ICL Surgery - Procedure, Aftercare, Risks & Cost

8 sources cited
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What is ICL Surgery?

Implantable collamer lens (ICL) surgery, commonly Visian ICL, is a popular eye surgery for correcting myopia (shortsightedness) and astigmatism (irregularly shaped cornea). It eliminates dependence on glasses or contact lenses.1

ICL surgery involves the placement of soft plastic and collagen-based lens (ICL) between the iris and the eye's natural lens to help focus light on the retina. The retina is found at the back of your eye. It contains photoreceptor cells that detect light and send signals to the brain for interpretation, enabling clear vision.

Implantable contact lenses resemble intraocular lenses (IOLs) used in cataract surgery and are a type of phakic intraocular lenses.2 Phakic refers to the placement of artificial lenses without removing the eye’s existing lens.

ICL is a great alternative to LASIK eye surgery in people with severe nearsightedness. It offers a permanent solution to vision issues. The process is reversible through lens removal.

Studies show that over 94% of people who undergo ICL surgery achieve 20/40 vision or better without needing contact lenses or eyeglasses.3

Who Needs ICL Surgery?

Implantable contact lens surgery isn't safe for everyone. A good candidate for ICL surgery has the following characteristics: 

  • Is between 21 and 45 years old
  • Is in good general health
  • Meets the minimum endothelial cell density for their age
  • Is not a good LASIK candidate 
  • Has moderate to severe myopia (-3 diopters to -20 diopters)
  • Has minor to no astigmatism
  • Has good eye health
  • Does not take medications that can interfere with surgery or healing
  • Has at least 6 months to a year of unchanged vision correction prescriptions
  • Is not pregnant or breastfeeding
  • Is not allergic to local anesthesia

ICL Surgery: What to Expect

ICL surgery is an outpatient vision correction procedure, meaning you'll go home on the same day. Below is what to expect before, during, and after surgery. 

Preparing for Surgery

Your doctor will perform a YAG laser iridotomy about 2 weeks before surgery.4 This procedure involves creating tiny holes in the anterior chamber of your eyes to allow proper flow of the aqueous humor. Iridotomy prevents pressure buildup after surgery.

A week before the procedure, your eye doctor will perform a comprehensive eye exam to make sure your eyes are healthy and suitable for the procedure. You'll also undergo pupil and corneal evaluation and endothelial cell count.5

If you wear contacts, your ophthalmologist will advise not wearing them for several days to weeks before the surgery. This will allow your eyes to return to normal.

Tell your doctor about any medications you're taking and any previous surgeries, underlying medical conditions, or allergies you have or have had. Also, inquire whether you can drink or eat before surgery.

Lastly, prepare reliable transportation both to and from surgery. You won’t be able to drive after eye surgery, as you may have distorted vision. 

Procedure Steps

Once you arrive at your doctor's office, you'll sit on a reclining chair, and the doctor will prepare your eyes. They'll first administer dilating eye drops to enlarge your pupils. 

After, they'll apply a topical anesthetic medication to prevent pain and discomfort during surgery. They may also use a sedative to help you relax.

Your surgeon will then clean the eye and surrounding areas. Using a device called a speculum, they'll hold your eyes open, making them ready for surgery.

Surgery will involve an incision made in the cornea and the placement of a tiny ICL between the iris and the eye's natural lens.

Once the lens is in place, the surgeon will close the incision with small stitches. They will then apply antibiotics and topical steroids to prevent infection and inflammation and a patch or eyeshield for protection and comfort.

The entire procedure takes about 30 minutes. You may need a few hours in the recovery room for close monitoring before you're discharged. 

Aftercare & Recovery

After surgery, your doctor will prescribe antibiotics and other ointments to ease pain and discomfort. They'll also provide post-op care instructions to follow.

You'll be required to make a follow-up appointment a day after surgery for close monitoring.

General care instructions after ICL surgery include:

  • Avoid rubbing your eyes 3 to 5 days after surgery
  • Take medication as prescribed
  • Rest your eyes
  • Avoid strenuous activities such as weightlifting, contact sports, etc.

Following your surgeon's instructions and attending regular follow-up appointments will allow proper wound healing. Ask your doctor before resuming driving, contact sport, or any other strenuous activity.

You’ll notice improved vision within 2 to 3 days. Expect full recovery after 3 to 4 weeks.

Call your doctor if you experience severe eye pain or notice any sudden vision changes, as this may signal a complication.

Side Effects and Risks of ICL Surgery

Side effects of ICL surgery include:

In most cases, the ICL procedure will go smoothly. However, there are a few possible complications, including:6 

  • Overcorrection or undercorrection
  • Retinal detachment
  • Excessive bleeding
  • Eye infections (rare but serious)
  • Vision loss

How Much Does ICL Surgery Cost?

Visian ICL is considered elective surgery and is unlikely to be covered by your insurance. The cost may also vary from one surgeon to the other. Generally, expect to pay about $4,000 to $5,000 or more per eye

Alternative Treatment Options

The severity of your nearsightedness determines the type of treatment appropriate for you. Alternative treatment options include: 

Laser-Assisted In Situ Keratomileusis (LASIK)

Laser-assisted in situ keratomileusis (LASIK) is the most popular refractive surgery. It involves creating a flap on the cornea and reshaping it using laser technology. This improves visual acuity. LASIK corrects: 

  • Myopia
  • Hyperopia
  • Astigmatism
  • Presbyopia (age-related farsightedness)

There are also different types of LASIK: LASEK, Epi-LASIK, and iLASIK

Photorefractive Keratectomy (PRK) 

Unlike LASIK, PRK does not require flap formation to reshape the cornea. It's a good alternative for people with a thin cornea and therefore don't qualify for LASIK.7

PRK involves the removal of the corneal epithelium (thin top layer of the cornea) to allow for laser treatment.

Small Incision Lenticule Extraction (SMILE)

SMILE is a laser-based refractive surgery. The surgeon uses a femtosecond laser to cut out a piece of the cornea known as a lenticule. They then make an incision to remove the lenticule, which changes the shape of the cornea to achieve better vision.

Conductive Keratoplasty (CK)

Conductive keratoplasty (CK) uses radiofrequency energy to reshape irregular corneas. It treats low hyperopia with or without astigmatism and presbyopia (age-related farsightedness). CK also treats residual refractive errors after cataract surgery or LASIK.8

8 Cited Research Articles
  1. Astigmatism,” Foundation for Medical Education and Research (MFMER), 05 Oct. 2021
  2. What are phakic lenses?,” U.S Food & Drug Administration (FDA), 08 Jan. 2018
  3. Facts You Need To Know About STAAR SURGICAL'S Visian ICL Surgery,”  U.S Food & Drug Administration (FDA), 2004
  4. Aref A., “Laser Peripheral Iridotomy,” American Academy of ophthalmology (AAO), 02 Nov. 2021.
  5. Bonnell A., “Under the Specular Microscope,” Review of Optometry, 15 Aug. 2012
  6. Alió J., “ICL delivers visual stability, low complication rate at 12 years,” Healio, 10 Nov. 2015
  7. Vinciguerra R. “Conductive Keratoplasty” American Academy of Ophthalmology, 18 Sept. 2021.
  8. Vinciguerra R., “Conductive Keratoplasty,” American Academy of Ophthalmology, 18 Sept. 2021
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