With so many technical options and aspects to consider surrounding vision correction, determining what is truly the best option for you can be difficult. While LASIK surgery is the most well-known procedure for improving vision through surgery, it may or may not suit you and your eyes.
Implantable contact lens (ICL) surgery, which delivers a lens implant as a no-maintenance and lasting solution to improving your vision, has grown in popularity over the years.
A Visian ICL (Implantable Collamer® Lens) is installed just behind the iris, connecting the eye’s natural lens and colored iris, during ICL surgery. This procedure aims to change the eye’s focusing power and eliminate the need for eyeglasses or contact lenses. ICL surgery treats moderate to severe myopia (nearsightedness) or astigmatism.
What are Implantable Contact Lenses?
Implantable Contact Lenses (ICL) are another type of contact lens that can treat severe nearsightedness. It functions similarly to a contact lens, and the procedure aims to correct a refractive error without jeopardizing the integrity of the cornea structure.
It is a choice for those who are ineligible for LASIK. It functions as a contact lens but is placed directly in the eye.
The Implantable Collamer Lens (ICL) is a safe and effective treatment option for a wide range of vision problems, including:
- Short-sightedness (myopia): -3.0 diopters (300 degrees) to -19.0 diopters (1,900 degrees)
- Long-sightedness (hyperopia): up to +10.0 diopters (1,000 degrees)
- Astigmatism: up to -6.0 diopters (600 degrees)
The ICL does not alter the natural shape or health of the cornea. The eye surgeon implants it through a microscopic incision that does not require stitches. It is a low-risk, long-term solution that requires no maintenance.
Furthermore, you cannot feel the lens while in the eye, and you can choose to remove it if necessary. Preparation before and after ICL surgery is critical for achieving the most significant benefit and safety.
How Does Implantable Contact Lens Work?
The Visian ICL functions similarly to a standard contact lens, except that it does not need to be removed or replaced. If necessary, you can remove the ICL from your eye. It is a long-term corrective option that eliminates the hassle that traditional contacts can cause. The Visian ICL’s lack of maintenance is just one of its many advantages.
Some people are apprehensive about undergoing a permanent procedure such as LASIK. ICL surgery is a minimally invasive procedure that can be completed in as little as 7-10 minutes per eye.
Because you cannot fit the implant through a much smaller incision, it is even less invasive than LASIK. The Visian ICL is made of collamer, a biocompatible material. Your body will not reject the ICL because Collamer makes up its whole material.
These special contact lenses are surgically implanted into the eye and are made from a material called Collamer, which is biocompatible. Collamer is made up of a combination of polymer and collagen which also help to make the lenses lighter and more permeable for gas and nutrients.
Is Implantable Contact Lens Surgery Right for Me?
ICL corrects myopia ranging from -3.00 to -20.00 D in patients aged 21 to 45. Preexisting lenticular opacity or early cataracts are relative contraindications to phakic IOL implantation.
Although the percentage of cataract formation requiring surgery in the ICL’s FDA trial was low (0.6 percent), implantation of a phakic IOL could hasten cataract formation. Fortunately, the presence of an ICL does not complicate cataract surgery because eye surgeons can easily remove the lens during the procedure.
The ICL may also be unsuitable for an eye with a shallow anterior chamber. One of the first things surgeons notice when beginning to implant this IOL is the significantly reduced working area compared to cataract surgery.
Instead of working from the endothelium to the posterior capsule, the surgeon must work in the space of about 3 mm, which is the typical anterior chamber depth. A shallower chamber puts both the endothelium and the crystalline lens at risk. Although the ICL is labeled as small as 3.0 mm, experienced surgeons have gone as small as 2.7 mm.
A healthy endothelium and a high cell count are required. Endothelial cell loss was observed in the trials of both phakic IOLs approved in the United States. Before the lenses are implanted, any candidate for a phakic IOL should have a retinal evaluation and treatment for any significant pathology.
Narrow angles, glaucoma, synechiae, zonular weakness, irregular astigmatism, uveitis, and pseudoexfoliation are less common relative medical contraindications for the ICL. Large pupils are not a problem, but it did not specifically study them in the ICL’s FDA trial.
