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    What is ICL?

    ICL(Implantable Collamer Lens)refers to the operation that corrects refractive abnormalities (Myopia, hyperopia and astigmatism) by inserting lenses into eyes without reshape the cornea, so that people can see clearly with their naked eyes.

    ICL (Intraocular Contact Lens) is an abbreviation for Implantable Contact Lens, but the word “Implantable” means that it can be inserted, which is also used in dentistry such as implants. In other words, contact lenses that can be inserted, this is the beginning of the term intraocular contact lenses. However, it is described as Implantable Collamer Lens in academic journals. This is the correct word medically, and Collamer is the material of ICL.

    Today, it is generally called ICL overseas, but in Japan it is becoming more common to call it an intraocular contact lens rather than ICL. It's hard to imagine what ICL is just by the word of “ICL”. However, contact lenses need to be put on and taken off regularly, and depending on the type, also require daily cleaning and storage. However, the intraocular contact lens (ICL) is in the eye, it does not get dirty or scratched at all, so it does not require maintenance, it is basically okay to leave it in the eye.

  • Sharp vision and vivid color recognition

    Because myopia is corrected with the lens in the eye without scraping the cornea, the "aberration" that affects the postoperative appearance does not increase. It’s clear and colorful appearance gives you a feeling of depth and three-dimensionality that is different from conventional ones.

    When ICL (Intraocular Contact Lens) is implanted

    Eye vision after implantation of ICL
    ※Illustration (image)

    When the cornea is scraped and aberration increases

    Eye vision after thinning corneal and aberration increases
    ※Illustration (image)
  • The ICL Technique

    ICL surgery does not require creating a corneal flap and corneal tissue removal. This is a surgical procedure in which an intraocular lens called ICL is implanted in a position called the "posterior chamber" between the iris and the crystalline lens while retaining the focus adjustment function of the crystalline lens. Once inserted, the lens (ICL) is also called an "intraocular contact lens" because it is maintenance-free and can be maintained in good condition for a long period of time.

    Illustrated about the method of posterior Phakic IOL
  • Advanced Hole ICL lens

    How to reduce the risk of complications? We use an advanced hole ICL * with a small hole in the center of the lens. Prior to the widespread use of the current Hole ICL, an iris incision was required before or during surgery to maintain the flow of aqueous humor in the eyeball and reduce the rise in intraocular pressure. At our hospital, we have adopted an advanced hall ICL that has been researched and developed to eliminate iris incision. This keeps the aqueous humor flowing well and considerably reduces the risk of complications and the strain on the patient's eyes.
    * Approved by the Ministry of Health, Labor and Welfare on March 3, 2014.

    Illustration of the latest lens Hole ICL
  • Recommended ICL surgery results

    Postoperative naked eye visual acuity 20/20 is over 98.2%, 20/12.5 is over 83.4% (the data of 6 months after surgery from February 2019)
    The graph of the detailed results is as follows.

    Naked eye vision after ICL surgery Naked eye vision after ICL surgery
  • About the lens body

    Because these lenses are placed in the eye for a very long time, it is critical to verify that they are safe for use in the human body over the long term. Hall ICL uses Collamer®, a new hydrophilic material with excellent biocompatibility. This lens was launched in Europe in 1997 and has undergone numerous surgeries worldwide. It has a proven track record of over 20 years since it was first implanted.

    Illustration of the effects of ICL lenses on living organism
    Illustration of the effects of ICL lenses on living organism

    Optical properties: a built-in anti-reflective layer
    A softly contoured refractive index running from the surface to the inner center of the lens dramatically reduces glare. Because Collamer® is made of hydrophilic materials, it is characterized by less reflection and minimal higher-order aberrations.

