- Medically Reviewed by: Mr Mfazo Hove, Consultant Ophthalmic Surgeon
- Author: Mr Mfazo Hove
- Published: January 4, 2025
- Last Updated: October 15, 2026
TL;DR: After ICL surgery (implantable collamer lens surgery), you need early post-operative reviews followed by annual long-term monitoring for as long as the implant remains in your eye. At Blue Fin Vision®, endothelial cell counts are taken before surgery, at three months and twelve months, then annually. Long-term monitoring is included in the cost of surgery under the ICL Lifetime Monitoring Protocol™, with no subscription and no expiry.
An implanted lens is not a completed procedure. It is the beginning of a measurement relationship that lasts the life of the implant.
Why Lifelong Check-ups Matter After ICL Surgery
- Vault changes over time. The gap between the ICL and your natural lens tends to reduce gradually over the years as the natural lens grows.¹ Too little space increases the risk of cataract; too much can affect eye pressure.
- Endothelial cells do not regenerate. These cells line the inner surface of the cornea, the clear front surface of your eye. They are counted before surgery and tracked afterwards, so any unexpected loss is seen early.²
- Eye pressure can rise in the early weeks, usually as a response to steroid drops, and is checked at every visit.³
- The natural lens is examined for early clouding, which is more likely the longer an ICL has been in place and the later in life it was implanted.⁴
Reviews of modern central-port ICLs, lenses with a small central opening that allows fluid to flow through, report low adverse event rates and emphasise careful measurement of the eye before and after surgery.⁵ None of these changes can be felt. All of them can be measured.
In Mr Hove’s 2024–25 series, 100% of vault measurements at one week were within the target range; lifelong monitoring exists to detect changes and guide timely review.
Three Questions Monitoring Answers
What Could Change Without Affecting My Vision At First?
The vault, the endothelial cell count, eye pressure and early clouding of the natural lens can all change while your vision still feels perfect.
How Will A Meaningful Change Be Recognised?
Every measurement is compared with your own baseline, the measurements recorded before or soon after surgery, and your previous results, as well as with our defined thresholds. A result within the normal range can still warrant attention if it has moved unexpectedly for you.
What Can Be Done If A Change Occurs?
The response is matched to the finding. Options include:
- A closer review or more frequent checks.
- Further investigation.
- Treatment to control eye pressure.
- Repositioning or exchange of the ICL.
- Removal of the ICL.
- Cataract surgery through our pre-priced pathway.
Your Check-up Schedule At Blue Fin Vision® Eye Clinic
The First Year
Following a three-year audit in which routine same-day pressure checks and day-one reviews did not change management, Blue Fin Vision® revised its follow-up protocol.
At our eye clinic, your consultant contacts you the day after surgery, with an examination arranged whenever clinically indicated.
Pain, headache, nausea or blurred vision require urgent assessment.
Your routine examination schedule is:
- One week: your first routine examination.
- One month: a follow-up review.
- Three months: a further review.
- Twelve months: a consultant review.
All these reviews are included in your ICL surgery fee.
From Twelve Months, For Life
The ICL Lifetime Monitoring Protocol™ begins:
What Is Measured | How Often |
|---|---|
Endothelial cell count, measured by specular microscopy, a non-contact scan that counts the cells lining the inner surface of the cornea. Performed at Harley Street. | Before surgery, at three months and twelve months, then annually for as long as the ICL remains in the eye. |
ICL vault, measured using anterior segment optical coherence tomography (OCT) and Pentacam imaging, scans that provide detailed images of the front of the eye. Available at any clinic. | Annually. |
Eye pressure, slit-lamp examination, a detailed examination using an illuminated microscope, and refraction, a check of your prescription. | At every visit. |
Written monitoring report comparing your results with your own baseline. | After every visit. |
The Nidek specular microscope used for endothelial cell counts. The scan is non-contact and takes moments per eye.
If your measurements show faster change than expected, you move onto a schedule of more frequent checks.
