Phakic Intraocular Lens Implantation:
Treatments & Prices
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What Are Phakic Intraocular Lenses?
A Phakic Intraocular Lens (IOL) is an artificial lens made from synthetic plastic inserted into the eye. Some IOLs are implanted to replace the natural crystalline lens, for example during cataract surgery, but a phakic IOL is a lens implanted in addition to the eye’s natural lens, leaving the natural lens in place. They are positioned either just in front of, or just behind, the pupil.
An Implantable Collamer Lens (ICL) is a type of Phakic Intraocular Lens – both ICL and PIOL can be used interchangeably. ICL is also referred to as an Implantable contact lens but in this context it should be collamer.
ICL (PIOL) differs from Refractive Lens Exchange (RLE), which is also known as Refractive Lens Replacement, Clear Lens Exchange (CLE) or Clear Lens Surgery, as that those treatments involve removing the eye’s natural lens and replacing it with an artificial intraocular lens. ICL is not a lens replacement surgery, it is an additive procedure which leaves your natural lens and cornea unaltered.
The most popular type of PIOL and ICL used in the UK and worldwide is the Visian EVO ICL from STAAR Surgical.
Which Conditions Can Be Treated By Phakic Intraocular Lens Implants/ICL?
Phakic Intraocular Lens Implants/ICL are an excellent alternative to laser eye surgery and also where LASIK surgery is contraindicated, which typically happens with those with higher prescriptions, thin or abnormal corneas, Keratoconus or dry eye.
A Phakic IOL / ICL treatment can correct far-sightedness up to +10 dioptres and near-sightedness to -20 dioptres. It can also correct astigmatism of up to 10 dioptres.
The ideal patient will:
- Be fit and healthy.
- Not be allergic to anaesthesia.
- Have had stable vision for at least a year.
- Be aged between 21-60 years of age.
- Have a refractive error in the following range:
- Up to -20.00D of near-sightedness (myopia).
- Up to +10.00D of far-sightedness (hyperopia).
- Up to +/-10.00D of astigmatism.
Phakic intraocular lenses/ICL may not be right for you if:
- You have cataracts or glaucoma.
- You’re pregnant or breastfeeding.
- You’re taking immunosuppressant drugs.
- You suffer from certain medical conditions, including rheumatoid arthritis, hepatitis C, diabetes, the herpes virus and lupus.
- Your doctor determines that the shape of your eye is not an appropriate fit for an ICL.
- You do not meet the minimum endothelial cell density for your age at the time of implantation as determined by your eye doctor.
- Your vision is not stable as determined by your eye doctor.ichan
Clinic Prices For Phakic Intraocular Lens/ICL Treatments
Below are the current prices charged for Implantable Contact Lenses across the most popular clinics in the UK. All of the clinics below use EVO Visian ICL.
| Clinic | Consultation | Price (Per Eye) | Interest Free Credit (Months) |
|---|---|---|---|
| Optical Express | Free | £3,395 | 10 |
| Optegra | Free | £3,495 | 24 |
| Optimax | Free | £2,495 | 24 |
| Advanced Vision Care | £200 | £3,450 – 4,450* | 24 |
| Center For Sight | £350 | £3,350 – £3,675* | 24 |
Prices updated as of Dec 2019.
* Increasing prices depending on whether you have the Simple Lens, Myopic Specialist Lens, Hyperopic Specialist Lens, Specialist Keratoconus Lens
** Toric vs Non Toric
What Is The EVO Visian ICL?
The Visian EVO ICL (Implantable Collamer Lens) is designed and manufactured by the US company STAAR Surgical. They are the most popular type of implantable contact lenses and have now been used in over 1 million procedures across 75 countries in the past 30 years. Their promo video below will give you a brief overview of the treatment.
Patient Experience
| EVO ICL | LASIK | PRK | |
|---|---|---|---|
| 20-30 Minute Outpatient Procedure | Yes | Yes | Yes |
| Removes Corneal Tissue | No | Yes | Yes |
| Contributes to “Dry Eye” | No, doesn’t induce dry eye syndrome | Up to 20% can experience dry eye | Occasional |
Safety Features
| EVO ICL | LASIK | PRK | |
|---|---|---|---|
| Removable or Reversible | Removable | Not Reversible | Not Reversible |
| Flexibility for Future Procedures | Removable | Limited if additional treatments involve the cornea | Limited if additional treatments involve the cornea |
| Treats thin corneas | Yes | Limited | Limited |
| UV Protection | Yes | No | No |
| Biocompatible Lens | Yes | N/A (laser based) | N/A (laser based) |
| Long Term History | Yes | Yes | Yes |
How Is The Collamer Lens Implantated?
The Implantable Collamer Lens (EVO Visian ICL) is a refractive lens made from collamer, which is derived from two words that describe the composition of the material; Collagen, which naturally occurs within your body and Copolymer (synthetic material).
Collamer is also incredibly soft and very pliable which makes it easy for the surgeon to manoeuvre it within the eye, easy to insert through a very small incision and it also offers patients UV protection by means of a UV absorbing chromophore.
ICL is inserted into the eye through a 3.5mm keyhole incision into the space behind the iris (the coloured part of the eye). Unlike with other surgical vision correction, the natural (crystalline) lens is not removed, the ICL is simply placed in front of it.
The ICL focuses light onto the retina at the back of the eye, in the same way that glasses and contacts lenses do. The key difference being that the ICL does this from inside the eye — directly behind the iris and in front of the natural lens. It is from there that the ICL focuses light accurately onto the retina, helping create clear vision.
