ICL vs. IOL Surgeries: Is There a Difference?

Eye surgery can change many people’s lives, but the idea can seem daunting without an understanding of the different kinds of procedures and their risks. Two common procedures — IOL and ICL surgery — are used to treat a variety of vision conditions. ICL, short for implantable contact lens, is an artificial collamer lens implanted behind a patient’s iris and in front of the natural lens, while an IOL, or intraocular lens, replaces the natural lens. 

Even though ICLs are technically a phakic type of IOL, the purpose and procedures for these implants have some subtle, but important differences. Although it is not a laser surgery, ICL is similar to LASIK in that it is a vision correction surgery to improve refractive errors such as nearsightedness and astigmatism. For some patients who cannot have LASIK due to thin corneas or high prescriptions, ICL is seen as a LASIK alternative.  

IOLs on the other hand are used primarily in cataract surgery. Cataract surgery and RLE (refractive lens exchange) surgeries —both types of IOL procedures — are often better for patients over the age of 40 who do not qualify for LASIK, PRK, or ICL surgery. 

Beyond that, however, there are plenty of other differences between ICL and IOL surgeries that can help guide you through your decision to improve your vision. 

What Is ICL?

ICL surgery creates clearer vision by helping your existing lens bend or refract light on the retina, which helps to correct nearsightedness (myopia) and astigmatism, according to the experts at Harvard Health. While the procedure is more like LASIK than IOL surgeries, these two have important distinctions. 

For example, though both treat refractive errors, LASIK permanently changes the shape of your cornea, while ICL uses an additive implant to improve vision. Both procedures are common for people under 40, but research shows that ICL can be a better option for patients whose levels of nearsightedness are too high for LASIK. 

An ICL is a specific type of IOL called a phakic intraocular lens, or phakic lens. They are implanted into the eye without removing the eye’s natural lens — in contrast to typical IOLs, which replace the eye’s cloudy natural lens that was removed during cataract surgery. According to a study in the National Library of Medicine, phakic IOLs can provide the best possible quality of vision for patients who are seeking vision correction surgery but are not candidates for LASIK.

Advantages

There are many benefits of choosing an IOL, in part due to its versatility and durability; advantages include:

• Ability to correct high levels of myopia that cannot be resolved with other surgical procedures.
• Can help patients who are not candidates for LASIK.
• Improving night vision.
• Reduced risk of creating or contributing to dry eyes.
• Faster recovery time.
• Can be permanent or surgically removed.

What Does the ICL Surgery Entail?

ICL surgery has some variations, but there is a general structure to the procedure. Typically running about 30 minutes, ICL surgery can also have a relatively quick recovery time — if you follow the dos and don’ts, of course. In the actual surgery, your surgeon will go through the following steps: 

• First, you’ll be given a local anesthetic to numb your eye and perhaps a mild sedative to ease any anxiety.
• The area is cleaned and the eyelids are held open with a lid speculum.
• The doctor then makes a small incision in your eye, and lubricates the cornea. 
• The ICL will be implanted through the incision. 
• The doctor puts eye drops or ointment in your eye, which is finally covered with a patch.

There is only one kind of FDA-approved ICL available in the United States, the EVO/EVO+ Visian implantable Collamer lens, which is implanted in a patient’s eyes during an ICL procedure. 

What Is an IOL?

An IOL is an artificial, intraocular lens implant that is used to replace the eye’s natural lens to improve vision. For people with cataracts or myopia, IOL surgery is often more effective than ICL. 

In most cataract surgeries, a single focus IOL is inserted to replace the cloudy natural lens. Some IOLs, including some phakic IOLs, have ultraviolet protection built into the lenses to protect the retina well after surgery.

Types of IOLs

There are three different types of IOLs available: monofocal, toric, and presbyopic-correcting.

• Monofocal: This type of lens can help correct a single range of vision, as long as the patient doesn’t have astigmatism. 
• Toric: Toric lenses are designed to treat astigmatism. There are a variety of toric IOLs on the market, which can correct the blurriness caused by astigmatism in addition to near, intermediate and distance vision.
• Presbyopic-correcting: These lenses can correct two or more eye disorders and are designed to treat age-related near vision loss in order to reduce or eliminate dependence on reading glasses.

Who Should Opt for an IOL?

IOLs are the only vision correction choice for patients with cataracts. There are many different types of IOLs so patients can work with their eye doctor to determine which IOL is right for them. Refractive Lens Exchange surgery (RLE) with advanced IOLs can also be a good choice for patients who are seeking vision correction surgery that will help treat multiple vision problems and/or correct presbyopia. Patients with levels of myopia are so high that LASIK isn’t an option may also consider RLE with an IOL. 

Risks of Surgery

Cataract surgery can be performed in as few as 10-15 minutes. As an outpatient procedure, many patients resume some routines within just a day or two of surgery. However quick and simple, the removal of a cataract is still a surgical procedure, which comes with risks and side effects such as:

• Infection;
• Discomfort;
• Bleeding;
• Red eyes;
• Mild bruising around the eye; 
• Possible eye irritation;
• Initial blurriness or distorted vision.

While these risks are often temporary and rarely lead to major complications, they are still important to monitor. That’s why follow-up appointments are critical. When deciding whether IOL or ICL surgery is the right call, knowing the risks and side effects can also help guide your decision-making.

Living with eye disorders can be very challenging. Not only can it be frustrating, but there are times when it could even be somewhat dangerous. If you’ve struggled with poor vision or you have been diagnosed with an eye disorder and are looking for possible permanent relief, an ICL or IOL surgery might be the best solution.