ICL Surgery Guide: Review, Procedure & Side Effects

My EVO Visian ICL Experience at Latvian American Eye Center in Riga

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. 

Quick glossary

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? 

EVO Visian ICL - Visual Example
ICLs are implanted between the natural lens and the iris.

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.

All You Need to Know about ICL Surgery

Alternative eye surgeries

To give you a quick overview of other alternatives to ICL, here are some of the most common eye surgeries: 

  • LASIK 

    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. 


  • PRK 

    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. 


  • CK 

    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. 


  • SMILE 

    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. 

ICL Eye Surgery Tests at LAAC, Riga
ICL eye surgery tests at LAAC in Riga.

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. 

EVO Visian ICL, LAAC, Riga, Latvia
Can you spot the EVO Visian lens?

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.


  • Quick procedure

    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. 


  • UV protection

    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. 


  • Invisible

    Unlike a contact lens, ICL cannot be seen or felt. 


  • Easier life 

    No hassle with traditional contact lenses or eyeglasses and no concern of problems from daily activities such as swimming and sports. 

Eye exam equipment
A life without lenses and glasses is one of the best advantages of ICL.

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. 


  • Infection

    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. 

Patient form for ICL procedure at LAAC
The moment it became real: When I signed the patient registration form at LAAC

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. 

Pre-op eye test
Pre-op eye test before an ICL surgery

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

Beautiful window at LAAC, Riga
Latvian American Eye Center in Riga

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 €1,940With 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. 

ICL pre-op exam at Latvian American Eye Center, Riga
ICL surgery pre-op exam at LAAC in Riga

The Latvian American Eye Center 

Fancy stairs at Latvian American Eye CenterLAAC 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.

 


 

Pre-op ICL exam at Latvian American Eye Center, Riga
Pre-op ICL exam at LAAC

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.

Test to measure eyes before ICL procedure
A lot of tests are done to measure the eyes and see if you are a fit for ICL surgery. To me, this looks like Candy Crush.

Dr. Ilze at Latvian American Eye Center, Riga
Dr. Ilze Šveiduka at Latvian American Eye Center

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. 

Eye examination before ICL procedure at LAAC, Riga Latvia
The doctor will perform a series of standard tests to measure your eye's unique characteristics.

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. 

Pre-op ICL exam at LAAC, Riga, Latvia
Dr. Ilze looked deeply into my eyes.

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. 

Eye examination before ICL procedure
Me trying to figure out what all eye exams are about.


April 16, 2019
11.30 The day of the surgery 

LAAC, Exterior, Riga
Getting ready for surgery, outside Latvian American Eye Center

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.

ICL consultation at Latvian American Eye Center in Riga
Talking to Dr. Ilze in LAAC's office.

As I stepped inside LAAC, I first had a chat with Dr. Ilze, who reminded me about everything that was about to happen. 

ICL Procedure: Eye drops to dilate your pupils