    Lens Shape: Lens Design Evolution
    V1: Proto type model ICL (1990)
    V2: Positioning marks added (1994)
    V3: Optic diameter changed (1996)
    V4: Vault changed, new optical design developed (1999)
    V4c (EVO): Lens with central hole earns CE marking(2011)
    V5 (EVO+): Optic diameter further extended (2016)

    New material Collamer®️
    The lens itself carries a negative charge due to its collagen content, repelling negatively charged particles such as proteins. Collamer® demonstrates superior quality of vision and biocompatibility, rendering it stable in the eye over the long term.

  • History of ICL surgery

    ICL surgery may seem like a new-and-unfamiliar procedure to many, but it in fact predates LASIK. The first ICL surgery was performed in 1986, and it has since been employed in procedures around the world. So far there are 2 million patients have undergone this operation in the world (as of 2022) and this operation has been approved in more than 75 countries and regions.

    ICL clinical trials were held in Japan starting in 2003, ultimately gaining approval by the Ministry of Health, Labor, and Welfare in 2010. Early ICLs had problems with postoperative complications of cataracts and glaucoma, but Hole ICLs (with a small 0.36 mm aqueous humor circulation hole in the center of the lens) were devised after which these complications were no longer a concern. The number of people undergoing surgery has increased rapidly and has attracted worldwide attention (approved by the Ministry of Health and Welfare in 2014). Furthermore, in 2016, EVO +, a lens with a larger optical section, was developed while maintaining the overall size of the lens. It is expected to improve the appearance of young patients with large pupil diameters and night vision.

    ※Because of the selection of the optimum power for the patient, there may be no lens standard that has all the above characteristics. Depending on the power, it may take up to 3 months to order the lens. Please note that the staff will inform you in advance.

  • The surgery will be performed by experienced doctors led by expert instructor Kitazawa.

    Currently, there are only about ten expert instructors in Japan who can witness and license the surgery of doctors who wish to operate an ICL.
    Dr. Yoshihiro Kitazawa is an expert instructor license holder and also the caretaker of the ICL Study Group.
    At our hospital, two other expert instructors and experienced doctors also perform the surgery.

    ICL Expert Instructor Certificate
    ※Expert Instructor Certificate

ICL Surgery Process /
Flow to Surgery

Expert’s treatment, Reliable and effective

Our hospital average operation time is per eye1min52s(*1)

(*1) Surgery time is the time from making an incision to lens insertion, cleaning, and incision closure.

Steps of the ICL Procedure

STEP 1 Anesthesia and surgery on right eye
ICL surgery process STEP1 Right eye anesthesia・surgery

An anesthetic eye drop is applied, followed by an incision of approximately 3mm in the cornea, to insert the lens (ICL). Using an injector, the ICL, which is folded long and thin, is inserted into the incision.
Note: Because the incision is so small (3mm), stitches are not required. Though antibacterial eye drops should be used for some time after surgery, the incision will heal relatively quickly on its own.

STEP 2 ICL implanted
ICL surgery processSTEP2 Implant

The folded ICL will slowly open on its own in the posterior chamber of the eye.

STEP 3 Lens fixed in place
ICL surgery process STEP3 lens fixed

The open lens is fixed in place on both sides in the ciliary sulcus.

STEP 4 Anesthesia and surgery on left eye and postoperative examination
ICL surgery process STEP4 Left eye anesthesia・surgery~postoperative examination

The same procedure is repeated for the other eye.
The operation is completed in approximately 20-30 min, followed by a medical examination, after which the patient is free to go.

