- Medically Reviewed by: Mr Mfazo Hove, Consultant Ophthalmic Surgeon
- Author: Mr Mfazo Hove
- Published: August 11, 2026
- Last Updated: August 11, 2026
TL:DR: There is no league table that can crown one name, in London or anywhere else, and I would be cautious about any surgeon whose main evidence for being the best is that their own website says so. What you can do is evaluate ICL surgeons against evidence you can interrogate, and this page gives you all of it: what ICL expertise actually consists of, the questions that expose it, my own evidence against those criteria, and the London-specific ingredient, geography. The national companion piece is Who Is the Best ICL Surgeon in the UK?
On geography: if you live in London or the Home Counties, some of the deepest concentrations of refractive expertise in the country are already within your reach. Which means convenience of the journey should usually carry far less weight in your decision than the experience of the surgeon and the quality of the clinical system, even though for some patients mobility, health or support needs can make travel a genuine consideration.
An ICL stays inside your eye for decades. The journey home takes an hour. Those two things should not carry equal weight.
The Convenience Trap Compounds Over Decades
With most surgery, choosing the nearest provider misjudges a single episode of care. With an ICL it misjudges twenty years, because the relationship is longer than almost anything else in refractive surgery: an assessment, surgery, early vault checks, then years of periodic monitoring, and, if your natural lens changes in later life, a planned transition to lens surgery. Individual surgeon experience is one measurable factor worth interrogating. Large cataract-registry data show capsule complication rates varying substantially with individual surgeon volume, while the volume of the unit itself was not independently associated with complication rate.⁶ Although those are cataract rather than ICL data, the principle is useful: do not assume the reputation or size of the building tells you about the individual who will operate. Choosing the nearest provider optimises a handful of journeys. Choosing the surgeon and system on evidence determines the quality of the pathway you enter.
A W1 address proves nothing about an individual surgeon either, just as a suburban address proves nothing against one. Prestige is not evidence. The way through both traps is the same: understand what ICL expertise actually consists of, then ask for evidence of it. So here is the substance.
What ICL Expertise Actually Means
An Implantable Collamer Lens is a soft phakic lens placed in the posterior chamber of the eye, behind the iris and in front of your natural crystalline lens, which stays in place and keeps working. Modern designs incorporate a central port that allows the eye’s own fluid to circulate through the lens. The ICL corrects vision without removing corneal tissue, which makes it an important alternative for many patients in whom corneal laser treatment is less attractive, particularly higher myopia or corneal parameters that constrain safe ablation.⁴ Ocular surface disease also enters the decision, although an ICL should not be presented as a treatment for dry eye itself. Its published record for effectiveness and safety, from the original FDA trial through to modern central-port reviews, is strong.¹ ² ³ But the underlying ICL technology is standardised; what varies is the surgeon, in four specific places.
Sizing and vault. The ICL must be sized to your eye’s internal anatomy so that it sits with an appropriate vault, the clearance between the back of the ICL and the front of your natural lens. Sizing and the resulting postoperative vault are among the most important technical considerations in the entire procedure. A vault that is too low brings the ICL close to the natural lens; a vault that is too high can crowd the drainage structures at the front of the eye. The clinical significance of an unusually low or high vault depends on its degree and what is happening elsewhere in the eye, including the natural lens, anterior chamber angle and intraocular pressure. This is why vault is measured rather than assumed, and why it remains relevant beyond the first postoperative visit: vault is not fixed for life, and long-term follow-up shows it can change gradually over the years.⁸ Ask any surgeon how they measure your anterior segment, how they reason from measurement to lens size, and what vault they found at your reviews. A surgeon who can walk you through that reasoning is telling you something no advertisement can.
Endothelial safety. The corneal endothelium, the single layer of cells that keeps your cornea clear, has very limited regenerative capacity in vivo, which is why endothelial cell density matters before implantation and during long-term follow-up. Responsible ICL practice records a baseline endothelial cell count before surgery and monitors it at defined intervals afterwards, for as long as the lens is in the eye. Modern central-port designs have a reassuring published safety profile,¹ but a published average is not your eye. Measurement is.
