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.
Implantable Collamer Lens ( ICL)
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.
To be a suitable candidate for ICL, you should be:
At least 18 years old
Specs number should be stable for about a year – minor changes do not disqualify you from becoming a candidate
Ladies should not be pregnant or be breastfeeding
Should not have any eye disease
Controlling diabetes is not a contraindication.
Absolute Indications for ICL
Eye power more than -8 dioptres up to -18 dioptres.
Cornea thinner than 450 micrometers.
Cylinder power of the eye more than 3.5 diopters.
Unhealthy cornea including Keratoconus.
Dry eye situations.
Any situation where LASIK is not a suitable option.
Relative Indications for ICL
All indications for LASIK/SMILE are also indications of ICL as it is considered to provide high definition vision and is not tampering with the cornea as in the case of LASIK/SMILE procedures.
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:
Where can Toric ICLs be used?
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:
Keratoconus
Corneal Transplants (including Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty, in cases with adequate anterior chamber depth),
Who aren’t excellent candidates for LASIK,
Patients with thin corneas
Astigmatism, due to other corneal ectasias.
Sometimes, patients’ eyes are not fully corrected following refractive surgeries like LASIK, SMILE, etc, and after intraocular lens transplant following cataract removal. Toric ICLs can also be used for these patients with residual refractive error to allow them a complete spectacle free life.
ICL SPHERICAL
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.
Benefits of Spherical ICL
The vision results of ICL are sharper with a superior quality of vision than after other refractive surgeries.
The visual recovery is almost immediate
The lens is invisible to both the patient and observers
The ICL is free from the frequent problems associated with contact lenses like infections, allergies, and dry eyes
Ideal surgical procedure for patients with preexisting ocular surface diseases where the conventional refractive surgeries like LASIK are known to aggravate the preexisting condition.
Since the lens is made of a biocompatible, flexible Collamer, which contains an UltraViolet light protector, the ICL completely prevents harmful UVA and UVB rays from entering the eye.
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.
Please know everything about ICL surgery in Indore at Saluja Eye Care Center.
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:
No dry eyes
High definition vision which is sharp and crisp
Excellent Night Vision
Preferred choice in thin corneas
UV protection is inbuilt in ICL
A typically quick, 15-minute procedure and most people can resume daily activities in just a few short days with clearer vision
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.
Peace of Mind
The ICL can give you the freedom to live a life uninhibited by the day-to-day lifestyle demands of glasses and contacts. Your favorite activities and new adventures are on the horizon, usually in a few short days.
One of the most common concerns people have about laser-based correction is that the procedure permanently changes the shape of their eye by removing corneal tissue.
The advantage of the ICL is that it can permanently correct your vision yet no natural tissue is removed or reshaped in any way during the procedure.
If for the unlikely reason you need or wish to remove your ICLs in the future, you can get it done by your Ophthalmologist.
Getting ICL surgery done at Saluja Eye Care Center, Indore
Dr. Praveen Saluja considers restoration of good vision to be both an art and a science. He strives to inspire confidence and trust through experience and excellence in professionalism. His goal is to enrich the lives of his patients by bringing light to their eyes through quality care.
At Saluja Eye Care Center, Indore, your vision and the condition of your eyes are first evaluated.
Recommendations for treatment are made based on the visual outcome you desire, your budget and your health. Because each eye is unique, the shape, health, and dimensions of your eye will determine whether you are a candidate for LASIK or would get better results from another procedure.
Many people who are not able to have LASIK surgery get excellent results with ICLs.
One of the important benefits of the ICL is that it is reversible, i.e. it can be removed any time, if required, and the patient gets back to its previous state of refraction.
The implant surgery is done on an out-patient basis and takes less than an hour to perform. The implant generally has very few side effects and is usually without complication. Severe complications occur in less than 1 percent of patients. However, as with any surgery, there are risks. Most are treatable.