Flow to ICL surgery

①First visit reservation using the online booking form
Please select your desired date and time.
②Receive an email confirmation of first appointment reservation
③Initial indication examination with limited wearing of contact lens
Do not wear soft contact lenses for 2 days before your examination, and stop wearing hard- or continuous wear contact lenses for 2 weeks before your examination.
In order to check if you are eligible for surgery, we will examine your eyes and also check for eye diseases. You will not be able to drive a car after the eye examination (the pupil is dilated with eye drops and then examined). You may ask questions or concerns you may have to us and our Ophthalmologists who are certified by the Japanese Ophthalmologist Society or one-on-one counseling.
④Re-examination to determine ICL lens power
It is an important examination to ensure visual acuity after surgery. Please continue to stop wearing contact lenses before taking this re-examination.
⑤Antibiotic eye drops for surgery
Please use eye drops from 3 days before surgery. It is important to use eye drops in order to prevent infections.
⑥On the day of surgery
Contact lenses can be worn until the day before surgery, but please visit us wearing glasses on the surgery day. You can go home alone without attendants, but you cannot see clearly after the surgery, and you will sense a type of foreign matter in your eyes and have teary eyes, therefore, please go home early and rest your eyes. Eye drops are very important on the day of the surgery, so use them carefully.
⑦Examination of the next day after surgery
When getting up in the morning, there is almost no sense of foreign matter, and your vision will be quite clear. Please start your eye drops as soon as you get up. Please visit us at the reservation time.

ICL Surgery Costs

Surgery details
Costs
<Expert plan>

Surgery by expert instructor

  • Hole ICL - Without astigmatism:730,000 yen (tax inclusive)
  • Hole ICL - With astigmatism:830,000 yen (tax inclusive)
  • Bifocal contact lens - Without astigmatism:880,000 yen (tax inclusive)
  • Bifocal contact lens - With astigmatism:980,000 yen (tax inclusive)
  • LaserICL-Additional options:60,000 (tax inclusive)
<Specialist plan>(New plan)

Surgery by experienced ICL certified doctors

  • Hole ICL - Without astigmatism:580,000 yen (tax inclusive)
  • Hole ICL - With astigmatism:680,000 yen (tax inclusive)
Common to all plans
The charge is the same regardless of the power of the lens.
※Half price for one eye.
※a deposit of 300,000 yen is required.
※costs are not covered by Japan's National Health insurance.
Price list for 60 installments in the case of ICL surgery costs are 730,000 yen Price list for 60 installments in the case of ICL surgery costs are 730,000 yen

※For those who wish to apply for a medical loan, please notify us by the second pre-surgical medical examination.

Warranty period
Expert plan: 3 years
Specialist plan: 1 years - 3 year warranty option +50,000 yen(tax inclusive)
Supplementary Surgery
<Lens replacement>
Within the warranty period:size and power of lenses can be replaced once free of charge.
After the warranty period:50% of regular charge.(Specialist plans are standard cost)
<Lens removal>
Within the warranty period:free
After the warranty period:removal only is 100,000 yen for one time
* Free for those who undergo cataract surgery at our hospital
<LASIK additional correction>
Within the warranty period:free
After the warranty period:regular charge
Postoperative
examination
Recommended the day after surgery / 1 week / 1 month / 3 months / 6 months / 1 year, and every year thereafter (after the warranty period ends, 10,000 yen per examination).

Merits and Demerits

Merits

■ICL can correct myopia, hyperopia, astigmatism
For LASIK surgery, the Japanese Ophthalmological Society Refractive Surgery Guidelines go up to the 10D level Literature 8. Because ICL surgery involves implantation of a wide range of prescriptions of the ICL, it corrects severe nearsightedness and farsightedness as well as astigmatism. The lens standard power of CL is + 6.0D to -18.0D for hyperopia to myopia and 0.5 to 6.0D for astigmatism, which is much wider than contact lenses and can be used by most people.
■As you can go home after the day of surgery, you can return to work and life as soon as possible
ICL surgery is a day surgery that does not require hospitalization. Vision is hazy and blurry on the day of surgery, but it becomes quite clear the day after surgery; therefore, people with clerical work such as desk work can return to work the day after surgery.
■Highly accurate correction and long-term stability of vision
ICL provides the same level of accuracy as a conventional soft contact lens. The patient will enjoy stable, quality vision for the long term, without the risk of visual regression.
■Reduce postoperative complications and unclear night vision problems
A smaller corneal incision (approximately 3 mm) reduces the risk of postoperative side effects such as dry eye. In addition, ICL causes less problems with night vision such as halos and glare caused by higher-order aberrations (distortion of corneal surface) associated with LASIK surgery Literature 4-6are further ameliorated by the new EVO+ Vision ICL model (with an enlarged optical zone).
■Lens is removable in the unlikely event of problems
In the absence of particular problems, the ICL implant is considered semi-permanent. However, should any problems arise following the surgery, the ICL can be removed and the patient’s vision restored to its condition prior to the surgery and the patient can continue to use glasses or contact lenses for vision correction.