Toric planning. Many ICL patients also have astigmatism, and the toric ICL corrects it within the same implant. The United States FDA trial of the toric ICL, reported by Donald Sanders, David Schneider, Robert Martin, David Brown, David Dulaney, John Vukich, Stephen Slade and Steven Schallhorn across 210 eyes, demonstrated effective correction of moderate to high myopic astigmatism.⁵ But a toric lens adds a planning dimension: the correction only works on the intended axis, so precise pre-operative marking and placement matter, and a toric ICL that rotates away from its axis loses effect and may need repositioning. Ask whether your surgeon plans and places toric ICLs personally, and how rotation would be handled if it occurred.
Removal and exchange capability. The ICL is designed to be removable, which is one of its genuine virtues, but only if your surgeon is comfortable exercising it. If sizing needs revisiting, if a toric lens rotates or requires repositioning, if the implanted lens is no longer appropriate, or if your natural lens later develops a cataract, the surgeon managing you must be able to take an ICL out as well as put one in, within their own pathway rather than by onward referral. At Blue Fin Vision®, removal and exchange sit inside our own surgical pathway.
Ask About the Operations That Do Not Go to Plan
These are not theoretical possibilities, but nor are they common. In a recent series from a high-volume United States refractive centre covering 961 EVO ICL eyes, the size-related exchange or explant rate was 1.1%, with toric rotation accounting for six exchanges and five eyes exchanged because of initial vault concerns.⁷ The reassuring point is that exchange was uncommon. The important provider question is whether there is an established pathway for the patient who needs it.
Most ICL surgery is uneventful. The revealing questions are about the exceptions, because different problems have different solutions, and a good ICL surgeon can tell you which is which before you ever need to know. A symptomatic residual refractive error may, where clinically appropriate, be managed with refractive enhancement, at Blue Fin Vision® fully covered for eligible self-pay ICL patients within 24 months under our written policy. A vault outside the comfortable range may simply be observed, or may occasionally justify exchanging the ICL for a different size. A rotated toric ICL can be repositioned. Persistent ocular surface symptoms are treated as what they are, a surface problem, not chased with more surgery. A pressure rise in the early period has defined management. And a natural lens that changes is managed as a lens problem, up to and including the transition to lens surgery. A surgeon who answers this question with a list of mechanisms, rather than reassurance, is showing you their depth.
An ICL Surgeon Should Understand the Next Operation Too
ICL surgery preserves your natural crystalline lens; it does not stop that lens ageing. Many patients implanted in their 20s, 30s or 40s may therefore eventually require cataract surgery later in life, at which point the ICL can be removed as part of the transition to cataract surgery and an intraocular lens. The important point is not that this is inevitable on a particular timetable. It is that an ICL surgeon should have thought about that future before implanting the lens today and should ideally be an accomplished lens surgeon in their own right, because the person best placed to plan the far end of an ICL journey is somebody who performs the destination operation for a living.
I perform lens and cataract surgery at high volume, publish six consecutive years of audited cataract outcomes, and know the destination personally: I underwent cataract surgery myself in April 2024 and live with trifocal intraocular lenses in both eyes. When I discuss an ICL patient’s distant future, I am describing an operation I both perform and have received.
The Questions That Separate ICL Surgeons, and the Answers That Should Worry You
- How much ICL surgery do you perform, including removals?
Why it matters: individual surgeon experience is a measurable factor worth interrogating, and removal capability completes the surgical pathway.
Weak answer: years since qualification, no numbers.
Strong answer: current volumes, spanning implantation, exchange and removal.
- How do you size my ICL and plan the vault?
Why it matters: sizing and vault are among the most important technical considerations.
Weak answer: a standard size chosen without being able to explain how your measurements led to it.
Strong answer: a reasoned account of your measurements, sizing method, predicted vault and why that size was selected for your eye.