What Happens If A Measurement Moves
Consultant review is triggered, at no additional cost, when:
- Vault falls outside our 250 to 750 micrometre target range on two successive measurements, or drifts significantly from your baseline. Micrometres are units used to measure these very small distances.
- Your endothelial cell count trends below 2,000 cells per square millimetre, or falls faster than expected for your age.
- Any new lens opacity, meaning clouding of the natural lens, or refractive drift, meaning a change in your prescription, suggests early cataract.
Options then include closer monitoring, ICL exchange, ICL removal or our pre-priced Post-ICL Cataract Surgery Pathway.
What The Protocol Does Not Cover
It covers monitoring and the consultant reviews that monitoring triggers.
The following are outside its scope:
- Routine consultations without a monitoring trigger.
- Eye conditions unrelated to the ICL.
- Travel costs.
We publish those boundaries because a promise without limits is not a protocol.
Between Visits
Contact us straight away if you notice pain, increasing redness, a sudden drop in vision or new, persistent haloes, rings around lights. Urgent concerns are prioritised clinically, irrespective of billing.
If you live far from our clinics, ask about monitoring through a named local partner, with results returned to your consultant for comparison with your measurements over time.
For more information about recovery and follow-up:
- Read our ICL recovery page.
- Read our ICL surgery checklist, which asks every provider what happens after the final post-operative review.
Book a consultation with Blue Fin Vision® to discuss ICL surgery and the long-term monitoring included in your care. Our consultant-led UK team provides care across London, Hertfordshire and Essex.
References
- Schmidinger G, Lackner B, Pieh S, Skorpik C. Long-term changes in posterior chamber phakic intraocular collamer lens vaulting in myopic patients. Ophthalmology. 2010;117(8):1506-11. doi:10.1016/j.ophtha.2009.12.013.
- Goukon H, Kamiya K, Shimizu K, Igarashi A. Comparison of corneal endothelial cell density and morphology after posterior chamber phakic intraocular lens implantation with and without a central hole. Br J Ophthalmol. 2017;101(11):1461-5.
- Senthil S, Choudhari NS, Vaddavalli PK, Murthy S, Reddy JC, Garudadri CS. Etiology and management of raised intraocular pressure following posterior chamber phakic intraocular lens implantation in myopic eyes. PLoS One. 2016;11(11):e0165469. doi:10.1371/journal.pone.0165469. PMID: 27855172.
- Choi JH, Lim DH, Nam SW, Yang CM, Chung ES, Chung TY. Ten-year clinical outcomes after implantation of a posterior chamber phakic intraocular lens for myopia. J Cataract Refract Surg. 2019;45(11):1555-61. doi:10.1016/j.jcrs.2019.06.015. PMID: 31587936.
- Montés-Micó R, Ruiz-Mesa R, Rodríguez-Prats JL, Tañá-Rivero P. Posterior-chamber phakic implantable collamer lenses with a central port: a review. Acta Ophthalmol. 2021;99(3):e288-e301. doi:10.1111/aos.14599.
ABOUT THE AUTHOR
Mr Mfazo Hove
MBChB MD FRCOphth CertLRS
Consultant Ophthalmic Surgeon | Founder and Medical Director, Blue Fin Vision®
Mr Mfazo Hove is a Consultant Ophthalmic Surgeon with more than two decades of experience across NHS and private practice and more than 57,000 ophthalmic procedures performed. He trained for six and a half years at Moorfields Eye Hospital and served for five years as an NHS consultant at the Western Eye Hospital, Imperial College Healthcare NHS Trust.
He specialises in cataract surgery, refractive lens replacement, laser vision correction and implantable Collamer lenses (ICL). He is the founder and Medical Director of Blue Fin Vision®, a private ophthalmology group providing consultant-delivered care across London, Hertfordshire and Essex. His cataract surgery outcomes are publicly reported through the National Ophthalmology Database.
A ZEISS Key Opinion Leader and international speaker, Mr Hove is a contributing author to The Ophthalmologist. His writing examines how clinical governance and the organisation of ophthalmic services shape patients’ experiences and outcomes, with a focus on transparent outcome reporting, surgical training and long-term accountability for patient care.
