Visian Implantable Collamer Lens (ICL): Pros and Cons

Implantable Collamer Lenses (ICL) are gaining popularity in the refractive surgery field. ICLs are often seen as an alternative to laser-based corneal surgeries, such as laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Here, we’ll highlight the various advantages and disadvantages of ICL.

ICL Pros

ICL is an excellent vision correction procedure for those with high glasses or contact lens prescriptions. Every refractive surgery has an upper limit to the amount of correction it can deliver, per the Food & Drug Administration (FDA). The ICL upper limits are quite high, so this is good news for those that may not be candidates for laser-based refractive surgery like LASIK or PRK. The Visian ICL is FDA-approved for myopia between -3.00 to -20.00 D. Their toric version can correct astigmatism in the range of 1.00 to 4.00 D.

ICL has no minimum corneal thickness requirement, in contrast to LASIK and PRK. Therefore, even if your cornea is too thin for laser-based procedures, ICL remains an option.

If you have dry eyes, you may want to opt for ICL. It is not disruptive to the corneal nerves, like LASIK. Although the surgeon has to make a small incision in the cornea to implant the ICL, it does not have the same impact as a laser-based corneal procedure.

ICLs offer ultraviolet protection (UV) to the inner eye, including the macula. The natural lens is susceptible to UV, which can accelerate the formation of cataracts. While this protection is certainly a nice benefit, it doesn’t eliminate the need for sunglasses; these are still required to protect the parts of the eye that sit in front of the ICL, such as the eyelids and cornea.

Another benefit of ICLs is that their implantation is reversible. Most patients don’t ever need to have the lens removed, but they do feel comforted by having the option available to them. Just as easy as the lens goes in can it come out.

ICL Cons

If you’re under the age of 21 or over the age of 45, ICL may not be an option for you. ICL is only FDA-approved for patients between the ages of 21-45. LASIK, on the other hand, can be done for those over the age of 18.

It’s important to know what your refractive error is when you’re looking at surgical options. Emmetropia refers to the absence of refractive error. You wouldn’t be looking for refractive surgery if you were an emmetrope. Then, there’s myopia (nearsightedness), hyperopia (farsightedness) and/or astigmatism. ICL can only correct myopia and astigmatism. Therefore, if you have hyperopia, ICL won’t be an option at this time.

Recovery after ICL can take slightly longer than LASIK, about a week or so, but is generally quite smooth. This recovery time is somewhat comparable to PRK.

Implantable Contact Lens Risks

Generally, the ICL procedure goes smoothly. However, there is always a small risk that something could go wrong.

As the ICL is being inserted into the eye, it could bump the inner side of the cornea, called the endothelium. The endothelium contains the water pumps for the cornea and could be damaged in the process. This could lead to corneal swelling and resultant blurry vision.

If the ICL bumps the natural lens of the eye while it’s being positioned, it could cause a cataract to form. This can cause blurry vision and may require surgical intervention.

If the ICL is incorrectly placed or takes up too much space in the eye, it could cause the intraocular pressure to rise. This could lead to glaucoma, which can lead to vision loss.

The power of the ICL is determined by sophisticated calculation algorithms. Unfortunately, they’re not perfect. Occasionally, this can result in under- or overcorrection. This could mean that glasses or contact lenses are still necessary after surgery. Sometimes, an additional procedure can correct this issue.

There is also the possibility of retinal detachment, which could lead to vision loss. Patients with very high amounts of nearsightedness are at an increased risk for this complication.  

As with most surgeries, there is a risk of infection.

Am I a Good Candidate for ICL (Implantable Contact Lens)?

Some of the best candidates for ICL are those with high glasses/contact lens prescriptions. An ICL can offer the benefit of crisp, clear vision, free of halos and glare. A patient should be relatively young, between the ages of 21-45, since presbyopia and cataracts start to develop later in life and could impact the clarity of vision.  

Weighing implantable contact lens pros and cons is important when considering this refractive surgery option. Talk to your doctor today about whether ICL is right for you.