Implantable Collamer Lens (ICL) Surgery

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What is Implantable Collamer Lens (ICL) Surgery?

Implantable collamer lens (ICL) surgery helps address vision issues like nearsightedness (myopia)

During this procedure, an eye surgeon places a soft plastic and collagen-based lens behind the iris.

The lenses are similar to an intraocular lens used in cataract surgery. 

However, ICL will be within the posterior chamber (back chamber) of the eye and before the anterior capsule (front surface) of the eye’s natural lens. 

ICL surgery is a permanent solution. However, if necessary, your eye doctor can remove the implantable collamer lens. 

The lenses work by helping to focus light correctly on the retina and providing clear vision. 

When you have nearsightedness, you have blurry distant vision caused by a focusing error. Light from a distant object does not focus on the retina. Instead, it focuses in front of the retina. 

You may have heard the term “implantable contact lens” interchangeable with implantable collamer lens. However, the Food and Drug Administration (FDA) requested the change of name to avoid misunderstandings with corneal contact lenses.6 

Is ICL Surgery Safe?

ICL surgery is an FDA-approved vision correction procedure. This means that the surgical intervention has undergone an extensive review for safety. The FDA has documented the safety of this eye surgery. 

The FDA has reported that the ICL has effectively corrected nearsightedness between -3 diopters (D) to -15 D. It also partially corrects nearsightedness of up to -20 D in eyes with up to 2.5 D of astigmatism. 

Also, in a clinical study evaluating 526 eyes of 294 patients, 94.7% of patients who underwent the procedure described having 20/40 or better without glasses or contact lenses.7 

Eye doctors do not know the exact, possibly long-lasting impact of ICL on the eye after its removal or replacement. 

There is also not enough data to support statements about either the long-term impact on the corneal endothelium (a single layer of cells that cover the posterior cornea) or long-term risks of vision problems, including:

  • Glaucoma (increased pressure in the eye)
  • Peripheral anterior synechiae (iris adheres to the angle) 
  • Pigment dispersion (pigment from the iris floats to other parts of the eye)

Lastly, there has not been a safety and effectiveness assessment of ICL for the correction of moderate-to-high nearsightedness in patients with:

  • Diabetic retinopathy (damage caused to the retina as a result of a diabetes-related complication)
  • Glaucoma
  • A history of previous eye surgery
  • Serious non-ophthalmic disease
  • Unstable or worsening nearsightedness

Who is a Candidate for ICL Surgery? 

The FDA deems those as good candidates for ICL surgery if you meet the following characteristics:

  • Aged 21 to 45 years 
  • Need to correct myopia (between -3.0 diopters and -15.0 diopters) with less than or equal to 2.5 diopters of astigmatism at the spectacle plane (plane at which glasses are worn)
  • Need to minimize myopia (between -15.0 diopters and -20.0 diopters) with less than or equal to 2.5 diopters of astigmatism at the spectacle plane (plane at which glasses are worn)
  • Must have an anterior chamber depth (ACD) 3.00 mm or greater
  • Must have a stable refractive history within 0.5 diopters for one year before implantation
  • For patients with myopia and higher astigmatism, toric ICLs can correct up to 4.0 D astigmatism

Contraindications for vision correction procedures like this one include:

  • Have a narrow anterior chamber angle or the shape of your eye is not suitable for ICL (to be determined by your eye doctor)
  • Are pregnant or nursing 
  • Do not meet the minimum endothelial cell density for your age at the time of surgery

ICL Surgery: Procedure Steps & What to Expect

ICL surgery consists of the following steps: 

  1. You will complete a comprehensive eye examination that includes a corneal evaluation, including an endothelial cell count. You may also have a dilated retinal examination. 
  2. In the weeks leading to the surgery, your eye doctor will perform a YAG laser iridotomy to prepare your eye for the implantation. This procedure ensures fluid flows properly from the back chamber to the front chamber of the eye. It also helps avoid pressure build-up after surgery.  
  3. On the day of surgery, you will lie back on the treatment table or chair and receive a mild topical or local anesthetic in the eye. You may also need a mild sedative
  4. Your eye surgeon will make a small incision into the cornea. Given that the implantable lens is tiny, your surgeon will position it in its proper place before the anterior capsule (front surface) of the eye’s natural lens.
  5. The entire implantable contact lens surgery will take 20 to 30 minutes.
  6. Once your eye surgeon completes the implantation, you will have to follow eye care instructions. This means you will possibly need to take a prescribed antibiotic and/or topical steroid eye drops to prevent an eye infection and inflammation.
  7. You can go home the same day. However, you cannot drive and will need a ride. 
  8. The day after surgery, you’ll have a follow-up appointment. Your doctor will evaluate your progress. 

Recovery Time & Pain Management

Recovery time varies. 

You should follow the doctor’s instructions to avoid delaying the healing process. It is also important to not rub your eyes for the first 3 to 5 days. This can irritate or cause further injury to the eye. 

During recovery, you may experience light sensitivity. You may also feel like something is lodged in the eye. Sunglasses can help you feel more at ease. 

If you feel additional pain, speak with your eye doctor. They may be able to prescribe you pain medications. 

Patients with higher amounts of nearsightedness are at higher risk for symptoms before and after ICL surgery. The symptoms tend to be more frequent and severe in these patients.

How Successful is ICL Surgery?

This procedure is successful in many patients

An FDA 3-year follow-up study of ICL observed high rates of improved vision overall. 

Also, other studies have found ICL surgery to be superior to LASIK eye surgery in patients with more severe myopia (nearsightedness). 

Also, compared to patients who underwent LASIK, patients who opted for ICL had fewer cases of dry eyes or discomfort. The latter group also reported fewer limitations in normal activities and better vision-related quality of life. 

Pros and Cons of ICL Surgery

The advantages of undergoing ICL surgery include:

  • A suitable alternative to laser surgery 
  • Corrects high nearsightedness, which may be out-of-range for laser surgery
  • Produces clearer vision
  • Minimal discomfort after surgery
  • Quick procedure with immediate results 
  • Reversible, if necessary

The disadvantages of undergoing ICL surgery include:

  • A higher risk of complications in those with a higher degree of nearsightedness before surgery
  • More invasive than laser refractive surgery 
  • Possible postoperative vision fluctuations 
  • Expensive, as most health insurances do not provide coverage

How Much Does ICL Surgery Cost? 

Costs will vary according to where you live, your eye surgeon’s expertise, and other contributing factors. This procedure may also not receive coverage by most health insurance policies. 

ICL surgery costs between $1,500 and $5,000 per eye

Speak with your eye clinic and health insurance company about the financial options available.

Resources
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Fernández-Vega-Cueto, Luis, et al. “Implantable Collamer Lens with Central Hole: 3-Year Follow-Up.Clinical Ophthalmology (Auckland, N.Z.), Dove Medical Press, 11 Oct. 2018.

Implantable Collamer Lens.EyeWiki, 18 Apr. 2020.

Implantable Contact Lenses (Phakic Intraocular Lenses).University of Utah Health.

Kaur, M, et al. “Indications for Explant of Implantable Collamer Lens.Nature News, Nature Publishing Group, 12 Jan. 2018.

Swan, Russell, and Mark Mifflin. “Moran Core.Moran CORE | Implantable Collamer Lens (ICL) Explantation and Cataract Surgery.

United States Food and Drug Administration Clinical Trial of the Implantable Collamer Lens (ICL) for Moderate to High Myopia.Ophthalmology, American Academy of Ophthalmology.

Visian ICL (Implantable Collamer Lens) For Nearsightedness.”, Food and Drug Administration. Accessed 27 Sept. 2021. 

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