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Dr. ICL LEE DONG HOON
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ICL stands for Implantable Contact Lens. The term "implantable" is familiar from dental implants, and here it refers to a contact lens that can be placed inside the eye. Academically, it is commonly referred to as an Implantable Collamer Lens, where "Collamer" denotes the material of the lens, Collagen copolymer. "Collamer" is a patented material by the FDA, similar to collagen, a protein abundant in human skin, hair, and cartilage. This biocompatible material is highly suitable for implantation, causing minimal foreign body reactions or immune rejections.
While often called an intraocular contact lens, it is fundamentally different from typical contact lenses. Conventional contact lenses have oxygen permeability limitations, requiring regulated usage times to prevent hypoxic damage to corneal endothelial cells. They must be handled in hygienic conditions to avoid bacterial contamination, with regular cleaning and storage in special solutions to remove protein deposits. Moreover, the lenses contact the eyelid roughly 15,000 times daily, causing wear and diminishing anti-glare and antibacterial coatings, necessitating regular replacements. Neglecting these can lead to eye conditions like dry eye, allergic conjunctivitis, infectious conjunctivitis, or even permanent corneal diseases.
In contrast, ICLs do not require maintenance as they do not get dirty or scratched. Made from Collamer, a collagen-based biomaterial, they are safe to remain in the eye indefinitely. This semi-permanent solution can often last a lifetime with a single procedure.
< After ICL Surgery >
< In cases where corneal ablation causes increased higher-order aberrations >
Astigmatism-correcting EVO+ICL, models below -9D have an ICL optical zone (Optic Zone, OZ) of 6.1mm. The wider the optical zone, the better it is optically. This corresponds to a 7.6mm optical zone in LASIK or LASEK surgeries. While laser surgeries typically create a 6.0–6.5mm optical zone in the cornea, ICL correction offers a substantially broader range.
ICL surgery involves posterior lens implantation, where a lens is inserted into the empty space between the iris and the natural lens, much like wearing glasses inside the eye. There’s no need to create a flap in the cornea or remove corneal tissue. Since the natural lens remains unharmed, there’s no risk of presbyopia (age-related farsightedness) due to impaired lens focusing. Once inserted, the ICL lens requires no maintenance and can stay in good condition over an extended period, thus earning it the reputation of a semi-permanent contact lens.
Why have ICL-related complications, which were rare but possible, dramatically decreased in recent years? The answer lies in the tiny hole at the center of the V4c model, known as the Hole ICL, introduced in 2011. Before the Hole ICL, an iridotomy (cutting a small hole in the iris) was necessary before or during surgery to maintain the flow of aqueous humor (the fluid inside the eye) and prevent intraocular pressure from rising. However, a too-small iridotomy could occasionally become blocked, leading to increased intraocular pressure. Conversely, if too large, it could allow too much fluid flow, causing erosive damage to the corneal endothelium (the top layer of cells) from hydraulic pressure. However, with the 2011 EVO+ ICL upgrade, a 360µm hole in the center of the lens functions similarly to a pupil, making iridotomy unnecessary. This allows a smoother flow of aqueous humor through the natural pupil, significantly reducing the risk of complications and eye fatigue associated with previous models.
Given that ICL lenses remain in the eye for extended periods, it is essential to verify their long-term safety for human use. ICL lenses are made from Collamer, a patented material with excellent biocompatibility. Since its introduction in Europe in 1997, ICL has been used in over 2,000,000 surgeries across 75 countries as of 2023, with more than 30 years of proven long-term clinical results following the initial surgery.
The ICL surface is made of a hydrophilic material called Collamer, which minimizes optical reflections and reduces higher-order aberrations (irregular astigmatism). With a high water content, up to 40% of the lens is composed of water, allowing numerous water molecules to keep the ICL surface smooth and moist. Additionally, the minimal difference in refractive index between the water molecules and the aqueous humor in the eye significantly reduces light reflection and scattering commonly seen on the surfaces of glasses or hard lenses.
← Inside ICL, ICL Surface →
(Acrylic material guidance lens)
(Collamer material ICL)
Collamer possesses excellent optical properties and outstanding biocompatibility, ensuring stable vision over long periods.
Although lens implantation may appear new and unfamiliar to many, it actually predates laser surgeries like LASIK and LASEK by decades. In 1950, British ophthalmologist Dr. Sir Harold Ridley pioneered the method of inserting a lens into the eye after cataract removal to correct vision, earning him a knighthood from the Queen for his contributions.
The first ICL surgery using Collamer material, similar to today’s ICL lenses, began in 1994. Since then, ICL surgery has expanded significantly, with over two million patients worldwide by 2022, across more than 75 countries.
In South Korea, ICL clinical trials started in 2002, leading to KFDA approval the same year. Although early ICL lenses occasionally had complications like cataracts and glaucoma, the upgrade to EVO ICL in 2011 addressed these issues effectively. In 2016, the EVO+ model was developed, featuring a larger optical zone while maintaining the overall lens size. This enhancement has greatly improved vision for young patients with larger pupils who need clear night vision. Recently, the number of people undergoing ICL surgery has risen sharply, attracting global attention.
