TL;DR/Summary:
- Neither ICL nor LASIK is universally riskier; suitability determines safety
- LASIK suits moderate prescriptions with sufficient corneal thickness
- ICL is safer for thin corneas or prescriptions above 900 degrees
- Each procedure carries distinct, manageable risks
- A pre-surgery evaluation is essential before deciding
In Singapore, both LASIK surgery and implantable contact lens (ICL) surgery are popular refractive surgery options for those seeking a long-term and permanent vision correction. A frequently asked question – is ICL surgery riskier than LASIK surgery? The answer is more nuanced: both procedures are safe when performed on suitable eyes, but each has its own benefits and presents different types of risks, rather than one being universally riskier than the other.
What is LASIK?
LASIK (Laser-Assisted In Situ Keratomileusis) uses a precise excimer laser to remove corneal tissue from the front part of the eye, reshaping the cornea so that light can focus properly on the retina for clear vision without the use of glasses and contact lenses.
Those who have moderate myopia, hyperopia, or astigmatism, with sufficient corneal thickness and stable eye prescription (at least in the past 12 months), are typically good candidates for LASIK surgery.
Some common LASIK concerns include:
Dry eye: Most people will experience some dry eye during the immediate post-op recovery period, which is mostly temporary. Most eyes will return to the pre-surgery state 1 to 3 months post-surgery.
Flap issues: As LASIK involves creating a thin corneal flap, people are naturally concerned about flap complications/dislodgement. With the IntraLase bladeless technology, flap-related issues are rare. It is also very uncommon for the flap to be dislodged after 1 month. Many people have enjoyed contact and extreme sports without any complications after LASIK surgery.
Under- or over-correction: This is a common post-surgery concern and is always a possibility with all forms of laser vision correction, including ReLEx SMILE, epi-LASIK, and TransPRK. Some people may require an enhancement surgery to sharpen their vision, though in the hands of an experienced LASIK surgeon, the enhancement rate is usually low.
What is ICL?
ICL surgery involves the insertion of a soft, biocompatible lens inside the eye, between the iris and the natural lens. It works together with your natural eye structures to focus light correctly for clear vision.
In most cases, ICL surgery is recommended in lieu of LASIK when the corneas are thin. This is so as, unlike LASIK, there is no corneal tissue removal in ICL surgery. Hence, ICL surgery is a safer surgical option for those with thinner corneas to eliminate the risk of ectasia, a serious complication post-LASIK where the cornea is thinned out too much and bulges forward, causing loss of vision progressively.
ICL surgery is also recommended for those with very high eye prescriptions – more than 900 degrees. In such cases, ICL surgery can provide a better quality of vision post-surgery compared to LASIK.
Is ICL surgery riskier than LASIK surgery?
Instead of determining which is riskier, it is more meaningful and accurate to ascertain which is more suitable for your eyes. Each procedure has its pros and cons.
LASIK-specific risks include temporary dry eye, temporary night vision disturbances (haloes, glare, starburst), flap-related complications, and under-/over-correction. These risks are generally low and manageable, especially with modern laser technology, surgical techniques, and careful and thorough pre-surgery evaluation.
ICL-specific risks include being a more invasive procedure, early formation of cataract, inappropriate lens size selection, and increased eye pressure. Modern ICL designs, though, have significantly reduced these risks compared to earlier generations.
Why is ” risk ” dependent on a person’s suitability?
A procedure is only “risky” when it is performed on an eye that is not suitable based on the condition and eye anatomy. It is risky to perform LASIK surgery on a person with a very thin and irregularly shaped cornea. Likewise, it is risky to perform ICL surgery on a person who has a very shallow anterior chamber depth.
Hence, a pre-surgery evaluation/assessment is imperative as surgical suitability is determined by the following factors:
- Corneal thickness
- Level of eye prescription
- Corneal shape
- Anterior chamber depth
- Overall health of the eye
When is ICL surgery a safer or more suitable procedure than LASIK surgery?
