Perfect vision after a 20-minute procedure with an implantable contact lens? Discover all you need to know about ICL surgery in this ultimate guide.
It has now been over 5 months since I had my ICL surgery at Latvian American Eye Center (LAAC) in Riga. In this guide and review, I will list everything from risks and advantages to alternative procedures and what to expect of an ICL surgery.
Hyperopia – Farsightedness
Myopia – Nearsightedness
Dioptre – Measurement of the optical power
Astigmatism – problem with how the eye focuses light
You might be surprised by how many vision surgery options there are that offer ways beyond glasses and contacts to correct your vision. LASIK, LASEK, ICL, SMILE, CK, and PRK, are just some of the most known.
I have used contact lenses daily for over 13 years and many times thought about doing LASIK surgery.
But after, earlier this year, finding out more about what ICL is, I changed my mind. What made me do so was mainly that ICL is a reversible procedure, and more importantly, it does not remove a part of your cornea but works instead with the natural eye.
This half-year has been a journey to visual freedom. I hope this comprehensive guide can be of help to anyone interested in ICL, interested in correcting their vision, or just wanting to know more of what options are available.
What is ICL?
ICL is a lens implant known as a phakic intraocular lens (IOL). Officially, ICL stands for Implantable Collamer Lens, though it is often also called the Implantable Contact Lens.
Unlike LASIK, which is a surface procedure and require removal of a part of the cornea, ICL is an implantable lens that works with the natural lens of your eye to improve your vision. One of the major advantages with ICL is that the lens can be removed if needed as ICL is a reversible procedure.
ICL can treat patients with a severe level of nearsightedness, longsightedness, astigmatism, and thin corneas. The surgery can be performed on both eyes on the same day in about 20 minutes, and the recovery is quick.
Visian ICL is an advanced vision-correction option that is growing in popularity with more than one million lenses implanted worldwide since it was approved in 2005.
Alternative eye surgeries
To give you a quick overview of other alternatives to ICL, here are some of the most common eye surgeries:
Laser-Assisted In Situ Keratomileusis (LASIK) is the most performed vision correction surgery. It can treat nearsightedness, mild farsightedness, and astigmatism. It's a quick procedure with fast recovery and vision improvement. There are different procedures in the LASIK family, such as LASEK and Epi-LASIK. All of them remove a part of your natural cornea to alter your vision with pure laser or with a unique cutting device.
Photorefractive Keratectomy (PRK) was the first successful vision correction surgery and is still used today, though it has become less popular. It is a refractive surgery where the eye surgeon removes the corneal surface cell, then uses a laser to reshape the cornea. The procedure takes about 10 minutes to treat both eyes.
Conductive Keratoplasty (CK) is a non-laser refractive eye surgery designed to correct mild hyperopia and help people who are middle-aged and older reduce the need for reading glasses after becoming presbyopic.
Small Incision Lenticule Extraction (SMILE) is a new technique of laser vision correction. SMILE corrects the vision by removing a small piece of corneal tissue called a lenticule through a small incision.
Alternative surgical techniques for the correction of high myopia (>-8.00D) include RLE (refractive lens exchange) and ACL (anterior chamber lens) implantation.
Why choose ICL?
The major advantage of Visian ICL is that the lens is added to the eye to improve your vision and can be removed if required. Unlike other procedures, such as LASIK, which corrects vision through permanently removing tissue from the eye and making changes irreversible, ICL is an additive procedure that does not alter the natural eye.
Choosing a procedure that permanently changes your eye may also limit your options if you experience problems with your vision. It might even stop you from benefiting from new technologies later in life.
The Visian ICL is a biocompatible contact lens made of Collamer, which is collagen naturally found in your body. Other unique advantages are; The lens material contains a UV blocker that protects the eye by blocking harmful UVA and UVB rays, preventing the development from some eye diseases.
Also, the Visian ICL procedure does not cause dry eye, a common hassle, among other procedures. Customized for the eye, ICL has a high water content that minimizes reflections and delivers the best in optical performance.
Furthermore, the Visian ICL delivers a high definition vision that is sharper, clearer, more vivid, and has a greater depth and dimension than alternative vision correction procedures.
What are the benefits of ICL surgery?
ICL has an excellent safety profile documented for almost three decades. It can treat a wide range of prescriptions and gives a corrective procedure option to those with low to severe nearsightedness, low to severe farsightedness and astigmatism – all with a 99% satisfaction rate. Other benefits are:
Sharp and clear vision
Immediate vision improvement at all distances.
The process is painless and only takes around 20-30 minutes.
Short recovery time
The recovery is quick. Patients typically experience minimal discomfort, and many go back to work the next day.
A removable procedure
Although the ICL is intended to stay in place permanently, it can be removed or replaced if needed.
