For people with moderate to severe issues related to their glasses or contacts which may be causing them daily discomfort we have solutions. We may turn to ICL surgery as an option when other laser procedures don’t work or when an intra-ocular lens is what is best for the patient’s health. An implantable collamer lens is put inside the eye while the natural lens is left in place.
Also a type of refractive surgery which we term phakic lens implantation, this procedure changes how light hits the retina without the natural lens of the eye being removed. ICL eye surgery may reduce dependence on glasses, but it is still an intraocular procedure which requires careful pre and post op care.
What Is the Procedure?
ICL surgery or IntraLase Clear Lens is a refractive procedure which we use mainly for myopia, also we have some lens models which correct astigmatism. A thin lens is put in through a small corneal incision and is placed behind the iris and in front of the natural crystalline lens. As that natural lens stays in place the procedure is classified as phakic lens implantation.
An implantable collamer lens is a type of flexible, biocompatible corrective lens. It focuses incoming light which is more accurately on the retina and stays within the eye as opposed to the surface. Also unlike cataract surgery the natural lens is not removed. The US Food and Drug Administration reports that approved posterior-chamber ICLs are placed behind the iris and in front of the natural lens. Does the Procedure Improve Vision?
In myopia light focuses in front of the retina which causes distant objects to appear blurred. ICL surgery introduces corrective power within the eye to move that focus forward to the retina. A toric implantable collamer lens also may correct for astigmatism which is dependent upon the available lens range and individual measurements.
Unlike with LASIK or PRK which is to say we do not see the cornea being restructured. In ICL eye surgery, the cornea plays the role of entry point while the lens does the correcting. Also Phakic lens implantation may be put forth as a solution for high prescriptions or unsuitable corneas but it is not true that we may determine candidacy based only on spectacle power.
Who May Be Considered?
A large group of patients that do in fact under go ICL surgery are adults which present with stable vision, good health of the eyes and also have enough interior space for the lens. Also we see that the ophthalmologist will look at the health of the corneal cells, the size of the pupil, eye pressure, the retina and the precise degree of refractive error. That which age and refractive correction ranges are appropriate varies by device and country.
| Assessment Area | Why It Matters Before Treatment |
| Stable Spectacle Power | A stable vision prescription helps the surgeon determine the most appropriate ICL power and reduces the likelihood that ongoing refractive changes will affect long-term results. |
| Anterior Chamber Measurements | These measurements confirm that there is enough space inside the eye to safely position the implantable collamer lens without compromising surrounding structures. |
| Corneal Endothelial Cell Count | Evaluates the health and density of the endothelial cells, which are essential for maintaining corneal clarity. An adequate cell count is important for long-term eye health after surgery. |
| Eye Pressure and Angle Examination | Helps detect glaucoma or drainage-angle abnormalities that may increase the risk of complications during or after ICL surgery. |
| Dilated Retinal Examination | Examines the retina for tears, holes, or other conditions that are more common in people with high myopia and may require treatment before surgery. |
| Pupil Size and Night Vision Assessment | Evaluates the likelihood of glare, halos, or other visual symptoms in low-light conditions and helps set realistic expectations. |
Who May Not Be a Suitable Candidate for ICL Surgery?
ICL surgery is not suitable for everyone. Treatment may be postponed or avoided in people with:
- Pregnancy or breastfeeding
- Unstable vision or changing spectacle prescription
- Inadequate anterior chamber depth
- Low corneal endothelial cell counts
- Active eye inflammation or infection
- Uncontrolled or significant glaucoma
- Advanced cataracts
- Certain retinal diseases or untreated retinal tears
An implantable collamer lens is the best choice based on the anatomy of the eye and the health of the eye as a whole, not for convenience or preference. Preop evaluation is key to determine the safety and appropriateness of ICL surgery.
Medical Note: Regulatory guidelines report that which is of great importance is stable refraction, adequate anterior chamber depth, endothelial cell evaluation, and personalized risk counseling prior to ICL surgery.
Tests and Preparation Before Surgery
Before ICL surgery we perform a number of tests which include refraction, measurement of the cornea, anterior chamber depth, lens sizing, endothelial cell count, pupil assessment, measurement of eye pressure and a dilated retinal exam. These evaluations help to determine the power and size of the implantable collamer lens and also to identify any avoidable risks.