ICL is often recommended in place of LASIK surgery when:
- The corneas are thin: Not ideal, as LASIK surgery may remove too much tissue
- The eye prescription is very high: ICL provides a better quality of vision and predictability
- People do not want a procedure that removes corneal tissue: ICL preserves the natural corneal structure without removing anything from the eye
In some of the above instances, LASIK surgery may present higher relative risks.
When is LASIK surgery the simpler option?
LASIK surgery is an excellent refractive surgery option and remains one of the most popular and commonly performed procedures for many people who are seeking independence from glasses when:
- Refractive errors are moderate (less than 900 degrees): A high level of predictable results
- The corneal shape is suitable, and there is sufficient corneal thickness: A good level of safety
- One prefers laser vision correction: No implanted or additive lens inside the eye
It is also generally a less invasive procedure, and the procedure is faster and simpler.
ICL vs LASIK recovery and comfort
Recovery period
- LASIK: Fast vision recovery and improvement within 1 to 2 days
- ICL: Vision stabilises over several days to a week
Dry eye
- LASIK: Higher incidence of temporary dry eye
- ICL: Not much associated with dry eye symptoms as an additive procedure
Visual expectations
- LASIK: Fast to regain good vision, though fluctuations may occur during the first 3 months
- ICL: Slightly slower vision recovery, but it very often offers excellent vision quality, especially in high prescriptions of over 900 degrees
Follow-up visits
- LASIK: Requires fewer visits, usually about 3 to 4 post-op visits, and is discharged thereafter
- ICL: After initial standard post-op visits, recommended to visit once every 1 or 2 years to check on intraocular pressure, lens positioning, and the natural lens’s health
ICL vs LASIK cost in Singapore
Why does ICL cost more?
ICL involves ordering a customised lens to implant into the eye;, the lens itself has a high cost to it, which results in higher surgery fees compared to laser-based LASIK.
What is included in an ICL surgery quotation?
- The implantable contact lens
- Surgeon fees
- Consumables
- Operating theatre fee
Why should price not be the main determining factor when choosing which procedure to opt for?
Choosing a procedure based on cost alone can lead to sub-optimal surgical outcomes. Long-term safety and outcome should always be of utmost priority.
What happens during an ICL or LASIK evaluation?
A comprehensive pre-surgery assessment determines the safest and most suitable option.
- Corneal assessment – Thickness and shape are measured
- Anterior chamber depth – Measured to as it is important for ICL sizing and safety
- Refractive stability and retinal review – Determines prescription is stable in at least the last 12 months and screens for retinal issues, especially those with high myopia
How does the surgeon decide between LASIK, ReLEx SMILE, Epi-LASIK, and ICL surgery?
The decision is based on a combination of factors:
- Eye anatomy
- Level of refractive error
- Lifestyle, professional, and visual needs
- Risk profile
Who should specifically ask about ICL?
You may want to discuss ICL in more detail with your surgeon if you are a high myope, have very high astigmatism (above 500 degrees), have thin corneas, or have been rejected for LASIK surgery previously. In such cases, ICL is not just merely just an alternative but rather a safer and better surgical option.
Final thoughts
The above article has explained that ICL surgery is not necessarily more risky than LASIK surgery. Comparatively, though, ICL surgery is considered more invasive because it involves placing a lens inside the eye, but it is not inherently more dangerous when performed on suitable eyes. Its risks are mostly carefully managed with modern techniques and proper pre-surgery eye tests.
To summarise, the safest method is not choosing the “least risky procedure” but opting for the right procedure that suits the specific eye. A one-on-one consultation with an experienced ophthalmologist in Singapore will help you find a surgical option that balances safety, efficacy, and long-term visual quality.
To schedule an evaluation for ICL or LASIK surgery, please contact Lang Eye Centre at +65 6684 1000 or [email protected].
