ICL, also very commonly referred to as Phakic IOLs, are micro thin lenses implanted over the natural lens, inside the eye, to correct spectacle power. They are similar to contact lenses placed in eyes except that a contact lens is temporary and has to be put on a daily basis whereas ICL is put inside the eye permanently. The vision with an ICL is better than that of a contact lens because the ICL does not move and can correct cylindrical power, along with spherical power, in a better way.
ICL gives high definition vision and does not require creating a corneal flap and corneal tissue removal as in LASIK, SMILE & other laser specs removal procedures. It also does not cause any corneal dryness as seen in standard specs removal processes. The ICL surgery provides a safe and effective surgical correction of powers as high as -20D and cylindrical correction of 6D.
If you wear corrective eyewear such as glasses or contact lenses and would like to be free of the encumbrance, then there are several options which provide permanent vision correction. Although LASIK surgery is the most well-known method to correct vision, there are other options for people who may not be suitable candidates for LASIK.
Over 10,00,000+ ICL’s have been implanted worldwide over the last 20 years. ICL surgery is the best option in specs power of -8 or more. In lower powers, they are preferred when the cornea is thin, if you have dry eyes and LASIK is not advisable.
ICL is of two types, ICL Spherical and ICL Toric. Spherical ICL lens corrects only spherical power of glasses while Toric ICL lens corrects cylinder along with spherical power of glasses. Below is a comparison of both:
The Toric ICL over time has proven to be an extremely safe and effective option for better vision without glasses even for patients following surgery for:
The Spherical ICL is usually prescribed for people (21 – 60) who have a Moderate to High power of glasses, and where the usual LASIK procedures cannot correct the same due to either very high refractive error or thin corneas. The spherical ICL may be used for the correction of moderate to high myopia ranging from – 3.0 D to –20.0 D. However, they are most commonly used in powers beyond -8 DS in eyes with normal corneas, or in eyes with lower power very thin corneas.
The spherical ICL offers perfect vision correction to patients who do not require cylindrical correction for their astigmatism, that is, their refractive error is purely spherical.
The ICL is inserted into the eye using a small, almost painless incision, and the surgery usually takes about fifteen minutes. Spherical ICL can be used in patients with thin corneas, large pupils, as well as dry eye, and in refractive errors as high as -20D, all of which are not suitable candidates for LASIK.
Like other refractive surgeries, it is a permanent solution for refractive errors and spectacle free life. In addition to that, the most remarkable part of the procedure is that it is entirely reversible, unlike LASIK. It means that the surgeon can undo the procedure in the future in case newer, better technology is available, or in case the patient wants to revert to his or her original refractive status for any reason.
Spherical ICLs have revolutionized the outcomes of refractive surgeries in the subset of patients who need it the most, but till now, have had no options but to continue with glasses.
ICL has been approved in Europe since 1997 and in the U.S. since 2005. In that time, over 500,000 eyes have been implanted with ICLs by certified, specialized surgeons with a study showing a 99% patient satisfaction rate. In addition to that, one also gets the following benefits:
For people who value health and wellness, the ICL surgery could be the choice for you. The Collamer base of the lens material is 100% biocompatible, meaning it is designed to function in harmony with your body’s chemistry.
A. ICLs are very very safe procedures. These procedures are also US-FDA approved, which means they have been given safety clearance for Human Eyes. However, like any other surgical procedure, it can have some complications which are extremely rare if a proper screening check is done before the process. Some of the risks include infection, increased intraocular pressure, and the possibility of accidental damage to the crystalline lens during the procedure. Some patients may experience some discomfort during the healing process (like dry eyes, light sensitivity), but these effects are temporary. Your doctor will discuss with you the risks and benefits of the procedure during your consultation. Nobody in our surgical experience has ever lost sight due to this procedure.
A. There are other variants of ICL manufactured by other companies, and a leading Indian brand manufactures a version called I-PCL.
A. An ICL has to fit perfectly in a space within the eye, and therefore ICL size and parameters have to be customized to the individual eye. The small ICL will be loose and make it float around. A large size will make it too tight and disturb adjoining areas. It is similar to a custom fitted suit. Even the slightest variation can disrupt final outcomes.
ICL Screening is the most crucial step in the entire process. For an ICL to go within the eye, the eye should have a natural space for it. This space is called the Anterior Chamber Depth (ACD). Ideally, the ACD should be 3.0 mm or more, but anything more than 2.75 mm is acceptable for a new generation of ICL.
Besides ACD other parameters to be checked are, accurate spectacle power of the eye, open angles of the eye, size of the cornea which is termed as white to white, the curvature of the cornea which is termed as Keratometry and the corneal thickness which is termed as Pachymetry.
Retina evaluation is a must and should be done by a retina specialist. It is because ICL are usually done in high spectacle powers called high myopia. The retina is weak in such eyes and can be associated with retina breaks and holes. Such lesions run the risk of retinal detachment, and preventive management is essential. Prevention is very simple and requires retina photo-coagulation which is a painless, non-touch, 5-minute procedure. It takes about 2-3 weeks for retina lesions to stabilize after which ICL can be implanted.
A. The whole procedure usually takes 15 to 30 minutes.
A. The procedure doesn’t cause any pain. There might be a little pressure during the whole process. After the procedure, for the next three to four hours, there can be some discomfort but that is easily taken care of by simple medicines. One should contact their ophthalmologist in case there is any pain afterwards.
A. The preoperative evaluation is entirely painless but takes around two to three hours for a complete, comprehensive check.
