Implantable Collamer Lens Surgery – ICL

The Implantable Collamer Lens (Visian ICL) is a small, highly flexible, biocompatible lens that is inserted into the eye and floats on the natural lens of the eye to correct spectacle error. It can be used to correct astigmatism as well as short and long-sightedness.

The ICL is often used as an alternative to LASIK or LASEK when the spectacle correction is high or the cornea is too thin or the eye too dry to support laser vision correction. The ICL can be used to correct a range of refractions from -8.50DS to -20.00DS of myopia, or from + 4.00DS to +8.00DS of hyperopia and up to 4.00DC of astigmatism.

The lens can be removed from the eye through the same small (~3mm) entry port it was originally placed so that although the procedure is designed to be permanent, the lens can easily be removed at a later date.

David Anderson has been certified ICL Surgeon for a decade and has experience of using the lens in Keratoconus and other complex refractive cases as well as in routine refractive correction. Globally, around 700,000 ICL’s have been implanted since 1997.

What does the surgery involve?

On the day of surgery and once in the hospital you will be given eye drops to dilate the pupil. The area around your eye will be washed and cleansed. The operation usually is usually performed under a local or topical anaesthetic, is painless and lasts 15-20 minutes in most cases.  Sedation or general anaesthesia are available if required. We do not typically use stitches during surgery, which allows for a faster recovery.

After the operation you will rest for a while, have refreshment then go home. You will be given a dressing pack to swab the eye clean the following day, and some antibiotic and anti-inflammatory eye drops to apply at home after the surgery.

You will need to allow 3-4 hours for your hospital stay so that we can run through your treatment and aftercare with you. You will need someone to collect you or we can arrange transport for you.

Timing of sequential cataract surgery

Surgery normally takes place with an interval of one week or less between each procedure.

How quickly will my vision be restored?

Your vision will be slightly blurred for a day or two while your pupil returns to its normal size and your eye heals. It is not uncommon to feel some discomfort, usually a feeling that something is in the eye until your eye settles but there should be no pain.  After a couple of days you will start to notice a significant improvement in your vision.

When can I return to normal activities?

You can quickly return to many everyday activities, although heavy lifting or other strenuous activities should be avoided for two weeks. We suggest taking the week off work between procedures and at least a few days after second eye surgery. Driving can be resumed when the legal standard is met, typically one week post surgery. We expect 95% of patients to achieve the legal standard for driving post-operatively without the use of spectacles or contact lenses.

You can use your eyes for screen work or reading as soon as they feel comfortable to do so, you cannot strain your eyes through visual effort.

You can fly on the day of surgery but we recommend that you remain local to the hospital for two weeks post-operatively.

What are the risks of ICL surgery?

David Anderson has performed many thousands of intraocular lens operations and has been a certified ICL surgeon for a decade. We ensure that the technology and products used for the surgery are of the highest standards available. We operate using state of the art equipment with facilities for sedation and general anaesthesia if required.

Although the large majority of patients achieve excellent results without complications, it should not be forgotten that ICL surgery is a surgical procedure. As with all forms of eye surgery, ICL surgery has risks and whilst we make every effort to minimise them, they cannot be totally eliminated. Further information can be accessed from the Visian website here. A PDF information booklet can be downloaded here.

Although uncommon, risks include:

  • Infection: Whenever an incision is made in the eye it is possible to contract an infection that could potentially cause permanent visual loss.  Due to the quality of our hospital theatre environment and our surgeon’s skill, this is extremely rare, incidence less than 1:1000 (reported rate < 1:5000).  As an added precaution we prescribe antibiotic eye-drops for compulsory use after the operation.
  • Lens exchange: Although several measurements are made of the eye pre-operatively to calculate the correct size of the ICL, the dimensions of the space in which the ICL is placed cannot be visualized directly. This means that occasionally the ICL will need to be replaced with a slightly larger or smaller lens. This is estimated to be required in around 5% of all cases. The ICL is removed and replaced through the same tiny entry port as the original procedure.
  • Cataract: The ICL is designed to float above the natural crystalline lens, which remains transparent until the natural onset of cataract in later life. Placement of an ICL may accelerate the process of cataract development bringing forwards cataract surgery. In patients under the age of 45 years this is extremely uncommon, but overall the risk of cataract formation in ICL surgery is estimated at 2%.
  • Retinal Detachment (RD): Surgery in highly myopic eyes carries a risk of retinal detachment where the interior lining of the eye, the retina, becomes separated from the outer coat. RD is a particular risk of cataract surgery in high myopia but ICL surgery is far less invasive so that the risk of RD measured by several studies is not thought to be higher than the risk of spontaneous detachment (i.e. the risk when no surgery has been performed) in high myopia. Although RD is a potentially sight threatening condition and an ophthalmic emergency, approximately 90% of RDs can be repaired surgically if treated in time.
  • Raised pressure: Since the introduction of Centraflow technology the risk of acutely raised eye pressure following surgery has fallen to less than 1%. Surgery can however, temporarily increase eye pressure requiring further treatment and the pressure of your eye will be carefully monitored post-operatively and treated if required.

Side effects

About 20% of patients will experience some unwanted visual effects such as glare, starbursts and halo that may become apparent after any intraocular lens surgery or laser vision correction procedure. All patients will experience these effects immediately after ICL surgery whilst healing but they may rarely persist so special consideration needs to be taken e.g. for professional drivers who drive at night. These symptoms rarely require removal of the ICL.

Download the Insert ICL Consumer Guide here