1990
Conceptualized in Russia
1992
Development initiated by STAAR
1994
First ICL surgery performed by Dr. Zaldivar
1997
Registered with the European CE Mark, surgeries officially begin
2002
V4 (ICL) approved by KFDA, start of prescriptions in South Korea
2003
TICL registered with the European CE Mark
2005
ICL receives FDA approval, becoming the only FDA-approved posterior chamber lens; TICL approved by KFDA, start of prescriptions in South Korea
2011
V4c (EVO ICL, TICL) registered with the European CE Mark; the only lens that doesn’t require iridotomy
2013
KFDA approval of EVO ICL and EVO TICL
2014
100,000 surgeries completed in South Korea
2017
Launch of V5 (EVO+ICL), offering enhanced visual quality
2020
Over 1.1 million surgeries worldwide, over 200,000 surgeries in South Korea
2020
CE approval for EVO PRESBY ICL (Presbyopia ICL)
2022
FDA approval of EVO/EVO+ICL
2022
Over 2 million surgeries worldwide, 250,000 surgeries in South Korea
1. Initial Appointment Reservation: Schedule your preferred date and time for an initial consultation via phone or online booking.
2. Receive Confirmation Text for Initial Appointment
3. Primary Comprehensive Examination to Assess Eligibility for ICL Surgery
Contact Lens Restrictions: Stop wearing soft contact lenses for 3 days and hard contact lenses for 2 weeks before the examination. (If stopping contact lens use is difficult, please inquire separately.) This examination will determine if you’re a suitable candidate for the surgery and check for any other eye diseases. During the one-on-one consultation after the exam, you can ask about any concerns or questions.
4. Secondary Comprehensive Examination to Determine ICL Lens Prescription
This is a crucial examination related to post-surgery vision. Please avoid wearing contact lenses before the exam. After the examination, you won’t be able to drive for 5-6 hours due to eye drops used to dilate your pupils.
(Because the examination is conducted after dilating the pupils with eye drops.)
5. Antibiotic Eye Drops Before Surgery
To prevent infection, use antibiotic eye drops starting one day before surgery.
6. Surgery Day
Single-use contact lenses may be worn until the day before surgery, but multi-use lenses should be stopped 3-4 days prior. Wear glasses on the day of surgery. You may go home unaccompanied, though you won’t have clear vision on the same day. You may also feel a foreign body sensation, mild stinging, and tearfulness, so returning home to rest is recommended. Applying prescribed eye drops on the day of surgery is essential.
7. Post-Surgery Examination
The next morning, you’ll notice clearer vision with reduced foreign body sensation. Start applying the prescribed eye drops as soon as you wake up, and visit at your scheduled appointment time.
Wide Range of Myopia and Astigmatism Correction
ICL surgery allows for a broad range of correction for myopia and astigmatism. Utilizing the correction ability of the ICL itself, it can correct severe myopia and astigmatism. The correction range is much broader than that of contact lenses or glasses: -0.5D to -18.0D for myopia and 0.5D to 6.0D for astigmatism.
Same-Day Surgery and Quick Recovery for Early Return to Work and Daily Life
ICL surgery is an outpatient procedure, not requiring hospitalization. Although vision may be slightly blurred on the day of surgery, it becomes significantly clearer the next day, allowing individuals with office jobs to return to work as early as the day after surgery.
High Precision and Long-Term Stability of Vision
ICL provides correction precision equal to or better than that of soft contact lenses. With no vision regression over time, it ensures stable, high-quality vision in the long run.
Lower Risk of Complications and Reduced Night Vision Issues
Due to a minimal incision size (about 2.8mm), the risk of post-surgery side effects such as dry eyes is reduced. Additionally, the surgery is less likely to cause night vision issues like glare or halos, which are sometimes seen after LASIK due to high-order aberrations. The expanded optical zone in EVO+ ICL further reduces these night vision problems.
Removability in Case of Issues
ICL is designed for long-term use without any specific issues. In case of unexpected problems, the ICL can be removed, and vision can be corrected again with glasses or contact lenses in most cases.
Relatively High Cost
ICL lenses are custom-ordered to fit each eye precisely, which makes the procedure more expensive than other corrective surgeries. Once ordered, returns or refunds are difficult.
Possible Waiting Period for Surgery
Surgery is possible as soon as the ordered lens arrives. Typically, surgery can be done on the same day or within two weeks after the examination. However, in rare cases, such as those with unique astigmatism axes, there may be a wait of 2-3 months.
There may be occurrences of halos, glare, or rings of light.
In the early stages after surgery, mild halos, glare, or ring-shaped lights may appear. In most cases, these effects diminish to a negligible level within one to two months post-surgery.
Occasionally, additional treatment may be necessary after surgery.
If the corrective power or size of the lens is not appropriate after ICL surgery, it can be corrected by replacing the lens. In the case of astigmatism-correcting ICL lenses, it may sometimes be necessary to readjust the lens axis without replacing the lens.
Pre- and Post-Surgery Care is Crucial.
For ICL surgery, since an artificial lens is implanted in the eye, the periods immediately before and after surgery are critical. Although infection related to ICL is extremely rare (1 in 6000 cases), it is essential to follow the guidelines for using eye drops before and after surgery, as well as to adhere closely to precautions and preventive measures.
CARE 1
Receive a comprehensive preoperative examination for ICL surgery, including 3D precision measurement of the ocular space. Dr. ICL Donghoon Lee, who has performed over 15,000 ICL procedures, personally reviews the results to determine the most suitable surgical option.
CARE 2
An ICL specialist counselor will provide a one-on-one consultation to address any questions based on the detailed examination results and findings.
CARE 3
More in-depth testing follows to determine the size and corrective power of the ICL lens. Once the surgery date is confirmed, the patient is informed of the scheduled surgery date.
CARE 4
Surgery for both eyes takes approximately 10 minutes. After the surgery, the patient rests for 20-30 minutes and undergoes an evaluation to assess the ICL position, refraction, and intraocular pressure. If the results are satisfactory, the patient can return home.
CARE 5
A comprehensive follow-up care program, including regular post-surgery checkups, is provided to ensure stable long-term vision.
