ICL Surgery: Implantable Collamer Lens for High Prescriptions

What Is an ICL (Implantable Collamer Lens)?

An ICL (Implantable Collamer Lens) — also called a phakic intraocular lens (phakic IOL) — is a soft, flexible lens made from Collamer (a proprietary biocompatible collagen copolymer material) that is surgically implanted inside the eye, behind the iris and in front of the natural crystalline lens. Unlike standard IOLs used in cataract surgery, the ICL is placed without removing the natural lens ("phakic" means the natural lens is retained). The ICL corrects the refractive error by adding optical power inside the eye rather than reshaping the cornea.

The EVO ICL (formerly Visian ICL) by STAAR Surgical is the primary ICL system approved in the United States and globally. The EVO version includes a central aquaport hole that allows aqueous humor to flow naturally, eliminating the need for the iridotomy (laser iris hole) required by earlier ICL designs.

The ICL Procedure

ICL implantation is performed under topical or light sedation anesthesia as an outpatient procedure:

1. The custom-designed ICL lens is manufactured to the patient's specific prescription (available from -3 to -20 D myopia with up to 6 D of astigmatism)
2. A small self-sealing incision (2.6–3.0 mm) is made at the corneal limbus
3. Viscoelastic gel protects the corneal endothelium during lens insertion
4. The folded ICL is injected through the incision and unfolds behind the iris
5. The four haptics (flexible edges) are tucked behind the iris into the ciliary sulcus
6. Viscoelastic is removed; the incision is self-sealing and requires no sutures
7. The procedure takes approximately 15–20 minutes per eye

Ideal Candidates: Treating High Myopia

ICL is the preferred refractive procedure for:

• High myopia (-6 to -20 D): beyond LASIK's optimal range or with insufficient corneal thickness for safe LASIK ablation
• Thin corneas: ICL requires no corneal tissue removal, so thin corneas are not a limiting factor
• Dry eye: ICL does not disrupt corneal nerves and does not worsen dry eye
• Patients who want reversibility: the ICL can be removed or exchanged if needed
• Young patients with high myopia: preserves all corneal tissue for potential future procedures

ICL requires adequate anterior chamber depth (at least 2.8 mm) and appropriate pupil size for proper lens fit. A thorough evaluation with anterior segment OCT or Scheimpflug imaging is performed pre-operatively. For myopia in the overlapping range (-3 to -8 D), the choice between LASIK and ICL depends on corneal thickness, dry eye status, patient preference for reversibility, and cost considerations. See LASIK vs ICL comparison.

Reversibility: A Unique Advantage Over Corneal Surgery

Unlike LASIK or PRK (which permanently reshape the cornea), ICL surgery is reversible. The lens can be removed or exchanged through the same type of small incision used for implantation, and the cornea is left completely unchanged. If the patient develops a different refractive error over time, the ICL can be exchanged for a different power lens. If the patient develops a cataract later in life, the ICL is removed at the time of cataract surgery and replaced with a standard cataract IOL. This reversibility is particularly appealing to younger patients and those who are uncertain about permanent corneal modification.

Outcomes and Visual Quality

ICL consistently produces excellent visual outcomes, often rivaling or exceeding LASIK in some quality-of-vision measures:

• 97–99% of patients achieve 20/20 or better in FDA and international trials
• Significantly lower induction of higher-order aberrations compared to LASIK for high myopia (because no corneal tissue is removed)
• Superior contrast sensitivity at high myopia corrections (>-6 D) compared to LASIK
• Better night vision quality for high prescriptions
• Patient satisfaction rates of 97–99% in FDA trials

Long-term studies (10+ years) show ICL stability with no lens degradation, no induced corneal changes, and maintained endothelial cell health when appropriate sizing criteria are met.

Cost: $4,000–$6,000 per Eye

ICL surgery costs significantly more than LASIK, reflecting the cost of the custom-manufactured lens and the more technically demanding surgical procedure. Typical costs range from $4,000 to $6,000 per eye ($8,000–$12,000 for both eyes). FSA and HSA funds can be used; financing options similar to LASIK are available. For very high myopes who are not LASIK candidates, ICL may be the only surgical option available, making the cost comparison somewhat moot.

ICL vs LASIK: Key Differences

Feature	ICL	LASIK
Prescription range	-3 to -20 D (myopia)	-1 to -12 D (myopia)
Corneal tissue removed	None	Yes (stroma)
Reversible	Yes	No
Corneal thickness requirement	None	Minimum 500 microns
Dry eye impact	Minimal	Temporary worsening
Recovery	1–2 days	24–48 hours
Cost	$4,000–$6,000/eye	$1,800–$3,500/eye