Demerits

■Cost of surgery is relatively high
Because the ICL is ordered to exactly fit your eye, its cost is higher than other corrective eye surgeries. Please note that ICL orders cannot be refunded.
■Long waiting period before surgery
Surgery will be performed as soon as the ordered lens arrives. Surgery can be performed 3 weeks after the test at the earliest, but depending on the lens’s power, you may need to wait for 2 - 3 months.
■Halo, glare, and circle of light
After the surgery, you may experience a mild halo or glare or circle of light. This should virtually disappear within a month after the surgery.
■In rare cases, additional treatment may be required after ICL surgery
If the power and size of the lens do not match after ICL surgery, it may be necessary to replace the lens, and for ICL with astigmatism, it may be necessary to readjust the axis of astigmatism of the lens after surgery (see FAQ for details).
■The importance of pre-surgical and post -surgical care
With ICL surgery, pre-surgical and post -surgical are is critical because of the fact that the prosthetic lens is placed in the eye. Though the instance of infection associated with an ICL procedure is extremely rare (approximately 1 in 6,000 cases), it is important to follow instructions on the use of eye drops and to note any other precautions indicated.

Comprehensive pre-surgical
and post-surgical care system

  • CARE 1

    CARE1 Preoperative examination and examination by an ophthalmologist certified by the Japanese Ophthalmological Society
    Preliminary screening and examination by a Japanese Ophthalmological Society-certified doctor
    Each patient is first given a comprehensive screening to assess refraction and visual acuity as well as corneal shape, anterior chamber depth, fundus of the eye, etc. These results are then examined by an experienced Japanese Ophthalmological Society-certified doctor, who will determine whether the patient is a candidate for ICL, or not, to determine what type of surgery is best for you.
  • CARE 2

    CARE2 exhaustive counseling
    Detailed counseling
    Based on the results of screening procedures and an examination by a physician, a specialist counselor will meet one-to-one with the patient to answer any questions and help to alleviate any doubts or concerns.
  • CARE 3

    CARE3 Thorough preoperative examination
    Thorough pre-surgical medical examination
    A more detailed examination follows to decide on the patient’s postoperative visual acuity, in which the size and prescription of the ICL is determined. The patient will be informed of the date scheduled for their operation once the ICL delivery date is confirmed.
  • CARE 4

    CARE4 consistent surgery
    The surgical procedure
    Surgery takes approximately 5 minutes for both eyes. Following the procedure, the patient rests for 20-30 minutes, after which time the patient is given an exam to assess refraction and intraocular pressure. If there is no problem with the examination, you can go home.
  • CARE 5

    CARE5 Long-term aftercare
    Long-term follow-up care
    Our clinic offers a comprehensive follow-up care program, which includes regular post-surgical examinations, to help ensure the patient’s vision is stable for the long-term.

Related ICL videos

Explanations of main visual appeal

(*1) Please check here for expert instructor license.

(*2) Surgery time is the time from making an incision to lens insertion, cleaning, and incision closure.

(*3) Clinical Ophthalmology "Knowing International Standards! Forefront of Myopia Treatment"

(Document 16) Kitazawa Yoshihiro「手術手技のコツ」眼科手術 Vol.37 No.4 2024 In print