Implantable Collamer Lens
What are ICLs?
ICLs (Implantable Collamer Lenses) are a type of intraocular lens used to correct vision in patients whose prescription exceeds the safe limits of LASIK or PRK. For patients who have been told that they are not a candidate for Laser Vision Correction due to their strong myopic prescription, astigmatism, or chronic dry eye condition, ICLs may be an option. Keep in mind that ICLs are only available for the correction of nearsightedness (myopia) and astigmatism.
Sometimes referred to as “an implantable contact lens,” these lenses are made of a type of plastic that is well-tolerated by the eye. However, they are different from normal contact lenses and the lenses used in cataract surgery. For ICLs, the surgeon implants these precise lenses behind your pupil, and the power of the lens corrects your vision.
Are You a Candidate for ICLs
Adults over the age of 21
Those hoping to correct myopia ranging from -3.0 diopters to -16.0 diopters with less than or equal to 2.5 diopters of astigmatism
Those hoping to reduce myopia ranging from greater than -16.0 diopters to -20.0 diopters with less than or equal to 2.5 diopters of astigmatism
Must have stable vision and contact or glasses prescription for at least 1 year
No history or indication of active or potential corneal disease
No history or indication of any health issue that prevents normal healing
Not pregnant or nursing
Depending upon age and prescription, patient's must be aware of the potential need to wear glasses under certain conditions
(This is not intended as a complete list of qualifications or indications.)
How Does ICL Implantation Differ
from Laser Vision Correction?
ICL implantation is an option for vision correction, but it does not involve the use of a laser. Unlike LASIK or PRK, ICLs are removable, although this is not the goal.
Due to the nature of intraocular surgery, these procedures are commonly performed in the outpatient surgery center rather than in the clinic. While there is a bit more pre-operative preparation involved, studies comparing LASIK to ICL implantation have found ICLs to be superior in treating patients with higher degrees of myopia.1
ICLs are usually used for stronger prescriptions, so they are not as common a procedure like LASIK or PRK. However, over one million ICLs have been implanted worldwide, including by the US Military. The first ICLs were implanted in the 1990s, and they were approved in the U.S. by the FDA in 2007.
What's the Difference Between an ICL and an IOL?
Since the words lens and intraocular are commonly used in the context of cataract surgery, patients often confuse ICLs (Implantable Collamer Lenses) and IOLs (Intraocular Lenses). While both lenses have refractive power and are made of various plastics, the major difference is that in ICL surgery, the ICL lens is placed in front of your natural lens, and nothing is removed from your eye. In contrast, the first step during cataract surgery is removing the natural lens that has become a cloudy cataract. Then the cataract IOL lens is inserted to replace the natural lens. People who receive ICL implants will still develop cataracts naturally with age, and at the time of their cataract surgery, the surgeon will remove the ICL first, then proceed with cataract surgery in the same manner as for people who do not have ICLs.
To understand your specific vision needs, we will need to know your most current prescription. If you wear glasses, please bring them to the appointment. If you are a contact wearer, you will not need to be out of your contacts before the appointment, but you will be asked to remove them before your exam. To be considered a candidate for vision correction, your prescription must have been stable for at least one year, and preferably two.
Your eyes will not be dilated during this exam, and you can expect the hands-on time to be about an hour.
Laser Vision Correction is achieved by reshaping the cornea or the clear front part of the eye. Our technicians use advanced equipment to map the shape of your cornea and to measure its thickness.
If these tests indicate that you are NOT a candidate for a laser procedure, you may be a candidate for ICLs, and you can proceed with a second appointment to gain more information about your eyes and determine a plan for surgery.
Surgery Planning Consultation
This appointment is more detailed and may take up to two hours to complete.
Soft contact wearers will need to be out of contacts for one week before the visit,
Toric soft contact lenses must be two weeks out of contacts,
hard contact wearers, the standard time out of contacts is one month pre-exam.
Your eyes will be dilated during the appointment, so we recommend having a driver for your drive home.