In a few cases, an excellent preoperative candidate turns out to be a bad one during surgery. If the pupil does not dilate well (> 7 mm), the risk of ocular trauma with the ICL is too significant. Any capsular entry should cause surgeons to abandon the planned ICL procedure and perform a lens extraction instead. If they are unable to place the lens easily, ophthalmologists should consider performing a refractive lens exchange.
Setting Your Expectations for ICL Surgery
Preparing for ICL Surgery
An eye examination is necessary to assess vision and focus on and discern objects. Patients must remove their contact lenses and glasses before having their eyes examined. Ophthalmologists perform the following eye tests:
- Visual acuity: A term commonly refers to vision clarity, corneal topography (corneal imaging test).
- Optical coherence tomography: This test impacts vision. Patients’ eyes tend to become more sensitive to light after testing. It is strongly advised that patients bring sunglasses and refrain from driving following an eye examination. Friends or relatives must accompany patients.
What to Expect Before ICL Surgery
Further checkups on the eyes to determine overall health conditions are needed. Following an eye health assessment, your eye surgeon will discuss the benefits and drawbacks of ICL surgery.
Two to three weeks before surgery: Because Visian ICLs add material to your eye, you may notice an increase in eye pressure. To significantly reduce this risk, your eye surgeon will use a guided laser to make two small holes on the extreme outside your iris or the colored portion of your eye a few weeks before the ICL surgery. It ensures that fluid in your eye flows correctly from the back to the front.
One day before the surgery: You will use prescribed eye drops after the iridotomy procedure to keep your eyes healthy until the day before your operation. Your eye surgeon will then advise you to discontinue their use.
On the day of the surgery: On the day of surgery, you will be given eye drops to numb your eyes. Then you’ll be asked to lie down so your surgeon can place devices on your eyelids to keep them open. You need to keep a few other things in mind before your surgery:
- Do not wear soft contact lenses for seven days before your surgery (or as advised)
- Wear no make-up or fragrances on the day of surgery.
- Unless otherwise directed by your eye surgeon, continue to take all prescribed medications as usual.
- You must fast for at least 5 hours before your procedure. However, if you have other medical conditions, such as diabetes, your eye surgeon will discuss your specific fasting requirements with you.
Before the surgery begins, anaesthetic eye drops are used to numb the eye.
What to Expect During ICL Surgery
The surgeon makes tiny micro incisions near the cornea during the ICL procedure to allow the lens to be positioned between the iris and natural lens.
The lens is carefully implanted through these micro-incisions by the surgeon, and the implant unfolds. After unfolding the ICL, the surgeon positions the lens’s edges behind the iris, making it completely invisible.
Patients will usually see results within 24 hours of the procedure.
Many eye care professionals advise patients undergoing ICL surgery to have someone else drive them home, as their vision may be significantly impaired immediately following these procedures.
It takes about 20 minutes for a set of eyes: 10 minutes per eye. ICLs are implanted in both eyes on the same day concurrently.
There will be a slight downtime of 5-6 hours of blurred and distorted vision postoperatively because of fully dilated pupils. When the pupils return to normal size, you should experience visual recovery within the same day and may resume work the very next day.
What to Expect After ICL Surgery
The ophthalmologist must measure intraocular pressure two hours after ICL surgery. Patients will be discharged if there is no evidence of elevated eye pressure. However, if increased intraocular pressure develops, it will prescribe certain intraocular pressure-lowering medications.
Following ICL surgery, patients are advised to do the following:
- Oral medications and eye drops must be taken as prescribed by the ophthalmologist. Patients must do follow-ups regularly.
- Temporarily dress your eyes with an eye shield. After an examination, the ophthalmologist will have it removed the next day.
- When you first open your eyes, your vision may be blurry or unclear. Gradually, your vision will improve. It would help if you used eye drops with caution. Before using eye drops, always wash your hands.
- For at least two weeks, keep tap water out of your eyes. Avoid swimming pools, whirlpools, and saunas.
- To clean the eyes, use roughly wet and clean cloths to clean the eyes and face. Gently clean your eyes. It is best to wash your hair while lying down to avoid getting water in your eyes.
- You should wear an eye shield to prevent unintentional scratching while sleeping for at least a week after surgery or as directed.
- Wear sunglasses to avoid direct exposure to sunlight, wind, or pollution.