Suitable for up to -20 dioptres of myopia
Starting from low -0.5D, ICL can correct and reduce nearsightedness of up to -20D. The possibility to correct low diopters is especially useful for people with thin corneas or other conditions when laser vision correction is inadvisable.
The advanced lens material has a UV blocker that prevents harmful UVA and UVB rays from entering the eye.
No dry eye syndrome
Visian ICL's biocompatible Collamer maintains natural eye chemistry and won't induce dry eye syndrome.
Excellent night vision
Many patients achieve excellent night vision with Visian ICL.
Great for thin corneas
Patients who have too thin corneas or prescriptions too high for other forms of vision correction may still be able to correct their vision with ICL.
Suited to high demands
The US military's surgeons have implanted Visian ICL since 2006. ICL works under extreme conditions and meets the demand of soldiers with exceptional results.
High Definition Vision
ICL provides a sharper, clearer, more vivid vision with greater depth and dimension than other procedures.
Treatment flexibility for the future
Your vision changes as you grow older, and many will need cataract surgery. Because Visian ICL maintains the structure of the eye, ICL gives you options for future treatments.
Unlike a contact lens, ICL cannot be seen or felt.
No hassle with traditional contact lenses or eyeglasses and no concern of problems from daily activities such as swimming and sports.
ICL risks, side effects & complications
Visian ICL is FDA approved, which means it has been determined to be a safe and effective procedure. However, as with any surgical procedure, there are certain risks and possible complications. Most complications can be treated, and the risk of vision loss is slim to zero.
Overcorrection and undercorrection
This can happen when the ICL lens is too strong or too weak. In most cases, it can be corrected with corrective eyewear or with an ICL replacement.
Halos, glare and double vision
In any refractive procedure like Lasik, PRK or Visian ICL there is a possibility of residual halos and glare in situations of low-level lighting that can cause difficulty with performing tasks, such as driving, particularly at night or under foggy conditions. These symptoms tend to diminish with time, but it may affect night driving ability.
Increase in eye pressure
A rare ICL side effect is a sudden rise in eye pressure. This may happen in the first week after surgery. The sooner the doctor is alerted to this complication, the greater the chance of avoiding serious damage.
All surgical procedures mean there is a risk of infection. Severe infection during ICL implantation is rare.
Damage to the crystalline lens
Since the ICL is placed inside the eye, there is a potential risk in touching the eye’s natural (crystalline) lens. While occurring in less than 1.5% of patients, any damage to the natural lens may cause an opacity (cataract) of the lens and, in the most severe case may require removal of the cataractous natural lens and replacement of the natural lens with a synthetic lens.
Repositioning or removal of the lens
ICLs have the potential, however slight, of needing to be repositioned or removed.
Loss of vision
Though extremely rare, there is a possibility of vision loss from all refractive procedures. Typically, losing vision is because of bleeding, severe inflammation, or an untreated infection.
Before undergoing surgery, you should carefully weigh the risks and benefits.
What is the cost of ICL surgery?
The Visian ICL costs will vary depending on your prescription, location, and provider. Typically, it costs anywhere from $1,500 and $5,000 per eye. The Visian ICL treatment cost is higher than LASIK, mainly because the lenses and the procedure requirements cost more.
In most cases, the cost of ICL is around $3,500 and includes the implantable contact lenses, surgeon fees, facility fees, and a follow-up visit.
You can book a consultation with a Visian ICL doctor to see if the procedure is for you, and find out the actual costs, financing options, and payment plans for your specific procedure.
Is the cost worth it?
Compared to the long-term costs of glasses and contacts, the procedure pays for itself.
If you replace your glasses every other year, the cost of glasses can add up to $2,000 – $8,000 over 20 years. Most people who wear contact lenses will spend about $5,000 over 20 years. Imagine what you will spend throughout your entire life?
And then we haven't even taken into consideration the visual freedom and all the other advantages of ICL yet.
Who is the right candidate for Visian ICL?
The Visian ICL is ideal for those with an active lifestyle and might be for you if you:
- are between 21 and 45 years old
- are nearsighted with mild to severe myopia (-0.5 to -20D)
- have not had a change in prescription of more than .5D in a year
- are looking for a procedure that doesn’t create dry eye syndrome
When should you NOT have ICL surgery?
You should not have Visian ICL surgery if:
- you are pregnant and/or nursing
- your vision is not stable
- the doctor determines that the shape of your eye is not an appropriate fit
- you don't meet the minimum ‘endothelial cell density' for your age at the time
My EVO Visian ICL experience at LAAC
To the worry of many of my friends and family members, I did my ICL surgery abroad. At Latvian American Eye Center (LAAC), in Riga, Latvia, to be more precise.