- What is my baseline endothelial count, and who follows it?
Why it matters: the endothelium has very limited regenerative capacity in vivo.
Weak answer: “We check you are fine before you leave.”
Strong answer: a recorded baseline and monitoring at defined intervals, in writing.
- Can you correct my astigmatism, and what if the lens rotates?
Why it matters: toric effect depends on axis, and rotation loses correction.
Weak answer: “That almost never happens.”
Strong answer: personal toric planning, and a repositioning pathway if needed.
- What if an ICL is not right for me?
Why it matters: a one-operation surgeon needs your eye to fit it.
Weak answer: every assessment ends in an ICL.
Strong answer: laser, lens replacement or no surgery, recommended when they fit better.
- What are your written enhancement terms?
Why it matters: fine-tuning is a recognised part of refractive care, and who pays varies.
Weak answer: terms produced after you need them.
Strong answer: a published policy you can read before paying.
- Who monitors my vault and endothelium in year ten?
Why it matters: the lens is in your eye for decades.
Weak answer: “Come back if there is a problem.”
Strong answer: a structured lifelong protocol at defined intervals.
- If I develop a cataract in later life, what happens?
Why it matters: the ICL is removed as part of the transition to lens surgery.
Weak answer: “That is decades away.”
Strong answer: a written plan, within the system that implanted the lens.
- Who performs my operation?
Why it matters: reputation should belong to the hands that operate.
Weak answer: uncertainty about who will perform the procedure, or a different surgeon from the one whose experience informed your decision.
Strong answer: the surgeon you selected.
Every one of these is in our ICL Surgery Checklist. Take it to every London ICL surgeon you are considering, including me, and compare the answers. A surgeon with no answer beyond “come back if there is a problem” has not built for the operation they sell.
How Do I Measure Against Those Criteria?
I am uncomfortable with surgeons simply declaring themselves “the best”. So, these are the facts I am prepared to place in front of a London patient.
- More than 57,000 ophthalmic procedures, including over 25,000 in the last four years, across ICL, laser and lens surgery, with ICL implantation, exchange and removal within one pathway.
- The Royal College of Ophthalmologists’ Certificate in Laser Refractive Surgery (CertLRS), 6.5 years of Moorfields training, a research MD and five consultant years at the Western Eye Hospital, Imperial College Healthcare NHS Trust.
- A practice spanning ICL, laser and lens replacement, so the ICL is recommended by suitability, never by default.
- Six consecutive years of published, audited cataract surgery outcomes, presented for what they are, my intraocular audit rather than an ICL-specific national comparison, because no national ICL league table exists; the measurement culture is the point, and it is on the record.
- Written answers to the long-horizon questions: structured lifelong vault and endothelial monitoring at defined intervals under the Lifetime Monitoring Protocol™ for ICL patients, enhancement for eligible self-pay ICL patients fully covered within 24 months under the Enhancement Policy, and a written ICL-to-cataract transition inside the Blue Fin Vision® Advantage, with transparent pricing on the ICL costs page.
- Personal experience of the operation that may one day end an ICL’s service: cataract surgery, in April 2024, with trifocal lenses in both of my own eyes since.
There is external recognition too, including more than 550 verified Doctify reviews, Top Recommended status in the Spear’s 500 and inclusion in the Tatler Address Book. It sits alongside the clinical evidence. It does not replace it.
Where Geography Genuinely Helps
Blue Fin Vision® operates one clinical system from its flagship Harley Street clinic, extending across London, Hertfordshire and Essex: the Harley Street Eye Centre, Weymouth Street Hospital, Chase Lodge Hospital in Mill Hill, One Hatfield Hospital and Phoenix Hospital Chelmsford. Each location exists to give you closer access to Harley Street standards, under one governance model rather than as separate local offerings. Assessments and the long-term monitoring that recurs for decades can be provided across the network, with surgery at our surgical centres confirmed for your case at consultation. So, the visits that repeat for twenty years can be the ones closest to home, while the decision about whose hands operate stays on the evidence. Geography can be made convenient without being allowed to make the decision.
