This page is for patients considering ICL surgery who want to understand whether the implant is permanent, what secondary interventions may be needed over a lifetime, and how ICL interacts with the natural ageing of the eye.
ICL Is Designed for Permanent Implantation
The EVO Visian ICL is not a temporary device. Published ten-year follow-up data shows stable vault measurements, stable refraction, and stable endothelial cell counts in the vast majority of implanted eyes.¹ ² The lens itself does not degrade, does not lose refractive power, and does not require replacement as part of its normal lifecycle. The question of whether an ICL “needs replacing” is almost always answered: no.
What changes over time is not the ICL but the eye around it. Three scenarios are worth understanding clearly, because patients often conflate them, and this conflation is almost never addressed proactively at ICL consultations elsewhere.
Three Scenarios Patients Commonly Confuse
Scenario 1: Presbyopia. From the mid-40s, the natural crystalline lens loses its ability to accommodate, reading vision gradually requires correction. This occurs regardless of whether the patient has an ICL, LASIK, or unaided eyes. The ICL corrects distance prescription; it does not prevent the natural ageing of the lens that causes presbyopia. Reading glasses from mid-40s in an ICL patient are not a failure of the ICL, they are normal ageing.³
Scenario 2: Cataract. If the natural crystalline lens develops significant opacity in later decades, it requires removal and replacement with an intraocular lens, exactly as in a non-ICL patient. The ICL is removed at the same operation and the IOL is implanted. This is a planned procedure, not a complication, and is the “exit strategy” that makes ICL uniquely flexible among refractive procedures.
Scenario 3: Vault change. Occasionally, vault measurements drift outside the safe range over years of monitoring. If vault falls too low, the ICL can be repositioned or exchanged for a different power.⁴ This is rare in published series but is the reason annual monitoring is non-negotiable.
Who This Is Not For
This page is not a substitute for the ICL aftercare review schedule. Patients who have had ICL surgery and are experiencing new symptoms, blurring, halos, or visual change, should contact Blue Fin Vision® for a review rather than relying on this page to interpret their symptoms. Any new visual change in an ICL patient warrants assessment.
Clinical Perspective
At Blue Fin Vision®, Mr Mfazo Hove describes ICL to every patient as a permanent correction with a built-in exit strategy. In our practice, no patient has required ICL exchange for optical reasons across eight years of consecutive ICL implantation, a figure consistent with published ten-year EVO ICL data showing stable refraction and vault in the vast majority of implanted eyes. The monitoring programme is not a sign of uncertainty; it is the mechanism by which that record is maintained. If the natural lens develops cataract in later decades, the ICL is removed at the time of lens surgery, a planned procedure, not a complication.
Clinical Takeaway
The EVO Visian ICL is designed for permanent implantation. Vault and refraction are stable in published ten-year series. Presbyopia from the mid-40s is normal ageing, not a failure of the ICL. If cataract develops in later decades, the ICL is removed at the time of lens surgery, a planned procedure, not a complication. Annual vault monitoring is the long-term commitment that makes this safety record possible.
References
- Packer M. Meta-analysis and review: effectiveness, safety, and central port design of the intraocular collamer lens. Clin Ophthalmol. 2016;10:1059–1077.
- Igarashi A, Kamiya K, Shimizu K, Komatsu M. Visual performance after implantable collamer lens implantation and wavefront-guided laser in situ keratomileusis for high myopia. Am J Ophthalmol. 2009;148(1):164–170.
- Pesando PM, Ghiringhello MP, Di Meglio G, Fanton G. Posterior chamber phakic intraocular lens (ICL) for hyperopia: ten-year follow-up. J Cataract Refract Surg. 2007;33(9):1579–1584.
- Alfonso JF, Baamonde B, Fernandez-Vega L, Fernandes P, Gonzalez-Meijome J, Montes-Mico R. Posterior chamber collagen copolymer phakic intraocular lenses to correct myopia: five-year follow-up. J Cataract Refract Surg. 2011;37(5):873–880.
