Implantable Collamer Lenses (ICLs) – 08
Published on: November 25, 2020



Implantable Collamer Lenses (ICL)

Volume 08

We hope that you’re enjoying our newsletters. In this edition we are going to discuss Implantable Collamer Lenses (ICLs). An ICL is a posterior chamber phakic intraocular lens (pIOL). To be more specific, the ICL is placed in the ciliary sulcus of the phakic eye, so it ends up being positioned behind the iris, but in front of the crystalline lens. This is a vastly better option than the original anterior chamber (iris fixated) pIOLs which were “clipped” to the iris (enclavation).

Some people like to say that ICL stands for “Implantable Contact Lens”, in part, I suspect, because most people have no idea what the word “Collamer” means. Collamer is the material that Visian ICLs (Staar Surgical) are made of, and it is a fascinating creation. It is a blend of polymer and collagen with the intent of making the lens lighter, hydrophilic, and allowing for better exchange of gas and nutrients. All semantics aside, when a patient asks about the “Implantable Contact Lens”, I choose not to correct them. Instead, I choose to be glad that they even conceptually know about this great option.

ICLs are typically used for high degrees of myopic refractive error or when corneal refractive surgery is contraindicated. The Visian ICL is a rectangular one-piece plate-haptic design lens that is available in four lengths (12.1, 12.6, 13.2, and 13.7 mm). Currently, prior to implantation of the Visian ICL, we perform a peripheral iridotomy (PI) with a YAG laser to allow for equalization of pressure (IOP) in front of, and behind the iris. This is important since the ICL is placed in a space that could potentially impede aqueous flowing to the anterior chamber. [Note: In the future, we will likely have a newer version of the Visian ICL (not yet available in the US) that features a central port (or hole) of 0.36 mm that is intended to eliminate the need for the pre-operative peripheral iridotomy. The port is designed to allow for the natural process of aqueous humor circulation.]


In the US, the Visian ICL is indicated for:

  • Adults 21-45 years of age
  • Correction of myopia ranging from -3.0 diopters to -15.0 diopters with less than or equal to 2.5 diopters of astigmatism at the spectacle plane
  • The reduction of myopia ranging from greater than -15.0 diopters to -20.0 diopters with less than or equal to 2.5 diopters of astigmatism at the spectacle plane
  • Anterior chamber depth (ACD) of 3.00 mm or greater, when measured from the corneal endothelium to the anterior surface of the crystalline lens
  • Stable refractive history within 0.5 diopter for 1 year is required prior to implantation

In the US, the Visian Toric ICL (approved in 2018) is indicated for:

  • Adults 21-45 years of age
  • Correction of myopic astigmatism with spherical equivalent ranging from -3.0D to ≤-15.0D (in the spectacle plane) with cylinder (spectacle plane) of 1.0D to 4.0D
  • The reduction of myopic astigmatism with spherical equivalent ranging from greater than – 15.0D to -20.0D (in the spectacle plane) with cylinder (spectacle plane) 1.0D to 4.0D
  • Anterior chamber depth (ACD) of 3.00 mm or greater, when measured from the corneal endothelium to the anterior surface of the crystalline lens
  • A stable refractive history within 0.5D for both spherical equivalent and cylinder for 1 year prior to implantation


  • Anterior chamber depth less than 3.00 mm, when measured from the corneal endothelium to the anterior surface of the crystalline lens
  • Anterior chamber angle less than grade 2, as determined by gonioscopic examination
  • Pregnancy or nursing
  • Reduced endothelial cell density (measured by cells/mm 2 )

My personal experience with the Visian ICL has been fantastic. I have never seen a cataract form from a Visian ICL and I have managed around 1,000 cases. I have also never had a patient request to have the ICL removed (don’t forget that these lenses are removable, and therefore this procedure is considered reversible… a very nice conversation point). I love ICLs for high myopes who are not laser vision correction candidates, and now that the FDA finally got around to approving the toric version, I am even more ecstatic. [Note: hyperopes typically do not qualify for ICLs due to shallow anterior chambers.] Now, if you remember back to your ophthalmic optics class, if you can correct a prescription at the Nodal point, the optics allow for fantastic results. The ICL placement is closer to the Nodal point compared to corneal procedures, and as a result, I have seen some amazing outcomes. My favorite patient of all time was a 30-something patent who was a -16.50 OU with BCDVA of 20/30 OD / OS / OU. Post Visian ICLs, she was Plano OU and 20/15 OD / OS / OU and beyond thrilled. Life changing stuff!

In closing: Don’t forget about ICLs as a viable option when referring for refractive surgery! Just because a prescription seems too high for laser, there are other refractive options. Just yesterday, I scheduled a young man for ICLs whose manifest refraction was -17.00 -5.00 x 180 OU. This gentleman left our office so happy and I am sure he will be even more thrilled once his ICLs are in place. While we can usually achieve our target aim with ICLs alone, it’s important to remember that these patients are almost always candidates for PRK enhancement (remember that their full pachymetry is still available for future laser vision correction of whatever small residual prescription may remain). Even if you don’t think a patient is a candidate, refer them anyway so we can review all options. These are some of my favorite cases because I know that we are changing lives and making dreams come true. These are great cases to call me about. We’re your lifeline. Phone a friend!

Until next time!

George Goodman, OD, FAAO
Director of Cataract and Refractive Services
EyeCare Associates of South Tulsa
10010 E 81st St #100, Tulsa, OK 74133
O: 918.250.2020 | C: 405-245-9333 | F: 918.250.8910

Service-oriented, comprehensive eye care in a timely fashion.
Please send your comments and suggestions to
or call Dr. Goodman at (405) 245-9333 (cell).

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