s so nice that I don’t have to wear my glasses.”

Permanent contact lens implants have been a vision correction option across the country for at least a decade, but until now they were unable to correct astigmatism, Kugler says. This type of lens, called the Toric ICL, has been FDA-approved to treat astigmatism and myopia.

“It’s been a long time coming,” he says. “This was a product that took a long time to get all the research done that the FDA required, but now we have it available.”

Omaha Eye and Laser Institute offers Toric ICL through Dr. John Liu, but he had not performed the surgery as of press time. Liu has performed hundreds of other permanent contact lens operations. Ophthalmologists at Nebraska Medicine do not offer Toric ICL surgery, but they soon may, spokesman Taylor Wilson says.

The procedure is in-office, outpatient, takes a few hours, and is done with the patient awake—the eyes are numbed with drops. Doctors make two millimeter openings in the side of each eye. Then, the lens is folded, inserted into the eye and unfolded once inside.

Nobody can tell that anything was done by looking at patients who have had the procedure, Kugler says, and they walk out being able to see. Within four hours, their vision is 20/20 or better.

About half of the U.S. population age 50 and younger need glasses or contacts due to myopia. It occurs when the eye grows too long from front to back. Instead of focusing images on the retina, it focuses on the images in front of the retina, according to the National Eye Institute. People with myopia can see fine up close, but struggle to see anything even a little far away.

Astigmatism, meanwhile, is a vision condition affecting 33 percent of all people. It causes blurred vision, the American Optometric Association says, and occurs when the cornea is irregularly shaped.

LASIK surgery has been an option to correct for nearly two decades. However, Kugler says, about 15 percent of people with poor eyesight do not qualify for LASIK. Patients who are extremely nearsighted, for example, are not good candidates for LASIK. Others are patients whose corneas are abnormal or have an abnormal shape, he says.

The new permanent contact lenses can perfect vision in patients who can’t get LASIK.

“You hear stories about people who aren’t happy with their LASIK,” Kugler says. “The problem isn’t their LASIK—it’s that they shouldn’t have had the surgery in the first place. Getting LASIK when you shouldn’t may increase the risk of a complication.”

The patients who have received Toric ICL were on a list of people who had come to Kugler for LASIK but did not qualify for it. The ideal candidates for the Toric ICL are people between the ages of 21-45 years of age with high levels of myopia and mild-to-moderate astigmatism.

Although Leising was at the top of the age range recommended by the FDA, Kugler thought he would be an excellent candidate for this new procedure.

“A surgeon can decide to implant the ICL into older patients if they deem it appropriate,” Kugler says. “In Brian’s case, his eyes were in excellent shape and ICL was the best technology to suit both his vision needs and his lifestyle.”

Heidi Lichtenberg, O.D., of Eye Care West, P.C., says the longevity of the ICL surgery is reduced once a person hits their 40s.

“When a 45-year-old comes in here and asks me about ICL, it becomes a gray area,” Lichtenberg says. “Do you have ICL done and then have cataract surgery or refractive lens exchange done? Or do you wait 10-15 years and have one cataract surgery done?”

Refractive lens exchange, in which a person’s natural lens is replaced with an artificial intraocular lens (IOL), is the same as cataract surgery, but can be done cosmetically to correct vision in someone who does not have cataracts. Cataracts are a natural part of aging, being the most common cause of vision loss in people over age 40, and is the principal cause of blindness in the world.

Lichtenberg also says people should be aware that having surgery on the eyes such as ICL may mean a less successful cataract surgery down the road.

“The accuracy of the outcomes go down after cataract surgery,” Lichtenberg says. “You can have a more exact outcome in a patient who has not had a surgery done than one who has.”

Like LASIK, ICL is typically not covered by most insurance plans. The procedure runs about $10,500.For LASIK, each eye costs about $2,500.

Stephanie Bradley, a spokeswoman for Kugler Vision, says the cost of wearing glasses or contacts over a lifetime adds up to “tens of thousands of dollars,” with supplies, upkeep, and exams.

Leising, a life insurance sales director at Financial Brokerage in Omaha, had gone to Kugler seeking LASIK. He had worn glasses since first grade, when he found that he couldn’t see the blackboard at school, and contacts since middle school. Dr. Kugler thought the Toric ICL would be a better option for him.

Being able to see has been hard to get used to—in a good way, he says.

“It’s weird to get up, get out of bed, and I don’t have to take the phone off the nightstand to see it,” Leising says. “I still think I need to put in my contacts. But next time I go on a vacation, I’ll have so much more room in my bag because there won’t be contact solution, contacts, or glasses inside. It’s one thing if you forget a toothbrush, but if you forget your contacts or glasses you are in trouble.”

Kugler called the surgery “life-changing.”

“It’s about how people interact with the world. It’s about waking up in the middle of the night and being able to see, or going camping and not having to worry about trying to put in your contacts,” he says. “Vision is a fundamental need. This is another technology to give that opportunity to people.”


Visit lasikomaha.com for more information.

This article was printed in the April/May 2019 edition of B2B. To receive the magazine, click here to subscribe.

Toric ICL surgery