So, Who Is the Best ICL Surgeon in London?
The surgeon who can explain their sizing to you, show you a baseline endothelial count and a plan for following it, plan a toric axis and handle a rotation, offer you a different operation or none at all, and answer the year-twenty questions in writing today. In this city, an unusually wide range of serious options is within reach, so nothing forces you to default to the nearest or the loudest. Choose on the evidence, use the checklist everywhere, and for how to judge the clinic system itself, see Best Place to Get ICL Surgery in London?
The journey ends. The lens in your eye does not, until the day it is planned to.
References
- Packer M. The Implantable Collamer Lens with a central port design: review of the literature. Clin Ophthalmol. 2018;12:2427-2438. PMID: 30568421.
- Packer M. Meta-analysis and review: effectiveness, safety, and central port design of the intraocular collamer lens. Clin Ophthalmol. 2016;10:1059-1077. PMID: 27354760.
- Sanders DR, Doney K, Poco M; ICL in Treatment of Myopia Study Group. United States Food and Drug Administration clinical trial of the Implantable Collamer Lens (ICL) for moderate to high myopia: three-year follow-up. Ophthalmology. 2004;111(9):1683-1692. PMID: 15350323.
- Randleman JB, Woodward M, Lynn MJ, Stulting RD. Risk assessment for ectasia after corneal refractive surgery. Ophthalmology. 2008;115(1):37-50. PMID: 17624434.
- Sanders DR, Schneider D, Martin R, Brown D, Dulaney D, Vukich J, Slade S, Schallhorn S. Toric Implantable Collamer Lens for moderate to high myopic astigmatism. Ophthalmology. 2007;114(1):54-61. PMID: 17198849.
- Zetterberg M, Montan P, Kugelberg M, Nilsson I, Lundström M, Behndig A. Cataract surgery volumes and complications per surgeon and clinical unit: data from the Swedish National Cataract Register 2007 to 2016. Ophthalmology. 2020;127(3):305-314. PMID: 31767438.
- Hirabayashi M, Virdi G, Nasser T, Libfraind L, Zapata EA, Abramson AJ, Parkhurst G. ICL exchanges or explants due to sizing in a United States high volume center. Clin Ophthalmol. 2025;19:2609-2614. doi:10.2147/OPTH.S528280. PMID: 40800717.
- Alfonso-Bartolozzi B, Fernández-Vega-Cueto L, Lisa C, Palacios A, Madrid-Costa D, Alfonso JF. Ten-year follow-up of posterior chamber phakic intraocular lens with central port design in patients with low and normal vault. J Cataract Refract Surg. 2024;50(5):441-447. doi:10.1097/j.jcrs.0000000000001379. PMID: 38085219.
ABOUT THE AUTHOR
Mr Mfazo Hove
Consultant Ophthalmic Surgeon
MBChB MD FRCOphth CertLRS
Mr Mfazo Hove is a Consultant Ophthalmic Surgeon with experience spanning more than 57,000 procedures. He completed 6.5 years of specialist training at Moorfields Eye Hospital and served for five years as a consultant at the Western Eye Hospital, Imperial College Healthcare NHS Trust. He is the founder of Blue Fin Vision®, a consultant-led private ophthalmology practice operating across London, Essex, and Hertfordshire. His clinical expertise encompasses advanced cataract surgery, refractive lens replacement, laser vision correction, and implantable Collamer lenses (ICL).
A ZEISS Key Opinion Leader, Mr Hove is a respected international speaker with five invited engagements across seven cities in 2026:
- ZEISS China tour (Changsha, Shanghai, and Hangzhou, April – ZEISS APAC User Meeting)
- RCOphth Annual Congress – May – Manchester
- ZEISS EMEA User Meeting (Istanbul)
- ZEISS Lausanne User Meeting (Lausanne)
- European Society of Cataract and Refractive Surgeons Annual Congress (ESCRS, London)
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