For patients who want to reduce their dependence on glasses or contact lenses, laser eye surgery is often the best-known option. However, LASIK, SMILE and PRK are not suitable for everyone. Implantable Collamer Lens surgery, commonly known as ICL surgery or “implantable contact lens” surgery, is a lens-based form of vision correction. Instead of reshaping the cornea with a laser, a thin, biocompatible lens is placed inside the eye, behind the iris and in front of the natural lens. The composition of the lens means it works in total harmony with your eye, avoiding any foreign body reaction while providing exceptional optical clarity.
For carefully selected patients, ICL surgery can be an excellent alternative to laser eye surgery, particularly for those with moderate to high myopia, astigmatism, thin corneas or contact lens intolerance and dry eyes.
At Moorfields Private Eye Hospital in London, Mr Alex Day offers consultant-led assessment for patients considering ICL surgery. A detailed suitability consultation is essential, as ICL surgery is an intraocular procedure and, like all eye surgery, carries benefits, limitations and risks.
Key Takeaways
- ICL surgery is a lens-based alternative to laser eye surgery for selected patients.
- It is commonly used for moderate to high short-sightedness, with or without astigmatism.
- Unlike LASIK, SMILE or PRK, ICL surgery does not remove corneal tissue.
- It may be suitable for some patients with thin corneas or contact lens intolerance.
- The lens is designed to remain in the eye long term but can be removed or exchanged if clinically necessary.
- Suitability depends on careful assessment of the prescription, cornea, anterior chamber depth, endothelial cell count, lens status, eye pressure and retinal health.
- Possible risks include raised eye pressure, cataract, glare or halos, endothelial cell loss, inflammation, infection, retinal detachment and the need for further surgery.
What Is an Implantable Collamer Lens?
An Implantable Collamer Lens, or ICL, is a soft artificial lens that is surgically placed inside the eye to correct vision. Although many patients refer to it as an “implantable contact lens”, it is different from a standard contact lens.
A regular contact lens sits on the surface of the eye and is removed daily, fortnightly or monthly. An ICL sits inside the eye, behind the iris- the coloured part of the eye- and in front of the natural crystalline lens. Once in position, it is not visible to other people and cannot be felt.
The lens is made from Collamer, a biocompatible material used in modern phakic intraocular lenses. Its position inside the eye allows it to correct vision without removing tissue from the cornea.
How Is ICL Surgery Different from Laser Eye Surgery?
Laser eye surgery and ICL surgery are both designed to reduce dependence on glasses and contact lenses, but they work in different ways.
LASIK, SMILE and PRK correct vision by changing the shape of the cornea. These procedures are highly effective for many patients, but they may not be appropriate if the prescription is too high, the cornea is too thin, the corneal shape is unsuitable, or there are concerns about dry eye.
ICL surgery works differently. The cornea is not reshaped and no corneal tissue is removed. Instead, a lens is implanted inside the eye to focus light more accurately on the retina.
This can make ICL surgery particularly useful for patients who are not ideal candidates for corneal laser vision correction.
The EVO ICL
Mr Day uses the STAAR EVO ICL, this is the world leading type of implantable collamer lens used for vision correction in appropriate patients.
One of the important design features of the EVO ICL is its central port. Older ICL models often required a separate laser peripheral iridotomy before surgery to help fluid circulate inside the eye. The central port in the EVO ICL is designed to allow aqueous fluid to flow through the lens, which usually removes the need for this additional pre-operative step.
The lens also includes ultraviolet protection. However, this does not replace the need for appropriate UV-protective sunglasses in bright sunlight.
Many patients achieve a high quality of vision after ICL surgery. As with any form of refractive surgery, visual symptoms such as glare, halos or night-vision disturbance can occur, particularly in the early recovery period.
Who May Be Suitable for ICL Surgery?
ICL surgery may be recommended after a comprehensive eye assessment. It is often considered for patients who:
- Have moderate to high short-sightedness.
- Have astigmatism that can be corrected with a toric ICL.
- Have a prescription outside the safe treatment range for LASIK, SMILE or PRK.
- Have corneas that are too thin or otherwise unsuitable for laser eye surgery.
- Have contact lens intolerance.
- Want to reduce dependence on glasses or contact lenses.
- Have a stable prescription.
- Have healthy eyes with suitable internal eye anatomy.
A suitability assessment usually includes detailed measurement of the prescription, corneal shape and thickness, anterior chamber depth, endothelial cell count, intraocular pressure, pupil size, lens status and retinal health.
Who May Not Be Suitable for ICL Surgery?
ICL surgery is not suitable for everyone. It may not be recommended if there is insufficient space inside the eye for the lens, a low endothelial cell count, uncontrolled eye pressure, significant cataract, certain retinal problems, active eye inflammation, unstable prescription, pregnancy-related prescription changes, or other eye-health concerns.
