As a vision correction procedure, implantable contact lens (ICL) surgery involves implanting permanent contact lenses in your eye to correct short-sightedness, long-sightedness and astigmatism.
ICL is an option apart from laser vision correction (LVC) methods, such as LASIK and ReLEx SMILE, and is suitable for those with thinner corneas or higher prescription.
I am Dr David Chan, an ophthalmologist and the Medical Director at Atlas Eye Specialist Centre. This article will be your go-to guide for everything you need to know about having ICL surgery in Singapore.
I will cover the most frequently asked questions that my patients have including:
- What are the benefits of ICL surgery?
- What can I expect during the surgery?
- What are the risks and complications of ICL surgery?
- How much does ICL surgery cost in Singapore?
What is an implantable contact lens?
An ICL is a permanent contact lens that is inserted in your eye to improve your vision .
It is often used for patients with moderate to high refractive errors or those who are unsuitable for laser vision correction procedures like photorefractive keratectomy (PRK), LASIK and ReLEx SMILE.
Read more about ReLEx SMILE: Getting ReLEx SMILE in Singapore: An Insightful Guide by an Eye Doctor (2020)
ICL can correct the following:
- Short-sightedness: up to -18.00
- Associated astigmatism: up to -6.00
- Long-sightedness: up to +10.00
- Associated Astigmatism: up to -4.50
By creating a small 2mm to 3mm incision at the edge of the cornea, the lens is positioned behind the iris and in front of the crystalline lens. As the incision is small, no stitches are required.
The surgery is a day procedure and takes only about 20 minutes per eye.
Although the lenses are made to be permanently implanted, they may be removed if needed.
Key advantages of ICL
- Reversible — ICLs are permanent, but they can be removed if needed
- Preserves the structural integrity of the cornea
- Thinning of the cornea is not required; suitable for people with corneas too thin for laser vision correction
- Has the potential to provide a better quality of vision compared to laser vision correction at higher levels of refractive error
- Lower incidence rate of dry eyes compared to laser vision correction
To prepare for the surgery, you should stop using contact lenses for a certain period of time.
- Soft contact lenses: Stop use 3 days prior to surgery
- Hard contact lenses: Stop use 14 days prior to surgery
Do note that you are also required to fast for 6 hours before surgery.
During the surgery, topical anaesthesia will be administered to help you feel at ease and provide comfort.
However, you may experience the sensation of coldness and pressure around the eyes.
On the day of surgery
Even though the surgery for both eyes takes about 40 minutes, be prepared to stay in the hospital for half a day.
You should not drive that day, arrange for someone to pick you up from the hospital or take a taxi home.
I encourage you to bring sunglasses to the surgery; your eyes may be sensitive to light after the surgery.
You should not strain or overexert your eyes too much after the surgery. Most people will recover about 75% of their vision the following day. You should be able to return to work 1 week after.
However, take note that it will take about 1 month for your eyes to make a full recovery.
It is normal for your vision to fluctuate during recovery, with it being clearer some days compared to others. There is little to worry about, as this is part of the healing process, and it will take about 3 months for your vision to fully stabilise.
Post-operation reviews usually take place at the following times:
- 1 day after
- 1 week after
- 1 month later
- 6 months later
Pros and cons of ICL surgery vs LASIK/ReLEx SMILE
ICL has similarities to other refractive surgeries such as LASIK and ReLEx SMILE — all 3 methods correct the vision.
However, there are key differences between them, as outlined in the table below.
Uses permanent lenses
Incision of 2mm to 3mm 
Suitable for thin corneas
Suitable for both short-sightedness and long-sightedness
Has the potential to provide a better quality of vision compared to LASIK and ReLEx SMILE
Least affordable procedure
Corrects the eye with laser technology
Incision of 22mm
Not suitable for thin corneas 
More widely known and performed vision correction procedure
More affordable than ICL and ReLEx SMILE
Corrects the eye with laser technology
Incision of 4mm 
Not suitable for those with long-sightedness
Lower incidence of dry eye and infection compared to LASIK
More affordable than ICL
Side effects, risks and complications of ICL surgery
ICL is a low-risk surgery
To put your mind at ease, ICL is generally considered to be a low-risk surgery. The risk of developing an infection is about 1 in 1,000.
However, just like any surgery, ICL does come with possible risks and side effects.
Temporary side effects
After ICL, you may experience dry eyes, halos and starbursts. Rest assured, they are usually temporary and may last for about 3 months with gradual improvement over days, weeks and months. In rare cases, aspects of halos and starbursts can be permanent.