- Suppose you are experiencing unusual symptoms, such as a burning sensation in your eyes or blurred vision. In that case, you must seek immediate medical attention, even if you are late for an appointment.
- Do not overuse your eyes, for example, by reading books, watching TV, or playing computer or phone games.
- Pay special attention to children and animals who may cause unintentional injuries.
- Do not scratch your eyes.
- For at least two weeks, avoid wearing eye make-up.
- Do not sleep on the affected eye’s side.
- Lifting heavy objects is not recommended.
- Do not bend the head under the wrists, such as picking up fallen items or putting on shoes.
Most patients undergo only minor discomfort following the implantation of Visian ICL phakic intraocular lenses. Many patients gain optimal results within a week of having their Visian ICL phakic intraocular lenses placed, with full recovery taking one to three months.
Post-operation reviews usually take place at the following times:
- 1 day after
- 1 week after
- 1 month later
- 6 months later
It is normal for your vision to fluctuate during recovery, with it being clearer some days compared to others. There is little to worry about, as this is part of the healing process, and it will take about 3 months for your vision to fully stabilise.
Why Choose Implantable Contact Lens Over LASIK?
If your eye doctor does not think you are a good candidate for LASIK or other vision correction surgeries like ReLEx SMILE, you might be a good candidate for ICL surgery. It’s the alternative to LASIK.
ICL is a safe procedure that provides predictable and firm vision correction. Unlike disposable or gas absorbent contact lenses, intraocular contact lenses do not need to be cleaned or maintained and worn while sleeping, bathing, or swimming.
It means you won’t have to deal with the routine eye care that removable contact lenses require.
If you have problems with your intraocular contact lenses, an eye doctor can remove them. ICL surgery corrects a wide range of vision problems, including mild to severe myopia and astigmatism.
The following are more reasons why ICL surgery might be more suitable for you:
You Can Say Goodbye to Dry Eye Syndrome
The biocompatible Collamer in Visian ICL maintains natural eye chemistry and does not cause dry eye syndrome, a side effect that is usually related to LASIK surgeries.
It’s an Additive Procedure
Our method is known as additive vision correction. The ICL procedure, unlike other procedures, does not remove corneal tissue and instead works in tandem with your natural eye. The lens is biocompatible with your body chemistry and gently unfolds in your eye, resting behind your iris.
You Can Opt for the Detachable Choice
Patients with ICL can correct their vision with confidence. Visian ICL is completely removable in the event of a significant prescription change or the availability of new vision correction options, allowing our patients and their doctors to make changes to keep up with technology and their changing needs.
It’s a Short Procedure with Quick Recovery
Because of the Visian ICL Collamer material, the insertion method is minimally invasive. This can significantly improve the procedure and recovery time by using only a 3.5 mm insert. Because of the numbing medication, the procedure is also painless. Patients can usually expect a 20-30 minute procedure or less, and most people can resume daily activities with more precise vision in just a few days.
UV Protection
Eye surgeons can create a UV protection barrier by gently inserting the ICL into the eye. The Collamer material used to make the ICLs gives it unique UV-protective properties.
Better Vision Quality for Higher Prescriptions
ICL will usually provide better quality and acuity vision than LASIK for -6.50 or higher. It is also usually safer due to the minimal impact of the new lens compared to the amount of corneal change required with LASIK in these cases.
So, depending on your eyes, ICL may be superior to LASIK in every category that matters, from safety to vision quality. Because there is no one-size-fits-all solution for all patients, a thorough examination and discussion is the only way to determine what is best for each individual.
When is the Best Time to Do ICL Surgery?
The FDA approves ICLs for patients from the age of 21 to 45 years old.
ICL surgery is FDA-approved for the age of 21 years and above because that is when you have refractive stability. Your eyes are fully developed and suitable for ICL surgery.
Ideally, the younger you do refractive surgery, the more mileage you get out of your investment.
If you were to undergo ICL surgery at about 40 years old, you may only get 20 years of use out of the ICLs as opposed to double that time period if you had undergone ICL surgery at 20 years old.
Cataracts may start to develop when you are around 60 years old and like most people, you may then undergo cataract surgery. In the end, you may not feel that the investment in ICL surgery has gone a long way if you had undergone ICL surgery at a later age, e.g., in your 40s.
