What is ICL?

ICL (Implantable Contact Lens) treatment is the ideal solution for patients with prescriptions not suitable for laser eye surgery. ICL provides the same outstanding results as LASIK, but requires no removal of corneal tissue and thus is the treatment of choice for people with thin corneas and extremely high refractive errors of near-sightedness (myopia) or far-sightedness (hyperopia) and astigmatism.

At Dr Natasha Lim Eye Centre, the Visian Implantable Contact Lens (Staar Surgical Company, USA) is available.

The Visian ICL is able to correct myopia of -3.0 D to -20.0 D (US FDA approved). Toric models, which can correct both myopia and astigmatism simultaneously, are also available, so astigmatism sufferers can also expect total spectacle freedom post-operatively.

Implantable collamer lens or ICL, called by its manufacturer Visian ICL, is a soft, flexible gel-lens made of a collagen copolymer material, named by combining “collagen” and “polymer”. This material is biologically inert and will have no reaction with the rest of the eye once implanted. The ICL procedure is a popular alternative to LASIK and PRK since it requires no removal of the corneal tissue and is also reversible. It has been in use worldwide for more than 10 years , with > 100,000 ICL implantations having been performed worldwide and published clinical trials with long term results have shown ICL to be safe and effective. Visian ICL gained US FDA approval December 2005 for the treatment of myopia.

A picture of eye lens

Implantable Contact Lens at the corner of the eye
ICL enters the eye through a 2.5mm incision at the corner of the eye

LASIK is non-invasive and simply re-shapes the outer aspect of the cornea to treat myopia, hyperopia, astigmatism and Lao Hua.

During ICL surgery, the ICL is surgically implanted inside the eye where it resides behind the iris muscle and in front of the crystalline lens permanently. ICL requires no maintenance after the procedure and functions very similarly to contact lens in improving visual acuity. For most patients, ICL provides permanent freedom from glasses or contact lenses.

ICL Surgery

At Dr Natasha Lim Eye Centre, the procedure is performed under local anesthesia as a day surgery procedure only. Both eyes are operated on at the same time. The flexibility of the ICL enables the lens to be rolled for insertion into the soft silicone tip of the micro incision injector through a very small incision (2.5mm) thus avoiding the need for stitches, and this pain-free procedure usually takes 10 minutes per eye in the hands of an experienced ophthalmologist. Following the procedure, most people have immediate use of their eyes. The recovery period is typically 1 night, with no pains and most patients are able to go to work the next day. After surgery, the common advice is to avoid driving home and to visit Dr Lim regularly for several months so as to monitor the implants.

Whilst the older version of ICLs required a peripheral iridotomy laser procedure beforehand to prevent glaucoma (raised eye pressure) post-op, Dr Natasha Lim use the latest Visian ICLs with CenterFLOW that has central KS-Aquaport, thus peripheral iridectomy is eliminated so procedure time is shortened and the overall patient experience enhanced. With the addition of this central port, eye pressure remains stable and refractive outcomes match those of previous lens models.

Ideal Candidates for ICL Surgery

  • Suffer from moderate to high myopia (nearsightedness) of -3.00 to -20.00 diopters.
  • Suffer from hyperopia up to +12.00 (long-sightedness) diopters
  • Suffer from astigmatism up to -5.00 dioptres
  • Are not good candidates for LASIK because they have thin corneas or abnormal corneal curvature
  • Aged 21 – 45 years old (FDA approved age group for ICL in the US)

Contra-indications for ICL Surgery

A person is not a good candidate for ICL if they:

  1. Have a high risk of eye trauma.
  2. Have large pupils. If one’s pupil dilates in low lighting conditions to a size that is larger than the size of the ICL, one has a higher risk of experiencing visual disturbances after surgery that may affect one’s ability to function comfortably or normally under such conditions (e.g., while driving at night).
  3. Have glaucoma
  4. Have cataract
  5. Are over the age of 45 years old. ICLs are not FDA approved for people above 45 years of age. The internal environment of the human eye starts to change around after 45 years of age and ICL implanted may not be in a stable environment thus having a higher chance of explantation.

Possible Side Effects

ICL implantation carries several risks associated with invasive eye surgeries, such as:

  1. the development of cataracts which could occur if the natural lens is touched by the ICL during the surgery,
  2. increased rate of endothelial cell loss from the back surface of the cornea, and
  3. glaucoma (increased pressure inside the eye).

One of the key advantages of ICL surgery is reversibility. If any signs of an adverse reaction to ICL implantation are observed at review visits, the ICL can be removed relatively easily. More commonly, revision surgery involves replacing one ICL with a smaller or larger lens to improve the fit in the eye, or repositioning the ICL within the eye. If revision surgery is required, the recovery is the same and as quick as the original surgery.

If my eyes can do LASIK, should I still ask for ICL?

LASIK is a proven and safe procedure, but only 95% of people qualify for it. This is very much dependent on corneal parameters which are taken at the time of LASIK assessment. ICL surgery does not involve the cornea, hence for some patients whose corneas are unsuitable for LASIK, ICL may be an option.

Although the risks associated with ICL implantation are generally low, it is truly an invasive intraocular procedure, therefore the potential complications are more serious than LASIK.

The most serious complication is infection within the eyeball resulting in permanent loss in visual acuity. Infection of the intra-ocular tissues or endophthalmitis, although extremely rare, is a potentially sight-threatening complication.

Other potential problems include, but are not limited to, retinal detachment, cataract, corneal decompensation and glaucoma.

Dr Natasha Lim specializes in all types of refractive procedures such as LASIK, epiLASIK, LASEK and Implantable Contact Lens ICL. She is well equipped to help you select the safest and most suitable procedure for your eyes in an unbiased manner.

Authored by: Dr Natasha Lim