One of the more recent advancements in Refractive Surgery is a procedure where a special lens is inserted into the eye to correct a person’s vision. This procedure uses what is called an Implantable Collamer Lens (ICL), and it is growing in its awareness amongst patients who are seeking options to get them out of glasses and contact lenses. With this innovation of technology and surgical procedure, the field of refractive surgery has effectively widened yet again, and now more patients than ever are able to have some form of vision correction to improve their vision.
While it is helpful to have more options for patients. Too many options can make the decision-making process more difficult. In this article, we want to help you understand the facts about ICLs as compared to LASIK surgery.
One of the more significant differences between LASIK and ICLs is the amount and type of eyeglass prescription that is able to be treated with each procedure. In the United States, the FDA has approved ICLs to treat a very wide range of nearsightedness from a more moderate amount (-3.00D) up to more extreme amount (-20.00D). Currently, ICLs are not FDA-Approved to treat astigmatism or farsightedness.
LASIK on the other hand, is FDA Approved to treat farsightedness and nearsightedness with or without astigmatism, but it is not approved to treat as much nearsightedness as ICLs (-14.00D is the top of the nearsightedness range approved by the FDA).
If you are considering ICL surgery as an alternative to LASIK, two of the most important factors is your current eyeglass prescription and what is in your best interest from a safety standpoint. Most doctors agree that, because ICL is a more invasive procedure than LASIK, it should be reserved for patients who are not LASIK candidates. It is important for a patient to meet with a qualified doctor to review their individual situation and discuss their specific risks and benefits.
In ICL surgery, a tiny collamer lens, smaller than a contact lens, is inserted into the eye in front of the natural “crystalline” lens inside the eye. Depending on the actual ICL used by the surgeon, the tiny lens is either placed right in front of the iris (colored part of the eye), or directly behind it. Prior to the ICL surgery or during it, the surgeon will also create a tiny hole in the iris to allow for fluid movement inside the front part of the eye, as the inserted lens blocks the natural passage of fluid thru the pupil.
Recovery from ICL surgery is relatively quick, both in terms of visual recovery and patient comfort. The lens is intended to be a permanent placement, and the lens is not intended to require cleaning, adjustment, or maintenance like contact lenses require.
A primary difference between ICL surgery and LASIK surgery is that ICL surgery has an increased serious infection risk over LASIK. This is because the surgeon has to go inside the eye to place the ICL, while the LASIK procedure is performed on the cornea without entering the inside of the eye.
In addition to risks of intraocular infection, there are four specific complications that can occur during the ICL surgery:
- The patient’s Crystalline Lens can be bumped, possibly promoting the development of a traumatic cataract. If a cataract develops because of this, the treatment is to remove the crystalline lens inside the eye (cataract surgery). Most patients after cataract surgery need glasses to see things up close, regardless of their age.
- The back side of the cornea, called the endothelium, can be bumped and damaged. The endothelium is a one-cell-thick layer of the cornea, and it plays a very important regulatory role in the health of the cornea by controlling the water content inside the cornea. If the endothelium layer of the cornea is damaged, it can lead to swelling of the cornea and hazy, fluctuating vision.
- The iris can be bumped and damaged during insertion, potentially causing irregular iris shape and increased sensitivity to light.
- There is a natural flow of fluid thru the pupil in a healthy eye, and, as the ICL intentionally covers the pupil, there is potential to block that fluid flow. Standard of care with ICL surgery is to perform a laser procedure to create a tiny hole in the periphery of the iris to allow for that fluid flow to continue after ICL surgery. If the natural flow of fluid is disrupted, the pressure inside the eye can increase, potentially leading to glaucoma.
When considering whether to perform an ICL surgery or LASIK procedure for a patient, most surgeons recommend LASIK over ICL surgery because it does not carry the intraocular risks associated with ICL surgery. Of course there are situations for which ICL surgery is indeed the best treatment option for the patient. In general, most Vision Correction Specialist Surgeons agree that ICL surgery is indicated if the patient is not a good candidate for LASIK, has the right kind of ocular anatomy to be a good candidate for ICL surgery, is dissatisfied with their current methods of vision correction, and accepts the risks associated with ICL surgery.
Some patients are not a candidate for LASIK and can have ICL surgery, so ICLs have further expanded the scope of patients that Refractive Surgery is able to help. However, LASIK will most likely remain the commonly preferred and more affordable option for patients seeking to reduce or eliminate their dependency on glasses or contact lenses.