Vault – the axial distance between the posterior surface of the ICL and the anterior surface of the natural crystalline lens – is the single most critical anatomical parameter in ICL surgery. Its significance is not a technical footnote: it is the primary variable that determines long-term lens safety and the risk of the two most serious ICL-specific complications.
Insufficient vault creates chronic mechanical contact between the ICL and the crystalline lens, disrupting anterior lens epithelial metabolism and initiating the opacification process that produces anterior subcapsular cataract. ¹ ² Excessive vault displaces the iris anteriorly, impairs aqueous circulation, and may precipitate pupil block with acute elevation of intraocular pressure. ³
The target vault range for EVO Visian ICL implantation is generally 250–750 microns, though individual surgeons may define slightly different parameters based on their own series. What matters for the patient is not simply knowing the target – it is understanding what happens if the measured result falls outside it. Surgeons with genuine ICL experience will have a defined protocol: this may include lens exchange for a different size, peripheral iridotomy, or watchful observation with accelerated follow-up.
At Blue Fin Vision®, vault measurement is performed at every post-operative visit. The surgical plan always includes a documented vault target range and a prespecified management strategy for out-of-range outcomes. Patients should ask this question and expect a specific, pre-planned answer rather than a general reassurance.
References
- Gonvers M, Bornet C, Othenin-Girard P. Implantable contact lens for moderate to high myopia: relationship of vaulting to cataract formation. J Cataract Refract Surg. 2003;29(5):918–924. PMID: 12765773.
- Sanders DR. Anterior subcapsular opacification with the implantable contact lens. J Refract Surg. 2003;19(4):415–422. PMID: 12916486.
- Igarashi A, Shimizu K, Kato S, Kamiya K. Posterior chamber phakic intraocular lens and corneal endothelium: 5-year follow-up. J Cataract Refract Surg. 2009;35(3):488–492. PMID: 19251139.
Related Topics
- ICL Surgery Checklist
- Are You on the GMC Specialist Register for Ophthalmology?
- Does Your Surgeon Hold the CertLRS Qualification?
- How Many ICL Procedures Has Your Surgeon Performed?
- Can You Show Me Your Refractive Outcome Data?
- Is Surgery Performed in a Proper Hospital Theatre with Laminar Airflow?
- What Is My Pre-Operative Endothelial Cell Count?
- How Often Will ECC and Vault Be Monitored, and Is This Included?
- What Vault Are You Targeting?
- Does the Clinic Have Access to Laser Eye Surgery for Enhancement?
- Which ICL System and Calculator Do You Use?
- What Happens If I Develop a Cataract Within Two Years?
- What Is the Arrangement If Cataract Develops Between Two and Ten Years?
- Have You Performed Cataract Surgery in an Eye with an Existing ICL?
- How Do You Manage Biometry Calculations in Post-ICL Eyes?
- What Happens If My Myopia Continues to Progress?
- At What Level Would Enhancement Be Considered?
- When After Surgery Would Enhancement Be Performed?
- Who Performs the Enhancement – the Same Consultant?
- Is Laser Enhancement Included in the Price?
- Is Sedation Available, and What Does It Cost?
- Is Oral Diazepam Available for Anxious Patients?
- What Is the Minimum Stay Required Near the Clinic?
- Will You Identify a Named Local Ophthalmologist Before Surgery?
- How Will Annual Vault and ECC Monitoring Be Arranged If I Live Far Away?
