ICL Surgery: An Alternative to LASIK | EVO ICL
Reviewed By Jason P. Brinton, MD
"It’s always more economical to provide only one option, but the most economical route is not always the best one."
About the author: Dr. Jason P. Brinton is an internationally recognized St. Louis LASIK and vision correction surgeon. He received a BA from Harvard University, an MD from Harvard Medical School, and is board certified by the American Board of Ophthalmology. Brinton Vision, located in St. Louis, Missouri, is a state-of-the-art lens implant and laser eye correction surgery center that in recent years has been the top provider of EVO ICL (EVO) procedures in the United States. Brinton Vision has performed a number of ICL procedures for eye doctors, including other LASIK eye surgeons. Brinton Vision was recently honored by St. Louis Magazine’s People’s Choice Award as the #1 Best Laser Eye Treatment center in St. Louis.
ICL Surgery: An Alternative to LASIK
Advancements in science now mean that our St. Louis patients, like all patients around the globe looking to free themselves of glasses and contacts, have a number of innovative vision correction alternatives for clear vision – including the EVO ICL (Implantable Collamer Lens) procedure.
Over the past year, we have noticed that more and more of our younger patients up to age 45 are choosing EVO ICL. Why is ICL surgery in St. Louis such an increasingly popular option?
Understanding ICL: I asked our staff and patients
To better understand why we are seeing more of our St. Louis patients choose ICL surgery, I polled our staff. Here are some responses I received.
- “ICL patients are hands down the happiest patients we see – not only are they consistently 20/20, they are consistently 20/happy”
- “Patients’ vision is often clear right away – I love seeing a patient who can read 20/20 the moment they walk out of our laser room”
- “It’s nice to be able to give clear vision to patients with thin corneas and keratoconus where LASIK and other procedures are not an option”
- “We can treat patients safely with a wide range of eye prescriptions”
- “A majority of our 20/10 club members (our superhero vision patients who see 3 lines better than 20/20) are ICL patients”
ICL: St. Louis patient’s perspective
Some of our patients are good candidates for several vision correction procedures, and yet they chose ICL surgery. I asked several of these patients why they preferred ICL surgery, and here are some of my patients’ responses.
- “I like that you aren’t removing tissue from my cornea”
- “It’s nice to not worry about dry eyes”
- “This keeps my options open for the future when I want treatment for reading glasses or cataracts”
- “It’s comforting to have built-in UV light protection”
- “The lens is removable”
Is ICL Surgery Safe?
One would be hard-pressed to find an elective surgical procedure with the quality of track record EVO ICL possesses. For the past two decades studies have repeatedly demonstrated that ICL safety meets or exceeds the safety of other popular vision correction surgery procedures. Some studies have shown that ICL, SMILE, and LASIK all have excellent efficacy, safety, stability, and accuracy (J Refract Surg 2019 Nov 1;35(11):699-706. doi: 10.3928/1081597X-20190930-01) while other studies have demonstrated that in important respects, ICL’s safety and efficacy exceeds that of LASIK, PRK, and SMILE. (J Refract Surg 2007 Jun;23(6):537-53. Clin Ophthalmol 2016 Jun 29;10:1209-15, doi: 10.2147/OPTH.S106120. Cochrane Database Syst Rev. 2012 Jan 18;1:CD007679, doi: 10.1002/14651858.CD007679.pub3.)
Working with an experienced vision correction surgeon and team is one of the most important steps a patient can take to ensure that they have the best possible experience and outcome.
What is the difference between ICL and Lasik?
Corrective eye surgery corrects the refractive error (eye prescription) that causes vision problems. LASIK involves reshaping the cornea while ICL surgery corrects the eye through a different approach – by placing a corrective lens beneath the surface of the eye.
During LASIK surgery, the surgeon uses a laser or microkeratome to create an extremely precise flap of eye tissue in the cornea. After pulling back this flap to expose the inner corneal tissue, the surgeon then uses an excimer laser to remove corneal tissue and reshape the cornea. Reshaping the cornea causes light to bend, or refract, at an angle that focuses light in a more optimal place in the eye for better vision. This is where the term “refractive surgery” comes from.
With EVO ICL surgery, a lens containing collagen (an important natural protein in the eye) is placed in the eye to bend and focus light properly. The surgeon makes a tiny incision in the cornea, then places the ICL behind the iris. The lens works with the eye’s natural lens to correct refractive errors. The procedure is intended to let the natural lens stay intact (unlike with refractive lens exchange) and allow the self-sealing incision to heal quickly on its own. Most patients say that the 20 to 30-minute procedure is painless, and improvement is immediate. Many patients awaken the next day with clear eyesight, and for the first time in as long as they can remember.
