Implantable Collamer Lens (ICL) surgery actually has quite a long history. It was developed in the 1980s, before LASIK (laser in situ keratomileusis) was first reported in 1990. The director general of Sanno Eye Center, Dr. Kimiya Shimizu , was the first doctor in Japan to introduce the ICL procedure in 1997. After clearing a series of clinical trials in 2002, ICL surgery was approved by the Ministry of Health, Labor and Welfare in 2010. However, conventional ICL surgery interfered the circulation of aqueous humor (flow of clear fluid in the eye), and consequently there was a risk of 1~2% of patients developing cataracts.
Dr. Shimizu devised and developed the Hole ICL (ICL KS-AquaPORT) surgical procedure of opening up a miniscule hole in the center of the lens to eliminate the complication of cataracts. Then in 2007, he successfully performed the world’s first lens implant. Dr. Shimizu’s Hole ICL surgery improves the circulation of aqueous humor, and subsequently reduces the risks of cataracts developing. It is now approved in over 70 countries around the world as a global standard surgical procedure.

ICL is a reversible procedure; the lens can be easily removed if the patient is experiencing any post-operative discomfort or complications, and the eye is returned to its preoperative state. ICL is also suitable for a wide range of prescriptions. In LASIK surgery, a high level of myopia (near-sightedness) requires a considerable amount of the cornea to be shaved off, which makes the procedure more difficult. Consequently, there is a larger degree of post-operative error and the myopia may reoccur, or the patient could develop dry eyes as a result of the surgery. Also, once the cornea has been shaved it cannot be restored to its preoperative state.
In contrast, ICL surgery uses the same procedure to implant a single lens in the patient’s eye, irrespective of the prescription range; so the surgery has the same level of difficulty for all levels of myopia. Also, even if the patient develops cataracts after ICL surgery, he/she can still be treated with conventional cataract surgery.

Refractive Surgery

Currently, refractive surgery is performed in the following three ways.

• Laser surgery to
  correct the cornea

  PRK, LASIK

• Implanting an ICL
  in the eye

  Implantable Collamer Lens (ICL) surgery

• Replacing the crystalline lens with an artificial lens

  Cataract surgery

Differences with and advantages over LASIK

• No post-operative special care required

  Post-operative care only requires regular eye checks, and there is no need for daily maintenance such as washing the lens to keep it clean. The ICL does not become dirty or move around while in the eye.

• Wide range of lenses available

  The ICL prescription range covers a high level of myopia (near-sightedness) and hyperopia (far-sightedness), and includes a 6D lens for strong astigmatism (blurred vision). ICL is also suitable for a wider range of prescriptions than LASIK surgery can treat.

• No shaving of the cornea

  Once the cornea has been shaved, it cannot be restored to its original thickness. Unlike LASIK surgery, ICL surgery does not require the cornea to be shaved.

• Does not cause dry eyes

  The incisional wound is very small at only 3mm, so it does not cause dry eyes, which can result from an abrasion of the trigeminal nerve on the cornea’s surface. (ICL does not improve the symptoms of people who already have dry eyes.)

• Day surgery that only takes around 20 minutes

  ICL surgery can be performed on both eyes on the same day in about 20 minutes. It does not require any stitches to be put in or removed, and the incisional wound heals naturally.

• Reversible procedure

  The ICL can be taken out if the patient experiences any discomfort, etc.

• Performed by certified ICL surgeons

  Unlike LASIK surgery that even non-certified surgeons can do, ICL is performed by a certified surgeon who is specially trained* in the procedure.

  *In order to acquire certification, a surgeon must learn the procedures in a certified ICL course, and perform an ICL surgery under the supervision of a certified ICL instructor surgeon.

Post-operative results

Hole ICL surgery (ICL KS-AquaPORT®) performed at the Sanno Eye Center and Kitasato University Hospital between 2007 to 2015 292 eyes of 128 patients available for post-implant follow up

Complications

Between 2007 and 2015, we performed Hole ICL surgery on healthy adults (excluding those with external trauma to the eyes and aged 50 years and over), and none of the patients experienced any infections, rise in intraocular pressure or cataracts.
Only two of the patients (four eyes) required any additional surgery, and one (two eyes) of them switched their ICL prescription range . This patient already had presbyopia (age-related long-sightedness), and initially he wished to alleviate the symptoms while allowing for some level of myopia. He later decided to have ICL surgery, as he wanted to see objects in the distance a little more clearly. So it is also possible to switch the ICL prescription range later on, after the initial surgery.