Contact at times may have to be broken before we take our measurements which is a result of them changing the corneal shape or refraction temporarily. Patients should report health issues, past eye surgeries, allergies and what drugs they are on. Some lens types or clinical settings may call for a pre-procedure laser to the iris, others may not; in any that case the anesthesiologists instructions take priority.
Consent for phakic lens implantation should cover benefits, alternatives, limitations and complications. Glasses, contact lenses or another refractive procedure may remain reasonable choices. ICL eye surgery aims to reduce dependence on eyewear; it does not promise perfect vision.
How Is ICL Surgery Performed?
On the day of ICL surgery anesthetic drops are used and we may also give a mild sedative. The surgeon makes a small corneal incision, puts in the folded lens and places it behind the iris and in front of the natural lens. The implantable collamer lens opens up once inside the eye and we check its position very carefully.
The incision will heal without stitches which will vary by technique. In terms of patient stay, we have preparation and observation which is followed by variable time for the second eye. FDA reports that for phakic lens procedures general anaesthesia is not a common practice also which may last 30 minutes. For phakic lens implantation we use prescribed drops for control of inflammation and also to prevent infection. Also a protective shield is used at night. Patients must make other arrangements for transport home and also should not drive till they are cleared by the ophthalmologist.
Benefits of ICL Eye Surgery
A primary benefit of ICL surgery which is Implantable Collamer Lens is that it corrects extensive myopia without the removal of corneal tissue. This may be helpful when the prescription is very high and issues related to corneal thickness, shape or health which are contraindications for laser treatment present. The natural lens is preserved which also means that age related near vision changes will still take place.
The implantable collamer lens doesn’t require daily cleaning or replacement as do contact lenses. It may be surgically removed or replaced at medical necessity, although we do not call this full reversal since another procedure brings its own risks and also there is no guarantee the previous health of the eye will return.
For the right patient, we see that ICL eye surgery may reduce use of glasses and fix myopia which also includes the element of astigmatism. This must be looked at in the context of required long term follow up.
Risks and Possible Complications
In each case of intraocular procedure ICL surgery has risks. We see that temporary glare, halos, light sensitivity, fluctuating vision, mild discomfort or redness present during early healing. Some people may still require glasses for some tasks and we see that at times undercorrection or overcorrection may happen. Night vision issues may present more so when the pupil dilates beyond the optical zone of the lens.
More serious complications that may arise include raised intraocular pressure, inflammation, infection, bleeding, lens rotation or displacement, an abnormal space between the artificial and natural lens, corneal endothelial cell loss, cataract formation and retinal detachment. Also a poorly sized or placed implantable collamer lens may require repositioning, exchange or removal. Rare complications which may put vision at risk is why any increase in pain, growth of redness or acute loss in sight should be reported as an emergency.
The FDA reports that patients should be made aware of the fact that they may experience visual symptoms, have to undergo more surgery, develop high eye pressure, corneal clouding, cataract, retinal detachment, infection and severe inflammation before they choose phakic lens implantation. Also it is reported by them that an implanted phakic lens requires ongoing eye care as some issues may develop without warning signs. For ICL eye surgery thus should the discussion include the patient’s personal risk profile which is far from fully covered by a general health chat. High myopia in itself may bring about retinal issues which the operation does not do away with that lifetime risk. That which may see an improvement in distance vision may still require regular dilated retinal exams.
Recovery and Aftercare
Recovery from ICL surgery is usually faster than what patients think, we still give the eye time to heal internally. For the first few days vision may be hazy and it does fluctuate for several weeks. As for the care of your eye, use the antibiotics and anti-inflammatory drops as prescribed, do not put the tip of the bottle on the eye or eyelashes.