How Much Does Implantable Contact Lens Surgery in Singapore Cost?
ICLs are an excellent option for many people, but they are more expensive than LASIK. Prices range from $1,500 to $5,000 per eye, depending on the experience of your eye surgeon.
In general, ICL surgery for both eyes can range from $9,000 to $15,000, depending on the degree of the lenses, the type of anaesthesia used for the procedure and the doctor.
Since ICLs are considered cosmetic, both your insurance and Medisave will not cover this procedure.
What are the Risks of ICL Surgery?
Because ICL surgery is more invasive than laser eye surgery, it carries more risks than LASIK or ReLEx SMILE. Minor risks include a temporary increase in eye pressure and inflammation inside the eye.
The expected side effects are similar to other laser eye surgeries and include mild irritation and nighttime halos that usually fade with time. Most patients experience only slight discomfort and can return to work within a few days of the procedure.
Temporary Side Effects
After ICL, you may experience dry eyes, halos, and starbursts. Rest assured, they are usually temporary and may last for about 3 months with gradual improvement over days, weeks, and months. In rare cases, aspects of halos and starbursts can be permanent.
Possible Risk: Glaucoma
An increase in eye pressure (glaucoma) is one possible risk of ICL surgery. Glaucoma has the potential to damage your optic nerves if left untreated.
In the rare event of an increase in eye pressure, your doctor will prescribe eyedrops to lower the pressure in the eye. However, if the eyedrops are ineffective, the ICL may need to be removed to prevent further complications.
Possible Risk: Early Onset of Cataract
ICL surgery may lead to an early onset of cataract, as it sits near the natural lens.
With modern technology and equipment, the likelihood of developing glaucoma and cataract is generally not common though they are still risk factors that one has to consider before proceeding with the surgery.
After undergoing ICL surgery, it is recommended that you go for yearly reviews to screen for cataract and glaucoma.
You should contact your doctor as soon as you can if you experience any of the following after ICL surgery:
- Increased redness
- Blurred vision
- Swelling
- Sharp pain
- Tearing
Does Implantable Contact Lens Surgery Hurt?
The great majority of ICL patients report that the procedure is painless. Eye surgeons give you numbing eye drops before your ICL operation, so there will be no discomfort, though you may feel some pressure. You may also have some slight pain throughout the healing process, typically addressed with eye medications.
During the surgery, topical anaesthesia will be administered to help you feel at ease and provide comfort. However, you may experience the sensation of coldness and pressure around the eyes.
The type of anaesthesia used depends on the surgeon’s experience and comfort level. The more experienced the surgeon is, the more likely they would use topical anaesthesia. Some surgeons may be less experienced and prefer to use IV sedation or general anaesthesia.
If the thought of undergoing the surgery brings you discomfort, you can discuss this with your doctor and opt to be put in a sleep-like state. However, it is a point of note that this method would be more costly as you would also need an anaesthetic doctor.
How Long Does it Take to Recover from Implantable Contact Lens Surgery?
The recovery period for ICL surgery is brief – patients can usually resume normal activities between 1-2 days after surgery. If you are not a LASIK candidate but still want to improve your vision, the ICL is a viable option.
After a successful ICL surgery, you can start to do all sorts of activities the very next day, with the exception of swimming, which you must avoid for a period of 3 to 4 weeks. All other activities such as gyming, jogging, washing your hair, can be resumed the very next day.
You are allowed to rub your eyes and even wear contact lenses. As ICL surgery does not alter the shape of the cornea, you can also use off-the-shelf contact lenses after surgery.
Who is Not Suitable for Implantable Contact Lens Surgery?
ICL surgery is best suited to people in their 20s and early 30s who have a high prescription and are ineligible for laser eye correction. It would be best to keep in mind that various circumstances might prohibit you from having the procedure.
Anyone pregnant or nursing, for example, will not be treated since hormone swings might impair eyesight. Prescription, pupil size, cornea depth, and any eye dryness are all variables an eye surgeon needs to consider when you want to go for an ICL surgery.
Unsuitable Eye Size
LASIK patients have entry criteria based on cornea thickness. On the other hand, ICL is based on entry criteria involving sufficient anterior chamber volume (space).
