A patient from Santa Barbara recently asked my opinion about ICL surgery.  Unfortunately, some patients are not good candidates for laser vision correction, whether LASIK or PRK. In many cases (such as hers), this is simply because the patient is too extremely nearsighted to fall within the optimal range of LASIK or PRK treatment. One alternative for patients who are not good candidates for LASIK or PRK is the phakic intraocular lens, sometimes referred to as the Implantable Collamer Lens or ICL. Unlike LASIK or PRK, which work only on the outer surface of the eye (and do not enter inside the eye at all), the ICL is a procedure done inside the eye. In the ICL procedure, an “implantable contact lens” (which actually is not truly a contact lens) is inserted inside the eye. It rests above the natural lens and below the iris (colored part) of the eye. The ICL can give truly spectacular visual outcomes but because this is a procedure that goes inside the eye, it is inherently a riskier procedure than LASIK or PRK which stay outside of the eye. This elevated risk compared to LASIK and PRK not only applies to the time of surgery, but potentially places the eye at greater risk even for years after surgery. In order to analyze the long term risks of the ICL, a 10 year study conducted in Switzerland was just published. This study looked at 133 eyes (of 78 patients) who had undergone ICL implantation at one Swiss hospital between 1998 and 2004. The average age of patients at the time of surgery was 39 years old. In 2014, the long term outcomes of these patients were reviewed. Keep in mind that a 10 year study is difficult to conduct as many patients either move or simply do not come back for follow up for other reasons. In this study, 32% were lost to follow up by 2014. 11% of the original group needed cataract surgery by 2014. Additionally, 55% of eyes examined in 2014 had developed some degree of cataracts and 13% had a rise in intraocular pressure, which is associated with glaucoma. These data suggest that patients undergoing ICL are at increased risk for both developing cataracts and glaucoma over long periods of time. This is not the case with LASIK or PRK laser vision correction which, in my experience, are not associated with increasing the risk of cataracts and glaucoma on a long-term basis. While I think there is a niche role for the ICL, I think the patient must fully appreciate the risks associated with it in this and other studies both on a short, and on a long-term, basis. Many of the patients who are so extremely nearsighted that they are not candidates for LASIK or PRK carry such a high degree of visual handicap that they are willing to accept a higher level of risk to improve their quality of life. As with any elective vision correction procedures, the decision to undergo surgery needs to weigh the both risks and benefits.