Should I implant my contact lens into my eye? What Implantable Collamer Lenses (ICL) really means
What if we told you there was a way that you could wear your contact lenses permanently and have perfect vision?
Well, technically, it is possible – via a surgical procedure called the Implantable Collamer Lens (ICL). Of course, most people still opt for the laser-based vision correction methods if they can – like Lasik, TransPRK or ReLEx SMILE. But if you happen to be one of those with extremely high refractive errors (i.e. 1,000 to 2,000 degrees of myopia per eye), ICL may be your only chance at unaided, perfect vision.
According to ophthalmologist Dr. Natasha Lim, ICL can correct extreme myopia (short-sightedness) of up to 2,000 degrees per eye and hyperopia (long-sightedness) of up to 700 degrees per eye. 
ICL is a procedure which involves injecting an artificial lens into the eye’s anterior chamber via a side cut in the cornea, in the space in between your eye’s iris and natural lens.  This is also why ICL is considered more invasive as compared to the other laser-based refractive surgeries as the ICL procedure takes place deeper in the eye whilst laser refractive surgery takes place within the cornea tissue only.
It is the eye surgeon’s solution to correct eyes with high refractive errors and especially if the cornea is unsuitable for laser-based refractive surgery. 
Made by a company called Staar Surgical, their trademarked Visian ICL – made from collamer (a biocompatible material) is considered the gold standard for all lens implant surgeries in the industry. The Visian ICL is also approved by the U.S. Food and Drug Administration.  In fact, collamer is made from a polymer of collagen and since collagen is naturally present in the body, it makes the lens biocompatible and eliminates risk of implantation rejection.
“How is ICL done?”
Prior to the ICL procedure, the doctor first applies anesthetic eyedrops to numb the eye and minimize discomfort.
The doctor then makes a small incision on the side of the cornea. As the lens is soft and foldable, the doctor is able to roll up the lens like a taco and insert the soft folded lens into the eye. After insertion, the lens then unfolds into place at the ‘sulcus’, the narrow space between the iris and natural lens of the eye. Since the incision is small, the wound will heal on its own without the need for sutures. 
The ICL procedure is performed on an outpatient basis and typically takes around 20 to 30 minutes.
“Who is suitable for ICL?”
ICL is especially suitable for those who are unsuitable for corneal-based laser refractive surgery as well as those who have extremely high refractive errors (myopia, hyperopia and astigmatism). 
Unsuitable for corneal-based laser vision correction
The common reasons for being an unsuitable candidate for laser vision correction are:
- Your cornea tissue is not thick enough
- You have permanent corneal scarring (many a times due contact lens infection) or corneal damage (suffered trauma to the eye, etc)
- Your cornea has abnormal topographic shape
- You suffer from dry eyes
Due to any of the reasons above, you may be unsuitable for laser vision correction and ICL would be your only alternative of achieving clear, unaided vision.
Extremely high refractive errors
If you have 1,200 to 2,000 degrees of myopia and/or astigmatism, you will probably not be able to correct your myopia fully with laser vision correction simply because your cornea tissue thickness would not be enough. ICL is the only refractive surgical procedure which can correct all that 2,000 degrees of myopia.
If you’re pregnant or breast feeding, or if you have existing eye diseases like glaucoma, iritis, etc, you will also not be a suitable candidate for ICL and other vision corrective procedures.
“Advantages of ICL as a vision correction procedure”
Of course, the biggest advantage would be unaided crisp, clear vision after your ICL procedure.
But how does it compare with the rest of the vision correction methods? As mentioned, ICL is usually a fall back, last resort type of procedure choice, only when you’re unsuitable for the other methods.
A great advantage about ICL is that it does not run any risk of dry eyes. The ICL procedure occurs beyond the eye’s outer corneal layer and so no corneal nerves are damaged, so you’re safe from dry eyes.
Another (debatable) advantage is that the ICL procedure is reversible. In other words, you could technically undergo another surgery to remove the artificial lens that was implanted into your eye. The reason we say it’s debatable is because that would also mean undergoing the same surgery you did again just to undo what you already did – you wouldn’t want to “reverse” it if you’re enjoying clear, crisp vision anyway!
“Are there any risks or side effects of ICL?”
ICL does come with risks, as with any medical procedure. In general, when compared to the other laser vision correction procedures, ICL is considered riskier as it is more invasive and occurs deeper within the eye. Here are some of the common risks:
1. You will probably get an early cataract.
Because the artificial lens is placed in the small, tight space between your iris and natural lens, it would rub against your natural lens over time, causing an early cataract.
2. The risk of glaucoma is higher if you have had ICL done.
Again, it’s also due to the fact that the artificial lens sits in such a tight space within your eye structure. It is possible that the artificial lens introduced into your eye may block the blood flow in your eyeball itself, causing pressure to build up inside the eye. This can lead to an eye disease called glaucoma over time. If severe, the increased blood pressure can damage your optic nerves, resulting in blindness.
3. There is a risk of having an intra-ocular infection during the ICL surgical procedure.
Unlike laser-based procedures, your surgeon has to operate deep within your eye to insert the artificial lens into the eye. Although rare, it can run the risk of internal infection (also known as endophtalmitis). This kind of infection can be severe and sight-threatening as there is not enough white blood cells inside the eye to fight off pathogens. Our cornea is a multifunctional and regenerative tissue that acts as a barrier to keep pathogens and bacteria from reaching the eye structure, but since ICL operates in the deeper layers beyond the cornea, it is left vastly unprotected.
