ICL — the refractive correction when laser is not safe
The Implantable Collamer Lens (ICL) is a phakic intraocular lens — a soft, biocompatible lens placed inside the eye in front of the natural crystalline lens. It corrects refractive error without reshaping the cornea. For patients with high myopia, thin corneas, or topography that rules out LASIK and SMILE, the ICL is usually the right answer.
We perform ICL as a same-day daycase on the STAAR EVO+ Visian platform. Thirty minutes per eye in the operating suite, discharged the same afternoon.
What it is
The EVO+ Visian ICL is a soft Collamer lens (porcine-collagen-derived material). It is folded into an injector, introduced through a 3 mm corneal incision, and unfolded behind the iris and in front of the natural lens. A central port (EVO design) allows aqueous humour to flow without the need for a peripheral iridotomy.
The cornea is not touched beyond the small entry incision. If your prescription changes significantly years later, the ICL can be removed and exchanged. This is the reversibility that LASIK does not have.
When ICL is the right answer
| Indication | LASIK | SMILE | ICL |
|---|---|---|---|
| Myopia ≤ −10 D, normal cornea | Preferred | Preferred | Possible |
| Myopia −10 to −18 D | Not safe | Not safe | Preferred |
| Cornea below 480 µm | Not safe | Not safe | Preferred |
| Ectasia risk on Pentacam | Not safe | Not safe | Preferred |
| Keratoconus | Not safe | Not safe | Possible (toric ICL) |
| Significant dry eye | Less ideal | Better | No corneal nerve impact |
Choreography
| Time | What happens |
|---|---|
| 08:30 | Pre-op work-up, ICL re-confirmation against pre-ordered lens |
| 09:00 | Right eye — 30 minutes |
| 10:00 | Recovery lounge |
| 11:00 | Left eye — 30 minutes |
| 12:00 | Recovery |
| 14:00 | Discharge with antibiotic + anti-inflammatory drops |
Who is a candidate
- Myopia −0.5 to −18 D, hyperopia up to +10 D, astigmatism up to 6 D (toric ICL)
- Anterior chamber depth ≥ 2.8 mm
- Stable refraction for 12 months
- Endothelial cell count above 2,500 cells/mm²
- Age 21 to 45 (lens exchange becomes a different operation after that)
ICL is the right answer when LASIK is not safe — not as a "premium" version of laser surgery. We do not push ICL on patients whose eyes are good LASIK candidates.
Recovery
Day 0–1 — Vision sharp within hours. Mild light sensitivity overnight.
Week 1 — Tapering drops. Vault re-checked at slit-lamp.
Month 1 — Final refraction settled.
Year 1, then annual — Endothelial cell count and lens vault re-measured.
What it is not
ICL is not a substitute for cataract surgery. It is not a substitute for LASIK when LASIK is safe — the intra-ocular procedure carries a small infection risk that the corneal procedures do not. It does not correct presbyopia.
The package
Both eyes, custom-ordered EVO+ Visian lenses (lead time accounted for in scheduling), the daycase suite, all medications, two hotel nights, transfers, translator, twelve months of video follow-up plus an annual endothelial-count check letter to your home GP. One number.