ICL surgery is fundamentally different to other laser corrective procedures such as LASIK and LASEK/TransPRK. In these surgeries, vision is corrected by remodelling the cornea. But ICL surgery is an additive procedure. In ICL surgery, there is no remodelling of the cornea or any other natural components of the eye. The ICL is implanted into the space in front of the natural lens, working in harmony with the rest of the natural eye.
The procedure itself tends to be short and typically lasts only 20-30 minutes. In a 2018 clinical study 99.4% of patients would elect to have the ICL procedure again.
What are the benefits of Implantable Collamer Lenses?
Reversible, Additive, Removable Procedure
The ICL procedure can be described as additive vision correction. It is a is a corrective lens which works in a similar way to spectacles or contact lenses, but from inside your eye. This means that if your prescription changes or if other vision needs arise following the procedure, it is possible to have it removed and the correction adapted, in a second procedure.
Unlike other procedures, the ICL procedure does not remove corneal tissue, but works in harmony with your natural eye.
Treats a wide range of prescriptions
ICL corrects near-sightedness (short-sightedness/myopia) of up to -20 dioptres, up to +10.00D of farsightedness (hyperopia) and up to +/-10.00D of astigmatism, making it a corrective procedure option for those with low moderate to severe myopic vision problems. It’s also a viable alternative for patients who are not suitable for LASIK treatment because their prescription is too high, or other contraindications for corneal based treatments (e.g. PRK, LASIK, LASEK) including thin, flat or irregular corneas, keratoconus and dry eye.
Sharp, Clear Vision
It has a 99% success rate.
Excellent Night Vision
Many patients report gaining excellent night vision.
Great for Thin Cornea
As no corneal tissue is removed this can be the ideal treatment for those patients excluded from other forms of vision correction due of thin corneas.
Great for High Near-sightedness
For patients with a high degree of high myopia the postoperative visual quality of EVO- ICL implantation was slightly better than that of small-incision lenticule extraction (SMILE) treatments.
Quick results
Because the procedure is minimally invasive (the insertion point being only 3.5 mm in size) is usually takes just 20-30 minutes. Recovery time is short too. Most people are able to resume their daily activities in just a few days.
Painless
Local anaesthetic medication is used to numb the eye prior to the operation, which makes the procedure totally pain free.
No increased risk of dry eye syndrome
Because ICL surgery does not involve reshaping your cornea, it doesn’t carry a risk of inducing dry eye syndrome.
Lastly, what are the risks of Implantable Contact Lenses?
As with any procedure, there are risks associated with having ICL surgery.
If you are thinking about going ahead with it, you should have a complete eye examination and talk with your eye care professional about weighing up the benefits, risks, and potential complications in your particular case. Some of the potential risks of having an ICL procedure are listed below.
Over- or under-correction
The most common complication with any refractive laser eye procedure is over- or under-correction. To counteract this risk, meticulous measurements are taken before surgery, to ensure that the right amount of correction is applied. Even so, exact correction can never be guaranteed. But that’s where ICL has an edge on other forms of correction surgery — if over- or under-correction occurs with ICL, it is possible to have a second procedure to adjust the correction.
Risk of infection
All surgical or refractive procedures are invasive to some extent. Because of this, they carry a risk of infection.
Of course, steps are taken to minimise the risk of infection when ICL surgery is carried out. Sterile products are used, and preventative treatments are administered to the eye. The ICL procedure is also considered to be minimally invasive, requiring an incision of only 3.5mm, so the risk of infection is low.
Nonetheless it’s important to be aware, before going ahead with a procedure, that an eye infection can have a range of results from delayed healing to serious eye damage.
Halos & Night Glare
There is a possibility that, post-surgery, patients may experience halos and glare around lights at night. This is also true of other laser eye procedures, such as LASIK or LASEK treatments.
Loss of visual acuity
While extremely rare, all laser corrective eye procedures can result in damage to the eye including the loss of visual acuity. In the most severe cases, a loss of functional vision can occur, but mishaps of this severity are very, very rare indeed.
Damage to the natural (crystalline) lens
Since the ICL is placed inside the eye, there is potential risk of touching the eye’s natural (crystalline) lens.
While this occurs in less than 1.5% of patients, any damage to the natural lens may cause an opacity (cataract).
In the most serious case, a cataractous natural lens may need to be removed and replaced with a synthetic intraocular lens (IOL). The surgical risks for replacement IOLs are similar to those listed here for phakic IOLs/ICLs.
Iridotomy Complications (If Iridotomy is required)
Iridotomies are not required for most ICL treatments (EVO Visian ICL does not require iridotomy; unless for hyperopia/long sighted vision correction). You would need to speak with your ophthalmologist to find out whether your recommended treatment requires this step.
If you do require an iridotomy, this involves the use of a laser to make a small incision in the eye. Complications from this incision rarely occur but they can cause damage to the natural crystalline lens or cornea, inflammation, increase in intraocular pressure, bleeding, and scar formation.
Increase in eye pressure
In some cases, an increase in eye pressure can occur as a result of the ICL procedure. If this occurs, your doctor may need to correct the problem with additional medication or surgical intervention. If not corrected or left untreated, increased pressure can result in loss of vision.
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Spaces, 9 Greyfriars Rd, Reading, RG1 1NU
Copyright © Laser Eye Surgery Hub 2024