Possible risk: Glaucoma
An increase in eye pressure (glaucoma) is one possible risk of ICL surgery. Glaucoma has the potential to damage your optic nerves if left untreated .
In the rare event of an increase in eye pressure, your doctor will prescribe eyedrops to lower the pressure in the eye. However, if the eyedrops are ineffective, the ICL may need to be removed to prevent further complications.
Possible risk: Early onset of Cataract
ICL surgery may lead to an early onset of cataract, as it sits near the natural lens.
With modern technology and equipment, the likelihood of developing glaucoma and cataract is generally not common though they are still risk factors that one has to consider before proceeding with the surgery. 
After undergoing ICL surgery, I recommend that you go for yearly reviews to screen for cataract and glaucoma.
You should contact your doctor as soon as you can if you experience any of the following after ICL surgery:
- Increased redness
- Blurred vision
- Sharp pain
Read more about cataract: A Comprehensive Guide To Cataract Surgery in Singapore: An Eye Doctor Explains (2020)
Who is suitable for ICL surgery?
You may be an ideal candidate for ICL surgery if you:
- are 18 to 45 years old
- have had a stable prescription for the past 12 months
- do not have pre-existing eye conditions (e.g. cataract, glaucoma)
In addition, those who are not suitable for laser vision correction, perhaps due to thin corneas or high prescription, can consider going for ICL surgery.
At most eye centres, ICL surgery can cost between $9,000 and $15,000 for both eyes. Generally, the cost of ICL surgery in Singapore hinges on three factors:
- The experience of the doctor performing the surgery
- Where the ICL surgery is performed e.g. private clinics, private hospitals or government hospitals
- Your eye power/prescription
Your surgery cost may include facility fees, which are fees charged for using surgery facilities such as the operating theatre. The facility fees depend on the location, i.e. different hospitals or clinic settings charge differently. You should speak with your surgeon for a detailed cost breakdown.
Many surgeons opt to perform the procedure in hospitals due to their superior levels of sterility, availability of well-trained nurses and anaesthetists, and capability to support complications when required.
Your ICL surgery cost may also be affected by the type of ICL used; an ICL that treats both myopia and astigmatism will cost more than one for just myopia.
Post-op care after ICL surgery
During your recovery from ICL surgery, you need to take note of the following:
- Do not drive or operate heavy machinery for the first 24 hours
For the first week after surgery:
- Avoid rubbing your eyes
- Avoid travelling as you need to attend post-op reviews
- Avoid eye makeup
- Avoid smoky and dusty places
- Use headbands during exercise to prevent sweat from getting into your eyes
- Use eye shields when sleeping to prevent you from rubbing your eyes
- When washing your hair, tilt your head backwards to prevent water from running into your eyes
- When drying your face, use a towel to pat around your eyes
For one month after surgery:
- Avoid hot tubs, hot yoga, jacuzzis, saunas, swimming
- Avoid contact sports
ICLs are designed to last long
ICLs are permanent and designed to last hopefully until the time of your cataract surgery in your advanced years.
However, if the need arises, such as in cases of post-op complications, the ICLs can be removed.
ICL surgery is relatively painless
ICL surgery is a relatively painless procedure. Anaesthetic drops will be applied to your eyes to provide comfort throughout the entire procedure. You may however still experience some sensation during the surgery as everyone has a different pain threshold.
After the surgery, you may experience mild discomfort, with your eyes being more sensitive to bright lights. You may also experience a sandy feeling (dryness) in the eye. Lubricating eyedrops will be prescribed to alleviate the dryness.
Choosing an eye surgeon
Just like choosing a doctor for any other treatment, you should look out for one who possesses some of the following qualities:
- Medically qualified
- Knowledgeable in the field
- Attentive to patients’ needs and concerns
- Passionate in their work
During your consultation with the surgeon, have an open discussion on the risks vs benefits of the surgery. At the same time, you will also be able to establish the comfort and confidence level you have with him/her.
To sum up, ICL surgery is a US-FDA approved and evidence-based refractive surgery that aims to reduce or eliminate the use of glasses and contact lenses. When performed on suitable eyes, it is a highly successful procedure. Nonetheless, it is important to go through a thorough eye evaluation with your surgeon to ascertain your suitability and to weigh the risks vs benefits before coming to a decision.
Dr David Chan is the medical director of Atlas Eye Specialist Centre. He has been in ophthalmology practice since 1999. Dr Chan was previously a surgical instructor at the Singapore National Eye Centre and the University of Calgary, Canada. In his free time, he enjoys digital photography.
Would you like to ask any related health questions?
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