The main reason I considered doing my ICL surgery abroad was the cost – without compromising the quality or level of expertise. As it's the EYES, we're talking about you shouldn't compromise for a lower price. But it's definitely worth doing your research and checking out different options as the price of the surgery can vary a lot depending on just location.
At LAAC, the price of ICL surgery is a lot cheaper than many eye clinics back home in Sweden. At LAAC, the surgery for one eye cost from €1,400 to €1,940. With experienced surgeons and years of proven excellence, I felt comfortable enough to book a trip for a pre-op eye exam (and of course, do some sightseeing as well).
It's straightforward and cheap to travel to Riga from Sweden, and as I hadn't been in Riga before I had another reason to look forward to this weekend getaway.
The Latvian American Eye Center
LAAC is the first and unique model of a private eye clinic in the Baltic States based on principles of patient care and state-of-the-art technology famous in the USA. The American Professor John Joseph McDermott founded the center in 1993, with the goal of establishing a world-class clinic in the area.
Everything in the clinic has the same standard as in the US and the rest of the EU, from the certified equipment, medical instruments, treatments, professionalism and skill level of the warm-hearted people working there.
Almost three decades later, the clinic delivers the same high quality of service to locals, foreign patients, adults, and children.
March 28, 2019
15.00 Pre-op eye exam
Before an ICL surgery, your doctor needs to determine your complete medical and eye history. Followed by a comprehensive eye examination. The exams will tell if your eyes are healthy and if you are a good candidate for surgery.
It was March 28, and it was time for my consultation at the Latvian American Eye Center. As we were driving through a somewhat sketchy neighborhood, I started, for the first time, getting nervous. Luckily, as we pulled up on the driveway, I was pleasantly surprised by this tall, white building in front of me. LAAC stands out in this gray area in Riga.
With big windows, intricate staircases, a clean atmosphere and above all – welcoming and passionate personnel, I got a great first impression of LAAC.
After having gone through an extensive eye examination, it was determined: I was a great candidate for a Visian ICL surgery.
I met lovely Dr. Ilze Šveiduka, who is a certified ophthalmologist-surgeon and who would perform the surgery on me.
EVO Visian ICL
As Visian EVO ICL is the standard lens used in Europe, I didn't have to do tiny openings (YAG laser iridotomy) before the surgery. These openings are done for ICL models which correct ICLs with “+” power (hypermetropia), or if sometimes the surgeon uses previous ICLs for “-” powers.
EVO/EVO+ is the latest version of ICL from Staar Surgical, where there are a few tiny openings in the lens implant itself, one opening is right in the center of ICL (called “centraflow”, they work to keep normal fluid flow inside the eye, thus preventing from eye pressure peaks after surgery.
Good to know about EVO Visian ICL in the US
In Europe, many medical procedures, devices, and medication are available sooner than in the United States because of regulatory issues.
The Visian ICL received FDA approval in 2005. Unfortunately, the EVO/EVO+ Visian model with KS-Aquaport that is used in Europe is not yet approved. USA surgeons have to use the “older” model Visian ICL without a central hole. This means they have to do iridotomies before surgery.
The approval of the EVO lens by the FDA is in progress. Only recently, the FDA approved Staar Surgical's clinical study. Approval might come in late 2020.
Even though the pre-op examination only lasted for about an hour, it felt like I was at the clinic for so much longer. I was kindly hustled between so many rooms and advanced-looking instruments.
As I was writing this article, I emailed LAAC just to ask what exams we did on the consultation. They sent me these hieroglyphs:
keratometry, corneal topography, visual acuity, refraction, endothelial microscopy with pachymetry, OCT for retina and optic nerve, ocular slit lamp examination and fundus examination, ocular biometry with IOL Master device.
April 16, 2019
11.30 The day of the surgery
About three weeks after my pre-op eye examination, the day of the surgery had arrived. I thought I would be way more nervous than I was. Sure, I felt the butterflies, but it was almost like an amusement park experience for me.
I'm excited and standing in line for the scariest ride, feeling pumped and thinking ‘let's do this.' The ‘oh shit‘ moment came just as I took the first step inside the operating room.
As I stepped inside LAAC, I first had a chat with Dr. Ilze, who reminded me about everything that was about to happen.
Before the ICL procedure
When you arrive for your surgery, your doctor will give you eye drops to dilate your pupils and anesthetize your eyes.
I made myself feel at home while waiting for my turn in the clinic's busy ICL procedure schedule. I found out that 15 other patients would do the ICL surgery after me on this day. To calm my nerves, I received a mild sedative.
I felt relaxed all the way to the operating room. Then my nerves kicked in, and my heart started to race. Luckily, everything happened so fast that I didn't have time to think enough about the procedure itself. I was in and out in about 20 minutes.