| Recovery stage | What patients may generally expect |
| First 24 hours | Mild irritation, light sensitivity or blurred vision may occur. The first postoperative examination is commonly scheduled soon after ICL eye surgery. |
| First few days | Vision often begins to improve. Avoid rubbing the eye, getting unclean water into it and performing activities restricted by the surgeon. |
| First few weeks | Glare, halos or fluctuating clarity may gradually settle. Continue medicines and attend every follow-up after phakic lens implantation. |
| Two to four weeks | Vision may become more stable, although healing differs from person to person. |
| Longer term | Periodic checks assess vision, eye pressure, lens position, the natural lens, cornea and retina around the implantable collamer lens. |
During the early stages of recovery patients are told to stay away from eye rubbing, heavy lifting, strenuous exercise, swimming, dusty settings and eye make up until your surgeon says it is ok. Also very important is that hands are very clean when putting in eye drops. The FDA reports that vision may improve within 2 to 4 weeks, although full internal healing takes longer and activity restrictions should be tailored to the patient. Also report to your doctor at once any of these: rapid vision degeneration, increased redness, discharge, flashes of light, a sudden increase in floaters, a curtain like shadow or a serious headache with nausea. These are not issues to sort out at home after ICL surgery.
ICL Surgery Versus LASIK
The primary difference between the two is what the correction includes. In the case of LASIK we use a laser to reshape the cornea, and also within the ICL we put in a corrective lens. Also with LASIK we do not leave a permanent implant in the eye, but in the ICL surgery we do not alter the corneal tissue to create the correction.
Neither option is out and out better. For some patients LASIK may do the best which for others may be the phakic lens implantation as it’s true there are different issues like refraction, the health of the cornea, dry eyes or other clinical issues that come into play. The National Eye Institute reports that phakic IOLs are an alternative to traditional refractive procedures and also that a full eye exam is necessary to see what will work best. go to ASG Eye Care.
At ASG Eye Care we can do a consultation that will determine what is suitable for your prescription and ICL surgery. We will answer practical questions on what results you can expect from the surgery, choice of lens, recovery process, long term follow up and personal risks. Also this is the time to look at what other options are out there including glasses, contact lenses, laser vision correction and internal lens procedure.
Patients who are looking at ICL eye surgery should bring in their current glasses, past prescriptions and reports of any eye health issues or operations. We do a full personal assessment which is in depth and not to be replaced by online info which does not determine candidacy or which can take the place of a professional ophthalmologist.
Conclusion
ICL surgery which is a type of refractive surgery is a good option for certain adult patients that present with high myopia or when the cornea doesn’t do well with laser procedures. It includes internal lens correction, conservation of corneal tissue and reduced dependency on glasses. At the same time it has issues related to surgery which is a risk in itself and also a need for life time follow up.
The best outcome in phakic lens implantation is a result of in depth evaluation and open discussion of options. When done responsibility the procedure may present a great solution for improved vision but at all times it should be put forward as a medical procedure and not a sure fire cosmetic fix.
Frequently Asked Questions
1. Is ICL surgery permanent?
ICL surgery implantation is for the long term, the lens is to stay in the eye. It may be removed or replaced surgically if needed, but removal comes with added risk and does not promise that the eye will return to the exact same state as before.
2. Is the implanted lens visible?
The implantable collamer lens is placed behind the iris which is out of site for most interactions. Patients do not handle or clean it as they do a surface contact lens.
3. Is the procedure painful?
Phakic lens implantation is mostly done with numbing drops and local anesthetic so at the time of the procedure pain is not an issue. Post operatively there may be mild irritation, a foreign body sensation or light sensitivity. Severe or increasing pain requires urgent review.
4. How soon can I see afterward?
Many patients report improved vision in the first few days post ICL eye surgery, while at the same time may experience initial blur and fluctuation. Vision tends to stabilize over the following weeks and it is the ophthalmologist who will determine when it is safe to return to driving and normal work.
5. Can ICL surgery correct astigmatism?
A toric lens may do the job of correcting qualifying myopia and astigmatism with ICL. What is included is based on how severe your astigmatism is, what your measurements are looking like as they are changing can be ruled out, and if the ICL surgery has the right powered lenses available.
6. Will I ever need glasses again?
The aim is to do away with the use of glasses, we are not to say that they will totally disappear. Some small degree of prescription, night time driving issues and age related near vision changes may still see the value in wearing glasses post treatment.
7. Can the lens cause cataracts?
Cataract is a known issue which we see in some patients in which the intraocular lens abuts the natural lens. Size and position accuracy at the time of surgery as well as ongoing follow up helps the ophthalmic team to identify issues early but we can not eliminate risk entirely
