Definition : permanent Collamer implant (Implantable Collamer Lens) placed between the iris and the crystalline lens. Corrects severe myopia without touching the cornea.
Price in Brussels : 2700 to 3500 € per eye, implant included.
Recovery : functional vision in 24 to 48 hours, stabilisation in 1 month.
Main indications : severe myopia from -6 to -18 D, corneas too thin for laser, irregular or at-risk corneas.
Contraindications : anterior chamber too narrow, insufficient endothelial density, patients over 40 (PRELEX preferred).
Reversibility : implant can be removed or exchanged at any time.
The technique
What is an ICL exactly?
ICL stands for Implantable Collamer Lens: a soft, permanent lens placed inside the eye, between the iris and the natural crystalline lens. Unlike laser, which reshapes the cornea by removing tissue, the ICL removes nothing. It adds a corrective lens where it will be most effective optically.
The material used, Collamer, is a collagen-based copolymer developed and patented by STAAR Surgical. Biocompatible by nature, it is accepted by the eye as if it had always been there. It stays stable over time: its structure, transparency and flexibility are preserved after years in place.
Before. The cornea at the front, the iris, then the natural lens suspended by its fibres. The space between iris and lens is the one that will receive the implant.
After. The implant slides between the iris and the natural lens, which keeps its function. The cornea retains its thickness and curvature, and the implant remains removable.
I place exclusively EVO ICLs from STAAR Surgical, the most advanced generation available to date. It incorporates a central micro-pore, the KS-Aquaport, which allows natural circulation of aqueous humour without prior iridotomy. This is a significant safety advance over previous generations.[1]
What happens during the procedure
A 3 mm micro-incision is made at the periphery of the cornea. The soft ICL implant is inserted rolled up through this opening and gently unfolds in the natural space between the iris and the crystalline lens. It is guided and positioned with precision. The micro-incision closes by itself, without sutures. The procedure lasts about fifteen to twenty minutes per eye, under topical anaesthesia.
A few hours later, vision is already noticeably improved. Most patients describe functional vision that very evening, and stable vision within a few days.[2]
Optical quality in high myopia
For high myopia, ICLs preserve an optical quality that laser cannot match. A laser correcting high myopia must remove a significant amount of corneal tissue, which mechanically creates peripheral optical aberrations and a slight degradation in image quality, especially at night. This is not a flaw of the laser: it is a physical limit inherent to corneal ablation.
The ICL adds a perfectly centred lens, without touching the cornea. Light crosses the eye as in an intact optical system. Highly myopic patients operated with ICL frequently report visual quality comparable to, or improved over, their contact lenses or glasses.[3]
The most common concerns
The idea of a foreign body in the eye. Collamer is not a foreign body in the biological sense of the term: it is a material designed to be invisible to the eye's immune system. In practice, patients do not feel it, do not see it, and stop thinking about it a few days after the procedure.
The risk of displacement. The EVO ICL is custom-sized for your eye. The size is precisely calculated during the exam thanks to anterior chamber measurement. Once in place, it is held by its own architecture and by the natural pressure of the eye. Displacements are exceptional and almost exclusively linked to severe ocular trauma.
Reversibility. This is precisely one of the major advantages of ICLs over any other refractive technique. The implant can be removed or exchanged at any time if visual needs change. If a cataract develops in twenty years, the ICL is removed and a cataract implant is placed. No other refractive technique offers this flexibility.[4]
For whom is ICL indicated?
I offer ICLs to patients up to age 40, in the following situations.
High myopia, from 6 to 18 D. With or without associated astigmatism, toric models are available. This is the most frequent indication, where laser reaches its physical limits or offers a sub-optimal result.
Cornea too thin for laser. When pachymetry reveals insufficient thickness to allow safe ablation. The ICL entirely avoids this issue by not touching the cornea.
Corneal contraindication. Topographic irregularity, biomechanical fragility, or suspicion of keratoconus precluding laser. ICLs preserve the cornea intact.
Patient seeking a reversible solution. For personal or professional reasons, particularly patients whose occupation requires periodic visual checks and who wish to retain the flexibility to remove the implant if necessary.
Beyond age 40, the natural crystalline lens begins to lose its flexibility. In that case, PRELEX is often the more logical and more definitive solution. If the anterior chamber is too narrow to safely accommodate an implant, the exam identifies it precisely: this is a non-negotiable condition.
The ICL exam is specificIt includes measurements not systematically performed in a laser exam: precise measurement of the anterior chamber to determine implant size, and analysis of the corneal endothelium to verify cell density. These two parameters are decisive for long-term safety.
References
Packer M. The Implantable Collamer Lens with a central port: review of the literature. Clin Ophthalmol. 2018;12:2427-2438.
Igarashi A, et al. Visual outcomes after implantation of the phakic posterior chamber IOL. J Cataract Refract Surg. 2012;38(3):403-408.
Alfonso JF, et al. Prospective study of the EVO Visian ICL. J Refract Surg. 2011;27(8):614-618.
Sanders DR, et al. US FDA clinical trial of the Implantable Collamer Lens (ICL) for moderate to high myopia. Ophthalmology. 2003;110(2):255-266.
Frequently asked
What patients often ask
Are ICL implants truly reversible?
Yes. The implant can be removed or exchanged at any time if visual needs change.
Can you feel or see the ICL implant in your eye?
No. The implant is placed between the iris and the crystalline lens, completely invisible. Almost all patients forget its presence within a few days.
Up to what age can an ICL implant be placed?
I place ICLs up to age 40. Beyond that, PRELEX is often the more logical solution.
What is the difference between ICL and Femto-LASIK?
Femto-LASIK reshapes the cornea. ICL adds a lens without touching the cornea. ICL is indicated when myopia is too high for laser.
Ophthalmic surgeon · Refractive and cataract surgery
CHIREC Hôpital Delta, Brussels
Graduated from the ULB, trained at CHU de Liège and CHIREC. European Diploma in Ophthalmology (FEBO). Refractive and cataract surgery make up the bulk of my operating activity, with procedures every week at CHIREC Delta. Dual specialisation: corneal laser surgery (Femto-LASIK, PRK) and intraocular surgery (ICL, PRELEX, cataract). Consultations in French, Dutch, English, Turkish, Kurdish, Persian and Italian.
