Phakic intraocular lens implants are not for patients with cataract. They are for patients with very thick glasses and want to be rid of them. Patients who are unsuitable for Lasik surgery could also benefit from having a phakic implant. Phakic intraocular lenses (IOL) or intraocular spectacles are a new way to correct severe ametropia. More and more patients worldwide are choosing to take this option to correct their vision. But there are some things anyone contemplating having this done should know before making a decision. The correction of long or short sightedness has undergone a revolution in the last few years. Up until as recently as thirty years ago spectacles were the only option available. In the last few decades contact lenses have helped millions of ametropes to live almost normal lives with good quality corrected vision. The arrival of laser correction allowed doctors to use the patient’s cornea as the “blank“ lens unto which the patient’s spectacle correction was ground. This treatment is highly successful in the treatment of low levels of myopia and hypermetropia. It cannot however treat larger degrees of ametropia. Out of the development of intraocular lenses for patients with cataract has come an expanding expertise which has allowed the introduction of intraocular lenses for ametropia, intraocular spectacles. It is now possible to manufacture a spectacle lens which can be placed inside the eye and for it to remain there permanently. The vast majority of patients who have had this treatment see clearly and do not have to wear glasses or contact lenses. However it is not possible to guarantee this in each case and occasionally very thin glasses might be needed. It also appears that the quality of vision with phakic lenses is superior to that achieved with Lasik. The Risks Short term risks. The surgery involves making an incision into the eye and placing the lens on the iris. The lens is permanent but can be removed or changed of necessary. If anything goes wrong with the operation the eye might be damaged. That damage may result in anything from no damage to complete loss of the eye. Things going wrong include infection getting into the eye, damage to the natural lens which then may become cataractous. Long term risks. The corneal endothelium is a layer of cells that live in the back of the cornea. In these cells is the mechanism which keeps the cornea clear. These cells cannot repair themselves and their number declines as we grow older. If their number falls below a certain level then the cornea cannot retain its clarity and becomes cloudy. Any form of intraocular surgery causes the death of some of these cells. Merely touching the back of the cornea causes the death of some of these cells. It is theoretically possible that the presence of the lens might accelerate the natural decline in the numbers of these cells and eventually cause the cornea to become hazy. Additionally, there may be unknown risks which have not become manifest due to the fact that the operation in relatively new (about 10 years).