I was positioned comfortably, lying flat with my head on a rest. The next minutes are a blur. A drape was placed over my face, something was gently placed to keep my eyes open. What I remember most though was seeing a light. A bright operating microscope light was switched on almost instantly, and I stared up at it throughout the procedure.
I remember Dr. Ilze saying ‘We're moving on to the left eye' and I asked ‘Already?'.
Then it was done.
How the ICL surgery works
To prepare for the implant, your doctor will create a small incision at the base of your cornea to insert the Visian lens.
The lens unfolds and is positioned behind the iris, the colored part of your eye, in front of your natural lens. The procedure is painless because of the numbing medication. Usually, the entire procedure takes less than 20 minutes.
After the surgery
It is common to experience a transformational vision improvement, directly following the procedure. Your doctor will prescribe eye drops intended to clean your eyes and prevent infection for a few weeks following the procedure. You will need someone to drive you home, but usually, you can see at the driving standard or better within two days of surgery.
Even though I felt somewhat groggy afterward (maybe a combination of anesthesia, sedative and staring into the bright light), I instantly noticed that I could see better. But the ‘Wow' moment for me came as I was out on the street about two hours later and could see far-away signs in sharp detail.
After the surgery, the doctor noticed that the pressure in my left eye was higher than normal; It was a surprisingly quick fix, but I'm glad I had the opportunity to rest more in the clinic before heading out to explore Riga. Closing my eyes for an hour felt terrific.
It is common to be light-sensitive in the first few days after surgery. I got a pair of sweet safety goggles with a heavy tint to make everything easier on the eyes.
15.30 Late-lunch at Andalūzijas suns
Only about three and a half hours after surgery and I was sitting by the window with my protective glasses on inside the cool restaurant Andalūzijas suns. Ida and I had a long three-course lunch to celebrate my new vision. From a salmon tartare starter to a healthy poke bowl and a rye bread dessert with lingonberry sauce (and strawberry pancake for me).
This was a great meal to feast my eyes upon before heading back to the hotel to just relax and take it easy for the rest of the day.
April 17, 2019
16.00 ICL check-up
Your eyes will continue to improve over the next 48 hours. Your surgeon will need to see you the day after surgery for a check-up which will include monitoring the pressure in your eye. Another check-up is done two months later, and then once a year.
The day after the surgery, I felt like an eagle. As I walked out of bed in the morning and realized I could see without putting my lenses in (or without EVER having to put them in again), I felt on top of the world.
On the follow-up eye examination, everything went smoothly. I was only sad to say goodbye to Dr. Ilze, and everyone else I met at LAAC.
With me, I got English documents regarding my procedure, and ID cards for the EVO Visian lenses to prove their authenticity. I was also reminded about all the follow-up advice like not rubbing my eyes, using the eye drops daily, and booking a check-up visit in my hometown.
Five months after the surgery
After 13 years of using contacts daily, it took me a while to realize I didn't need to put them in every day.
I used to stumble to the bathroom each morning (sometimes accidentally kicking the livingroom table or a cat) to put in my contact lenses. The ability to just wake up and be able to see anything clearly is mind-blowing.
My only negative experience with ICL is my light-related side effects. I see halos and glares appearing around bright lights and light sources. I've heard that this side effect can diminish over time, but right now, I'm almost experiencing it every single day. Especially when driving in the dark and meeting approaching car's headlights, or being in low-lit rooms with very bright lamps.
Though this can be distracting, I can live with it. I don't regret for a second choosing ICL surgery. The benefits it's giving me has been life-changing.
Conclusion: My ICL surgery review
I walked in at LAAC with moderate myopia (-3.50 D). I literally walked out with visual freedom.
Even though I'm experiencing light-related side effects, this impact on my quality of life is minimal. I'm so happy I don't have to give a second thought about jumping into a pool, working out, or just remembering to bring an extra pair of lenses with me.
I'm glad forever avoiding days of falling asleep with lenses on and waking up hours later with bloodshot eyes. Or forgetting to pack lenses on a trip abroad. Or how sore the eyes could feel after being out on a windy day.
In conclusion, it's amazing to think about going from not seeing the television across the room without lenses to a 20/20 vision in a few days time. It's magic. That kind of wizardry has to have a price with it, and apparently, my price was a few halos at night.
That's a price I'm happy to pay for clear vision. The implantable contact lens has changed my life. And I just can't believe I didn't do the ICL surgery sooner.
Also, I can't say thank you enough to everyone who's been involved in making this experience extraordinary for me. It's heartwarming to be taken care of so passionate, professional, and welcoming people. I was deeply touched by how LAAC made me feel at home in a foreign country.