ICL patients are required to have adequate space in the eyes between the cornea and the iris, at 2.8mm³, to house the ICLs. The larger the eye, the more space there is to accommodate the ICL.
If your eyes are too small and cannot accommodate the lens, you will get an overcrowding effect in the eye if the ICL is implanted. Squeezing the ICL into a tight space may lead to a rise in eye pressure causing glaucoma or lens touch against important structures in the eye causing early-onset cataracts.
Pre-existing Eye Conditions
There are a few main eye conditions that make a patient unsuitable for ICL surgery such as:
- Glaucoma
- Cataracts
- Retina disease
- Autoimmune disease
- Unstable refractive power
- Narrow angles inside the eye
Is Implantable Contact Lens Permanent?
ICL is a permanent solution, but it’s also reversible.
ICLs are made of clear, flexible plastic, known as phakic intraocular lenses (PIOLs). The Visian intraocular Collamer lens, a soft and flexible implant designed to sit behind the pupil and in front of the eye’s lens, is the most common type of IOL implanted.
The eye surgeon will permanently implant the lens in your eyes. But if ICL is not working for you, the process is reversible since the ICL implant can be removed.
The ICL is permanent and will not change or become obsolete. However, with time, aging or injury may cause your eye health to deteriorate. For example, developing a cataract, or clouding in your eye.
If you develop a cataract, usually in your 60s to 70s, you will need to undergo cataract surgery to remove the cataract in order to correct your vision once again. This means that both the ICL that was implanted prior and the developed cataract would have to be removed and replaced by a different type of lens implant to restore your vision.
All in all, to a certain extent, the ICL lasts indefinitely until the day you may develop a potentially blinding eye disease of some sort, such as cataracts.
Are Implantable Contact Lenses Safe?
ICL surgery usually takes about 30 minutes, and recovery is quick. The procedure is also safe, but it may result in side effects such as cataracts or vision loss. Your doctor can advise you on whether ICL surgery is right for you.
If the size of the ICLs are not correct, complications may arise, which is why accurate pre-op measurements are crucial.
Think of ICLs like your wedding gown or your tailored suit — inaccurate measurements can lead to a poorly-fit and uncomfortable attire. The surgeon takes very detailed measurements of the inner dimensions of your eyes, which are then given to STAAR Surgical in Switzerland, who carefully determines the size of the lens for you to fit your eye perfectly.
The correct size of the lens has to be ensured so that post-operatively, the ICLs within your eyes should not move at all to prevent the risk of glaucoma or cataract formation.
However, even though detailed measurements were taken for the ICLs, there is still a rare chance that the ICLs may not fit properly. The implanted lenses may move differently within each eye, which then requires a size or position adjustment of the lenses. Although extremely uncommon, there is a 1% chance that you may have to undergo the procedure again.
In the rare possibility that the ICLs were not optimal, clinics usually offer patients a special rate so that you would not have to pay the full price all over again. It is similar to LASIK where you would pay a lower price if there is a need for enhancement with a second procedure, for any reason such as under or overcorrection of vision.
What is the Success Rate of Implantable Contact Lens Surgery?
ICL surgery has a high success rate, with a satisfaction rate of 99.9%. Lasik surgery involves reshaping the cornea of the eye, which can take some time. Because the implantable Collamer lens is implanted in the eye, there is no need to reshape the cornea with Visian ICL, and hence, success rate is known to be higher than LASIK surgery.
Conclusion
ICL surgery is a safe and effective option for patients looking to correct their vision conditions, especially for those who are unsuitable for other procedures like LASIK. While it may be daunting to undergo a surgical procedure involving the eyes, knowing more about it and trusting your doctor can ensure a comfortable and pleasant experience.
If your eye doctor does not think you are a good candidate for LASIK or other vision correction surgeries, you might be a good candidate for ICL surgery. It’s an excellent alternative that offers many benefits, including reduced risk of dry eye syndrome, UV protection, reversibility, and potentially better vision quality for those with high prescriptions.
Consult with a qualified eye surgeon to determine if ICL surgery is right for you. They will assess your eye health, discuss your vision goals, and help you make an informed decision about the best corrective eye procedure for your specific needs.