Patients with high myopia may also have a higher baseline risk of retinal tears or retinal detachment. This does not automatically rule out ICL surgery, but it means the retina should be assessed carefully before treatment.
The purpose of the consultation is to identify whether ICL surgery is likely to be safe, appropriate and beneficial for the individual patient.
What Happens During ICL Surgery?
If you choose to undergo ICL surgery at Moorfields with Mr Day, you can expect a highly streamlined, consultant-led pathway.
The procedure itself is performed as a daycase and is incredibly swift, typically taking just 10 to 15 minutes per eye. Anaesthetic eye drops are used to ensure the eye is completely numb, making the process comfortable and painless..
Mr Day creates a microscopic, self-sealing incision at the edge of the cornea. The STAAR EVO ICL is gently folded, inserted through the tiny opening, and carefully positioned behind the iris. The lens unfolds naturally into place. Because the incision is so small, no stitches are required, and the eye begins healing immediately. Most patients notice a dramatic improvement in their vision within 24 hours.
Recovery After ICL Surgery
Vision improves quickly after ICL surgery, with most patients achieving 20/20, so normal vision without glasses or contact lenses within the first 24 to 48 hours. However, the exact recovery timeline varies between individuals.
After surgery, patients are prescribed eye drops to reduce inflammation and infection risk. Follow-up appointments are important to check the lens position, eye pressure, healing and visual recovery.
Most patients can return to office-based work within a few days, depending on their vision, comfort and occupation. Patients are usually advised to avoid swimming, eye rubbing, heavy lifting and strenuous exercise for a short period while the eye heals.
Mr Day and the clinical team will provide personalised aftercare instructions.
Benefits of ICL Surgery
For suitable patients, potential benefits of ICL surgery include:
- Reduced dependence on glasses or contact lenses.
- Ability to treat higher prescriptions than may be suitable for laser eye surgery.
- Preservation of corneal tissue.
- A lower risk of laser-induced dry eye compared with corneal laser procedures.
- High-quality optical correction in appropriately selected patients.
- The possibility of lens removal or exchange if clinically necessary in the future.
It is important to understand that “removable” does not mean risk-free. Removing or exchanging an ICL is another intraocular procedure and would only be recommended where there is a clinical reason to do so.
Risks and Possible Side Effects
ICL surgery has a strong safety profile when performed in carefully selected patients by an experienced ophthalmic surgeon. However, it is still intraocular surgery and carries risks.
Possible risks and side effects include:
- Raised intraocular pressure.
- Angle narrowing or glaucoma.
- Cataract formation.
- Endothelial cell loss.
- Corneal swelling.
- Glare, halos or night-vision symptoms.
- Inflammation.
- Infection.
- Lens rotation or incorrect lens position.
- Need for lens repositioning, exchange or removal.
- Retinal tears or retinal detachment, particularly in highly myopic eyes.
- Under-correction, over-correction or residual prescription.
- Loss of best-corrected vision, although this is very uncommon.
These risks are one reason why careful pre-operative assessment and follow-up are essential.
ICL Surgery at Moorfields Private Eye Hospital
Choosing vision correction surgery is an important decision. At Moorfields Private Eye Hospital, patients considering ICL surgery undergo a consultant-led assessment with detailed measurements of the eye.
Mr Alex Day will discuss whether ICL surgery is appropriate, whether another form of vision correction may be preferable, and what risks and benefits apply to the individual eye. The consultation also allows patients to ask questions and make an informed decision without pressure.
Frequently Asked Questions (FAQs) About ICL Surgery
Can I feel the Implantable Contact Lens in my eye?
No. Because the lens is placed inside the eye rather than on the surface, it does not interact with the sensitive nerve endings. You will not be able to feel it, and it will be completely invisible to you and anyone looking at you.
How long does a STAAR EVO ICL last?
The EVO ICL is designed to be a permanent vision correction solution and can remain in your eye indefinitely. However, its greatest advantage is that it is entirely reversible. If your prescription changes decades later, or if you develop age-related cataracts in your senior years, the lens can be safely removed or replaced by Mr Day.
Does the surgery hurt?
The eye is completely numbed using topical anaesthetic drops. You may feel a sensation of light pressure and see bright lights during the 15-minute procedure, but you will not experience any sharp pain.
How quickly can I return to work?
Recovery is generally very fast. Most patients achieve excellent vision the very next day and can comfortably return to office-based work within 48 hours. You will be advised to avoid heavy lifting, swimming, and strenuous exercise for a short period to allow the eye to heal perfectly.
Is the STAAR EVO ICL safe?
Yes. Over 4 million STAAR ICLs have been implanted worldwide. When performed by a highly experienced, specialist consultant ophthalmic surgeon like Mr Day within a world-class clinical setting like Moorfields Private, it is one of the safest and most successful elective surgeries available.
Ready to discover your options for high-definition vision? Click here to book your comprehensive ICL suitability consultation with Mr Alex Day in London.