A. Generally, the operation is done in one day. However, before the treatment, one has to get a screening workup done which includes different types of investigations and takes about 2-3 hours. ICL sizing’s are calculated by eye specialists, and the order is sent to Staar Surgical to Switzerland and USA. If a custom fit size is available, the lens is received in India within two weeks however if a new lens is to be manufactured it will take about 6 to 7 weeks. Depending upon the condition of the eyes, it can take from one to two weeks to fully recover and do your daily jobs.
A. Most of the people, approximately 95 percent, will not need glasses for long. The remaining 5 percent will have their dependency reduced on glasses. Your surgeon will explain this difference to you better.
A. Usually, four weeks.
A. You can consult your doctor for more details. If there is a need, your doctor will recommend you to use specs or cosmetic contact lenses.
A. Yes but please consult your doctor before using any type of makeup.
A. After ICL treatment, the eye behaves like a normal eye. It means that you may require glasses for reading after 40 due to the normal aging process of an eye.
A. No. You can just let your doctor know about all your prior treatments and he will make the best choice for you.
A. Usually, the contact lens wear has to be discontinued for 2-3 weeks before you come for ICL workup and Surgery. However such should be discussed with your doctor who can suggest precautions in advance.
A. The lens is designed to remain in place permanently; a qualified ophthalmologist can remove or replace the implant, if required.
A. No. Since the lens is positioned behind the iris (the colored part of the eye), it is invisible to both you and observers.
A. The ICL is designed to be completely unobtrusive after it is put in place. It stays in position by itself and does not interact with any of the eye’s structures.
A. One advantage of ICL is that it offers treatment flexibility and it is entirely reversible If there is any change in vision, which is extremely rare, the ICL can easily be removed and replaced. If necessary, another procedure can be performed at any time. Patients can wear glasses or contact lenses as needed following treatment with the ICL. The implant does not treat presbyopia (difficulty with reading in people 40 and older), but you can use reading glasses as needed after receiving the ICL.
A. The ICL is placed just behind the black part of the eye iris in front of the natural crystalline lens.
A. It is an extremely rare possibility because ICL is made of Collamer, which is a highly inert and biocompatible material and has not caused any problem for the last 20 years, so it is unlikely it will cause any problem in future.
A. IOL is an artificial lens which is implanted after removal of the natural lens usually in Cataract surgery. In ICL surgery, the natural lens is not removed, but the ICL is placed on top of the natural lens.
A. Yes, ICL is a safe option for all of the above.
A. ICL surgery is a safer and more effective option for these patients in case they want to avoid glasses or contact lenses since ICL surgery does not involve removing a part of the corneal tissue to correct the refractive error, unlike conventional laser surgery.
A subgroup of Keratoconus patients who can benefit significantly from ICL surgery are those whose disease is stable and has stopped progressing. Once the condition has stabilized, that is, there is no change in the refraction in the eye or the power of glasses, with no surgical intervention for two years, Toric ICLs can offer these patients a better quality of life.
Eyes having riboflavin-ultraviolet-A collagen cross-linking (CXL or C3R) tend to have a fluctuation in refraction in the initial post-treatment. After the refraction stabilizes, these patients may be offered ICL surgery.
Similarly, in patients with an off-center cone, the surgeon may first offer the use of adjunct Intracorneal Ring Segments (ICRS) to centralize the cone. Once the keratoconus is stabilized, better sight without glasses may be offered by the use of ICL.
However, there are three major caveats to this:
The use of ICLs for correcting the refractive error in keratoconus is an off-label use of the lens, even though it is widely practiced and accepted by both patients and ophthalmologists all over the world. Keratoconus patients unfit for corneal procedures and intolerant to refractive correction by spectacles or contact lenses have significantly benefited from Toric ICL implantation alone or as an adjunct with other surgical procedures to correct the refractive errors associated with keratoconus after proper informed consent from the patients.
A. Refractive surgeries are elective surgeries, and best planned after having the baby, and preferably six months after stopping breastfeeding. That said, there have been several cases where LASIK or ICL surgery has been performed, not knowing that the lady having the surgery was pregnant, with no harmful effects to either the baby or the mother.
As a part of the pregnancy-induced changes in the mother’s body, hormones can cause decreased tear production, leading to dry eyes. It manifests as irritation and redness, especially in patients who wear contact lenses. The water retention in the body caused by the hormonal changes also affects the eyes. The curvature of the cornea changes, and consequently, the power of your glasses. It results in the fluctuation of vision that is often reported during pregnancy. The fluctuation of vision is much more in people with diabetes.
In case you were to have ICL surgery for removal of glasses during pregnancy, and the eyes were to return to the pre-pregnancy state, you would need glasses again. Also, since there is no algorithm to determine how much of the change in power will come back, the doctor cannot rely on your pre-pregnancy glasses either to determine the exact power of the ICL. That is why the doctors advise that it is better to wait until the refractive power of the eye has stabilized before considering the surgery.
Another consideration to avoid elective surgery during pregnancy is that the eye drops used during and after the surgery may be absorbed into your bloodstream and reach the growing baby. This quantity is minimal, and there is no evidence that it can potentially harm the fetus, but doctors generally feel that it is best to defer surgery unless necessary.
A. The answer to this is simple. Do not panic. You are not the only one. Several young women have had ICL surgeries, only to find out that they were pregnant at that time. There have been no reported harmful effects to their eyes, or to the growing babies. In fact, some people use this as an argument to allow the surgery during pregnancy.