Why look for a surgeon who can offer more than just LASIK?
In 1966, Abraham Maslow famously said, “I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.” The concept known as the law of the instrument describes a cognitive bias. Essentially, if you only have one tool, understand one process, or perform one operation, you risk over-relying on that single instrument to the point that it distorts your view of the task and the problem at hand.
Imagine calling a repair person to your house to fix something critically important to your comfort and safety. What would you think if they opened their toolbox and you saw only one instrument – a hammer?
Don’t get me wrong – a hammer is an important tool, and you can do a lot with a hammer. But if you only have a hammer you run the risk that steps better accomplished with other instruments are either skipped or are accomplished in a round-about way – by using the hammer in a way that it wasn’t intended to be used, or in a way that is at least suboptimal.
Top repair professionals carry a full toolbox. They understand and appreciate the role of all of the tools they carry. They undergo initial training and certification in their use as well as ongoing instruction to keep up to date in the tools of their trade.
The tools of our trade – vision correction surgery – include a number of procedure options. There are many ways of correcting your vision and these can be divided into procedures which alter your cornea (like LASIK, PRK, SMILE, or Kamra Inlay), procedures which alter the natural lens inside your eye (like refractive lens exchange or "RLE"), or procedures like the EVO ICL which spare both your cornea and your natural lens. Our tools are similar to those of the repair professional. They require years of training to master and involve millions of dollars of investment in technology, staff, education, and optimal maintenance. It’s always more economical to provide only one option, but the most economical route is not always the best one. Going to a surgeon who provides multiple options gives you the assurance that you are receiving the best procedure for your eyes rather than the only procedure a surgeon can offer to correct vision.
Consider a group of people wearing glasses. Are they all wearing the same glasses? How well do one-size-fits-all articles of clothing fit? Sometimes they fit fine and sometimes they don’t, but if that’s the only option you consider you will never know.
If you take nothing else away from this blog, remember this: optimal surgical correction of vision cannot be accomplished with a one-size-fits-all LASIK-only approach. LASIK has an important role in what we do, but it’s just one tool in the toolbelt. Great vision correction surgeons customize the procedure to the patient rather than channeling all patients toward one solution, such as LASIK.
Is ICL better than LASIK?
It depends on your circumstances. To answer this question, you need to consult a qualified vision correction surgeon. If you’re one of the numerous patients worldwide, like many of our St. Louis LASIK prospects, who discovered that LASIK is not an option, there is a good chance that ICL surgery will work for you. Our patients tell us that all of our options are infinitely better than staying in prescription eyeglasses and contact lenses for the remainder of your natural life.
Since they are so accustomed to paying the cost of these visual aids, most don’t process the long-term price tag of glasses and contacts. According to All About Vision, most people spend $500-$700 per year on their contacts. The cost of LASIK eye surgery for our St. Louis patients could scarcely exceed the cumulative expense of contacts, lens cases, solution, backup glasses, prescription sunglasses, and eye doctor fees, which can top out at over $1,000 per year. Over an 8 to 12-year period most people will have already paid for the cost of their vision correction procedure. The sooner you have the procedure done, the more you save and the longer you get to enjoy the benefits of clearer eyesight.
Beyond the dollars and cents cost of relying on glasses and contacts, what are the hidden costs of a lifetime of poor vision?
How much does ICL eye surgery cost?
The cost of EVO ICL in the United States varies greatly from one region to the next, and even from one eye surgeon to another. Nationwide, surgeons commonly cite an EVO ICL procedure cost range of $4,000 to $6,000 per eye, and many clinics, like Brinton Vision, offer payment plans that land in the range of $150 to $250 per month. A number of factors can influence where on this range your surgeon falls. Remember that when paying for EVO ICL, the monthly payments eventually stop, however when managing poor vision with glasses and contacts, there is no end.
Quality and experience of the surgeon are important factors, as is the level of staff expertise and training. Ask most business owners what their #1 expense is and they will tell you “staff wages.” Experienced, highly trained staff and doctors are sought after and merit higher pay than average staff. The level of diagnostic and treatment technology in the practice are also reflected in any estimate of EVO ICL cost in St. Louis or elsewhere. We recommend that you do careful research and seek the best eye surgeon rather than focus on the lowest price. This is one of those areas where if a price sounds too good to be true, it probably is. You get what you pay for and you only have one pair of eyes.
