You have been told you cannot have laser surgery. Cornea too thin, myopia too high. That is not the end of the road. For many of these patients, ICLs are not a compromise: they are often the solution best suited to their profile.
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 does not degrade, does not calcify, does not provoke an inflammatory reaction.
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]
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]
For high myopia, this is where ICLs make a difference that laser cannot offer. A laser that corrects 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. This is a documented optical reality.[3]
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]
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.
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