Cost of ICL Surgery in Indore:
The cost of ICL surgery may seem high at first glance. However, when you consider that the EVO Visian ICL implant is permanent, you may save money over the long term.
The cost depends on your prescription, your doctor and where you have the procedure done. EVO Visian ICL costs more than LASIK surgery. Costs factored into the procedure include:
A thorough exam and pre-surgical screening to ensure proper fit and prescription.
A custom-made lens of high-quality and proprietary material.
Hospital and surgeon’s fees.
When you compare the costs of an implant to a pair of eyeglasses, you may spend the same or more over a period of 10 years for the glasses. If you have a strong prescription, you may opt for thinner lenses, which cost more. When you include UV, anti-glare and anti-scratch coatings, the price of spectacles increases dramatically. Frames also add to the price. A single pair of spectacles can easily cost a lot of money. You can easily end up spending as much as the surgery over a period of 10 years.
After an ICL implant, 95 percent of the patients do not need glasses or contact lenses. If you are in the 5 percent of people who may need external vision aids after an ICL implant, there are ways to achieve better visual acuity. If you are over 45 years old, you may need reading glasses.
After an initial consultation to evaluate your unique eye condition, Dr. Saluja can better inform you about the cost of surgery.
Q. What are the risks associated with an ICL procedure?
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.
Q. What is EyePCL? How is it different from ICL?
A. There are other variants of ICL manufactured by other companies, and a leading Indian brand manufactures a version called I-PCL.
Q. What happens during ICL screening?
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.
Q. What is the duration of ICL surgery?
A. The whole procedure usually takes 15 to 30 minutes.
Q. Is there any pain involved in the procedure?
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.
Q. Is the preoperative evaluation painful?
A. The preoperative evaluation is entirely painless but takes around two to three hours for a complete, comprehensive check.
Q. What is the time involved in the whole procedure?
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.
Q. Will I get freedom from specs forever?
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.
Q. For how long will I have to put medications after ICL surgery?
A. Usually, four weeks.
Q. After the ICL surgery is done, can I use spectacles or contact lenses?
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.
Q. Can eye makeup and cosmetics be used once the ICL surgery is done?
A. Yes but please consult your doctor before using any type of makeup.
Q. Will I ever get glasses after ICL treatment?
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.
Q. If I plan to go for a cataract surgery later, will there be any issues?
A. No. You can just let your doctor know about all your prior treatments and he will make the best choice for you.
Q. I wear contact lenses regularly; do I have to take any extra precautions?
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.
Q. Can it be removed from my eye?
A. The lens is designed to remain in place permanently; a qualified ophthalmologist can remove or replace the implant, if required.
Q. Is the ICL visible to others?
A. No. Since the lens is positioned behind the iris (the colored part of the eye), it is invisible to both you and observers.
Q. Will I be able to feel ICL once it’s in place?
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.
Q. What if my Vision changes after I receive the ICL?
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.
Q. Where is the ICL placed in the eye?
A. The ICL is placed just behind the black part of the eye iris in front of the natural crystalline lens.
Q. Is it possible that my body doesn’t accept ICL?
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.
Q. What is the difference between Intra Ocular lens (IOL) and ICL?
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.
Q. Is ICL Surgery safe for nearsightedness (myopia), farsightedness (hyperopia) and astigmatism?
A. Yes, ICL is a safe option for all of the above.
Q. Is ICL surgery safe in patients with Keratoconus (Conical Cornea)?
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 visual results obtained after ICL surgery in severe keratoconus are less predictable than in patients without keratoconus
The vision obtained with the use of Toric ICL in severe keratoconus is the same as the best-corrected vision with glasses or soft contact lenses. It is believed that keratoconus associated corneal aberrations would have an impact on the final visual quality.
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.
Q. Can ICL surgery be done during pregnancy?
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.
Q. What if you have had ICL surgery, and then discover you were pregnant?
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.