If the price tag seems daunting, keep in mind that there are ways to pay for surgery that take away some of the sting:
- Multiple payment forms – cash, check, credit card
- Medical spending accounts – health savings accounts (HSAs), Flexible Spending Accounts (FSAs), or Medical Savings Accounts (MSAs). Vision correction procedures are approved for 2020 under most plans. Patients can put up to $2,750 annually into an FSA, tax free, and $7,100 per family into an HSA.
- Monthly payment options – either through your surgical center or your own lender
- Tax deductions – vision correction surgery is considered by the IRS to be a qualified medical expense, which means that many patients receive a significant tax refund based on their having one of our procedures. This can offset a substantial portion of the cost of EVO ICL surgery and sometimes triggers tax refunds in the $1000s of dollars.
The first step toward determining whether you’re a candidate for any procedure, including EVO ICL, is to schedule an eye exam with a vision correction surgeon (refractive surgeon, or MD). Contact your eye care professional to find out their next availability.
Important Safety Information
The EVO Visian ICL Lens is intended for the correction of moderate to high nearsightedness. EVO Visian ICL and EVO Visian TICL surgery is intended to safely and effectively correct nearsightedness between -3.0 D to -15.0 D, the reduction in nearsightedness up to -20.0 D and treatment of astigmatism from 1.0 D to 4.0 D. If you have nearsightedness within these ranges, EVO Visian ICL surgery may improve your distance vision without eyeglasses or contact lenses. Because the EVO Visian ICL corrects for distance vision, it does not eliminate the need for reading glasses, you may require them at some point, even if you have never worn them before.
Implantation of the EVO Visian ICL is a surgical procedure, and as such, carries potentially serious risks. Please discuss the risks with your eye care professional. Complications, although rare, may include need for additional surgical procedures, inflammation, loss of cells from the back surface of the cornea, increase in eye pressure, and cataracts.
You should NOT have EVO Visian ICL surgery if:
- Your doctor determines that the shape of your eye is not an appropriate fit for the EVO Visian ICL
- You are pregnant or nursing
- You have moderate to severe damage to the optic nerve caused by increased pressure (glaucoma)
- 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
Before considering EVO Visian ICL surgery you should have a complete eye examination and talk with your eye care professional about EVO Visian ICL surgery, especially the potential benefits, risks, and complications. You should discuss the time needed for healing after surgery. For additional information with potential benefits, risks and complications please visit DiscoverICL.com.
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¹Packer M. The Implantable Collamer Lens with a central port: review of the literature. Clin Ophthalmol. 2018;12:2427-2438.
²Sanders D. Vukich JA. Comparison of implantable collamer lens (ICL) and laser-assisted in situ keratomileusis (LASIK) for Low Myopia. Cornea. 2006 Dec; 25(10):1139-46.
³Naves, J.S. Carracedo, G. Cacho-Babillo, I. Diadenosine Nucleotid Measurements as Dry-Eye Score in Patients After LASIK and ICL Surgery. Presented at American Society of Cataract and Refractive Surgery (ASCRS) 2012.
⁴Shoja, MR. Besharati, MR. Dry eye after LASIK for myopia: Incidence and risk factors. European Journal of Ophthalmology. 2007; 17(1): pp. 1-6.
5aLee, Jae Bum et al. Comparison of tear secretion and tear film instability after photorefractive keratectomy and laser in situ keratomileusis. Journal of Cataract & Refractive Surgery , Volume 26 , Issue 9 , 1326 - 1331.
5bParkhurst, G. Psolka, M. Kezirian, G. Phakic intraocular lens implantantion in United States military warfighters: A retrospective analysis of early clinical outcomes of the Visian ICL. J Refract Surg. 2011;27(7):473-481.
⁶Martínez-Plaza E, López-Miguel A, López-de la Rosa A, et al. Effect of the EVO+ Visian Phakic Implantable Collamer Lens on Visual Performance and Quality of Vision and Life, Am J Ophthalmol 2021;226:117-125.
⁷Packer M. Evaluation of the EVO/EVO+ Sphere and Toric Visian ICL: Six month results from the United States Food and Drug Administration clinical trial. Clinical Ophthalmology. 2022;16:1541-53.
⁸Parkhurst GD. A prospective comparison of phakic collamer lenses and wavefront-optimized laser-assisted in situ keratomileusis for correction of myopia. Clin Ophthalmol. 2016;10:1209-1215.
⁹Ganesh S, Brar S, Pawar A. Matched population comparison of visual outcomes and patient satisfaction between 3 modalities for the correction of low to moderate myopic astigmatism. Clin Ophthalmol. 2017;11:1253-1263.
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