The tests performed during this visit will be similar to the first exam but more extensive. They will provide your surgeon with the specific measurements that they and the equipment will need to assure the precise treatment and optimal outcome for you.
After discussing the options with your surgeon, you will have the opportunity to discuss scheduling, payment options, and pre-operative procedures with one of our surgery consultants.
ICL Implant Surgery
Three days before your surgery, you will begin using your prescribed drops. Most ICL surgeries are done with oral tablets for sedation, and with those, you may eat normally before surgery. Make sure to get a good night’s sleep so you will feel relaxed and comfortable for your procedure.
Plan to arrive a few minutes early to your appointment, wear comfortable clothing and have no eye makeup or moisturizers on your face that day. Our professional and compassionate staff will again walk you through your procedure and post-operative care steps and answer any other questions you may have. For your comport, a sedative will be administered. Our staff will prepare you for surgery, and eye drops will be used to numb and dilate your eyes. Then, after being greeted by your surgeon and assuring that your eye is correctly prepared, you will be taken to the operating suite.
ICL IMPLANTATION PROCEDURE
While the planning and testing may seem extensive, the ICL procedure takes only about 6 to 8 minutes per eye. Using the same sterile techniques of cataract surgery, tiny slits are made at the edge of the cornea. Anesthetic and protective gel are injected into the eye, followed by the ICL lens. The surgeon will position the lens precisely behind the iris, inject medicine to reverse dilation, and seal the incisions. Moments later, the patient is up and ready to have their eyes examined before heading home to rest.
With ICL implantation, there may be some discomfort after the numbing drops wear off, but this is usually manageable with preservative-free lubricating eye drops and over-the-counter pain relievers. While more variable, recovery is similar to LASIK, with functional vision on postoperative day one.
You should be able to resume regular activity within the next two days; however, you should refrain from strenuous activity for up to one week to aid in the healing process. Optimal results can be expected after several weeks.
Post-Op and Routine Care
Immediately after your procedure, your surgeon will examine your eyes and review the post-operative instructions with you and your driver. You will be given protective goggles to wear until the next morning to prevent rubbing your eyes. They will also act as sunglasses as your eyes will be sensitive to sunlight for the next few hours.
Over the next few weeks, you will use prescription eye drops on a specified schedule to protect your eyes from infection and promote healing. The instructions will be explained to you, and you are always welcome to call our office or our LASIK coordinator if you have any questions.
Q: Can I drive after surgery?
A: The day after your ICL procedure, you will see your doctor, who will determine if your vision is safe for driving. Most patients are safe within the first 1-2 days.
Q: Can I shower or take a bath?
A: We recommend that you wait until the next morning to shower or bathe and avoid getting soap or water directly in your eyes for 7 days.
Q: When can I go back to work?
A: You can resume most normal activities the day after surgery, but if your job requires using a computer, take frequent screen breaks and lubricate your eyes often. Also, avoid dust, smoke, and yard work for approximately two weeks.
Q: How long before I can exercise?
A: You may resume moderate exercise 1-2 days after your surgery, but avoid public gyms for 1 week, and avoid water sports for 14 days.
It is essential to properly protect and care for your eyes. During the first year following your procedure, you will see your primary eye doctor or us several times to make sure everything is healing properly. Specific instructions regarding these appointments will be given to you at the time of your surgery.
It is important to attend these visits and your annual eye exam to keep your part of the Vision Assurance Plan for good eye health. Our goal and expectation are that you will never need to see us for any adjustments after your initial procedure, but if that is ever the case, we need to know that you have done everything possible to take care of your beautiful eyesight since we saw you last.
Igarashi A, Kamiya K, Shimizu K, Komatsu M. Visual Performance after implantable Collamer Lens Implantation and Wavefront-Guided Laser in Situ Keratomileusis for High Myopia. Am J Ophthalmol.2009;148(1):164-170.e1.doi:10.1016/j.ajo.2009.02.001