“I’ve decided to opt for ICL. What can I expect after my ICL procedure?”
It’s important to get as much sleep and rest as possible to let your eyes recover after your ICL operation. In other words, try not to tire them out and you’ll definitely speed up its recovery.
Healing and discomfort
As the incision made during the ICL procedure is tiny, the wound can heal on its own fairly quickly. You will probably feel less discomfort as compared to corneal based laser vision correction procedures (as your outermost cornea that is lasered will need time to recover). But don’t be too quick to rejoice: because the ICL procedure is by nature more invasive, you will need to take extra care to keep your eyes clean and free of bacteria and germs, i.e. no going to dusty/smoky places, etc. Also avoid swimming so as to prevent any contamination.
You will not need your vision aids (glasses, contact lenses) anymore after your ICL procedure. Visual recovery is fairly quick. Some patients experience clear vision within hours, although some may also experience minor fluctuations in visual clarity in the first 3 months. Full visual recovery will usually take around 4-6 weeks. 
Medications (eye drops)
After the procedure, use the prescribed eye drops according to the doctor’s instructed schedule. The eye drops will not only help in lubricating the eyes and making them more comfortable, but will also speed up the healing process and help prevent infections.
Follow-up appointments are also required. In general, you will still need to go for at least 3 to 4 follow-up appointments with your eye surgeon to ensure that your eyes are healing well and your vision is clear.
“How much does ICL cost?”
ICL is the most expensive vision correction procedure and can cost around S$10,000 and up for both of eyes. 
The main factors contributing to ICL cost is due to the costly artificial lens implant as well as the surgeon’s fees for performing the procedure since it’s more complicated and requires more skills than the other refractive surgery procedures, where the laser does the main bulk of the job. The cost of surgical disposables are also higher for the ICL procedures since more surgical tools are used.
Other factors would also include the cost of the operating theatre venue as well as the assisting nurses and staff, which really differs for each centre.
“Does Medisave cover ICL?“
In general, no. ICL is considered a refractive surgery, which is classified as cosmetic procedures which are non-claimable by Medisave as stipulated by the Ministry of Health.
“OK so how should I get started on my ICL procedure?”
ICL – like cataract surgery – is a fairly complicated eye surgery and it takes a skilled surgeon to do it well. If I were to opt for ICL, I would definitely be picky about my surgeon and choose one with great surgical skills and has a whole lot of ICL cases and experience under his belt (I’m talking about thousands of cases!)
If you don’t have any doctor recommendations, we’ll share ours with you here. In this case, it’s also good to find an eye surgeon who is well versed in refractive surgery per se, so that he or she can best advise you on which procedure would be best suited for you.
References Lim, N. (2015). Ask the Experts: Options for eyesight correction, from https://www.straitstimes.com/singapore/health/options-for-eyesight-correction  Chen, M., Long, Q. R., Gu, H., Hong, J. (2019). Accomodation changes after visian implantable collamer lens with central hole for high myopia. Journal of Medicine, July Vol. 8, Issue 28, doi: 10.1097/MD.0000000000016434  Refractive Surgery, Singapore National Eye Centre website. Retrieved from https://www.snec.com.sg/patient-care/specialties-and-services/clinical-subspecialties/refractive-surgery-implantable-contact-lens  Sanders, D. R., Brown, D. C., Martin, R. G., Shephard, J., Deitz, M. R., DeLuca, M. (1998). Implantable contact lens for moderate to high myopia: phase 1 FDA clinical study with 6-month follow-up. J Cataract Refract Surgery 1998; 24:607-611  Dougherty, P. J., & Priver, T. (2017). Refractive outcomes and safety of the implantable collamer lens in young low-to-moderate myopes. Clinical ophthalmology (Auckland, N.Z.), 11, 273–277. https://doi.org/10.2147/OPTH.S120427  Griff A. M. (2020). What You Need to Know About ICL Vision Surgery, from https://www.healthline.com/health/icl-surgery  Alaa E. D. (2011). Advantages of Implantable Contact Lenses Over Laser-Assisted In Situ Keratomileusis, European Ophthalmic Review, 2009,2(1):72-5 DOI: http://doi.org/10.17925/EOR.2009.02.01.72  Mohindra V. K., Capt. S., NMa, Pereira S. (2013). An interesting case of implantable contact lens, Med J Armed Forces India. 2015 Jul; 71(Suppl 1): S69–S72. Published online 2013 Jun 21. doi: 10.1016/j.mjafi.2013.02.018  Han D. (2018), Ask Dr Daphne Han: Implantable contact lens, from https://www.doctorxdentist.com/ask-dr-daphne-han-implantable-contact-lens  Food and Drug Administration (2018), Phakic Intraocular Lenses: Before, During & After Surgery, from https://www.fda.gov/medical-devices/phakic-intraocular-lenses/during-after-surgery  Lin D. (2015), An Overview of Corrective Eye Surgeries in Singapore, A guide to vision correction surgery options, from https://www.shape.com.sg/health/overview-corrective-eye-surgeries-singapore/  Dr Leo Adult & Paediatric Eye Specialist Pte Ltd. Implantable Contact Lenses (ICL), from https://www.drleoeyespecialist.com/eng/specialised-services/implantable-contact-lenses.html