An implantable contact lens (ICL) is a special type of phakic IOL that is placed inside the eye between the iris and the eye's natural crystalline lens. Like other phakic IOLs, an ICL is usually recommended for severe amounts of nearsightedness that cannot be corrected with LASIK.

In December, 2005, the U.S. Food and Drug Administration (FDA) approved the Visian ICL (STAAR Surgical Co., Monrovia, CA) for use in the correction of myopia (nearsightedness) in adult Americans.

Made of STAAR's proprietary, highly biocompatible Collamer material, the Visian ICL has a unique foldable design, allowing an incision for the procedure to be 50% smaller than competing phakic IOL technology, according to the company.

In a December, 2005 press release, STAAR Surgical says that in addition to its approval in the U.S., the Visian ICL is also approved for use in 41 countries including the European Union and has successfully been implanted in more than 40,000 eyes worldwide. (It's estimated that as of June, 2006, approximately 50,000 ICL procedures have been done worldwide.)

(The FDA now prefers the term "implantable collamer lens" to avoid confusion with traditional contact lenses that are applied to the exterior of the eye are are made of different materials.)

A close-up of the Visian ICL and its implanted position in the eye, behind the iris and in front of the crystalline lens.

Safety and effectiveness of the Visian ICL

Approval of the Visian ICL by the FDA is based on the findings of a clinical trial of 526 eyes of 294 people ages 22-45 who had the ICL surgery performed to correct moderate to high myopia. Effectiveness of the procedure was determined by measuring the uncorrected visual acuity (UCVA) of the eyes several months after the ICL procedure. Results of this study show:

• Nearly 59% of the eyes had 20/20 vision or better.
• Nearly 95% of the eyes had 20/40 vision or better.
• Nearly 97% of the subjects said they would have the ICL surgery again.

The Visian ICL is approved for the correction of up to -15.00 diopters (D) of myopia and the reduction of myopia in adult patients with up to -20.00 D of nearsightedness.


The Visian ICL procedure

Implanting the Visian ICL is an outpatient procedure that takes approximately 15 to 30 minutes. Usually, one eye is treated at a time.

1. You will be asked to arrive at the surgery center about one hour prior to your procedure.
2. Once you have checked in, you may be offered a sedative to help you relax.
3. The area around your eye will be cleaned and a sterile drape may be applied.
4. Eye drops and/or a local anesthetic will be used to numb your eye.
5. A small retainer device will be placed between your eyelids to keep you from blinking during the procedure.
6. A small incision is made in the peripheral cornea and the Visian ICL is inserted into the anterior chamber of the eye. A gel-like substance will also be injected into your eye at this stage.
7. The Visian ICL is then carefully placed behind the iris and centered in front of the crystalline lens.
8. The gel-like substance is removed from your eye

The small incision made in the cornea will heal without the need for stitches. Medicated eye drops and/or oral medications may be prescribed for you to use for several days after surgery. Typically, you will be asked to return the following day for a check-up.


Considerations after Visian ICL surgery

• After surgery, a temporary protective shield will be placed over your eye to protect it for the first few hours after the procedure.
• The results of the surgery are almost immediate, but your vision will probably be a little blurry from the anesthesia.
• You'll need someone to drive you home after the procedure.
• You should relax for the rest of the day after surgery.
• You may experience some discomfort after the anesthesia wears off, but this is usually relieved effectively with an over-the-counter pain reliever.
• Most patients resume normal activities within a day or two.

Risks and complications of Visian ICL surgery

Though the risks of phakic IOL surgery are low, potential complications include:

• Inflammation
• Infection
• Cataracts
• Retinal detachment
• Corneal damage

If you are considering phakic IOL surgery, be sure to discuss the risks and potential complications of this procedure with your surgeon as part of your pre-operative consultation.


Other pros and cons of the Visian ICL

In addition to being able to correct higher prescription powers than LASIK, another advantage of the Visian ICL procedure is that it's reversible. If vision is poor or other complications develop, the ICL can be removed or replaced at a later date.

Also, the Visian ICL and other phakic IOLs do not contribute to dry eye symptoms like LASIK does.

The cost of the Visian ICL procedure is significantly higher than LASIK surgery. It runs approximately $4,000 to $5,000 per eye, and (like LASIK) it's not covered by most medical insurance plans.

For more information

For more information about the Visian ICL, visit www.visianinfo.com.