What is ICL: The Definitive Guide to Implantable Collamer Lenses in Japan
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Introduction: What is ICL Surgery in Japan?
The Implantable Collamer Lens (ICL), often referred to as a Phakic Intraocular Lens (IOL), represents a transformative advancement in refractive surgery. Unlike traditional laser procedures that reshape the cornea, ICL surgery involves implanting a thin, biocompatible lens into the eye, between the iris and the natural crystalline lens. This method provides high-definition vision correction while preserving the eye's natural tissue and structure, making it an increasingly popular choice globally.
What does ICL surgery treat?
ICL surgery is primarily used to correct a broad range of refractive errors, offering an excellent solution for patients seeking freedom from glasses and contact lenses. Specifically, it is highly effective for:
Myopia (Nearsightedness): Correcting a vast range of prescriptions, from moderate to severe (high) myopia.
Hyperopia (Farsightedness): Correcting certain ranges of farsightedness.
Astigmatism: Toric ICL models can simultaneously correct co-existing astigmatism.
ICL is often the superior choice, or even the only viable option, for patients with high myopia or those who are disqualified from LASIK due to thin corneas or chronic dry eye.
How common?
While LASIK remains widely known, ICL surgery is a globally accepted and increasingly common procedure. It has been available internationally for over 20 years, with millions of lenses successfully implanted worldwide. Its popularity continues to rise due to its excellent long-term results, high patient satisfaction rates, and the fact that it is reversible (the lens can be removed if necessary), offering an ultimate safety net not available with laser ablation.
Treatment Details
What should I do first? (Preparation)
Preparation for ICL surgery is crucial and begins with a comprehensive, rigorous screening process, particularly important in Japan's meticulous medical environment:
Consultation and Comprehensive Examination: The first step is an in-depth consultation with a specialist to discuss your visual goals and lifestyle. This is followed by a detailed eye examination, including assessment of visual acuity, refraction, and intraocular pressure (IOP).
Biometric Measurements: Specialized diagnostic equipment is used to precisely measure the internal anatomy of your eye, including the Anterior Chamber Depth (ACD) and the White-to-White (WTW) distance (the diameter of the visible iris). These measurements are essential for determining the correct ICL size—the single most critical factor for ensuring long-term safety and optimal vault (the space between the ICL and the natural lens).
Pre-Operative Care: You may be instructed to stop wearing soft contact lenses for a specified period (typically 1–2 weeks) or hard lenses (4–6 weeks) before the final measurement appointments to ensure corneal stability.
What can I expect during surgery?
ICL surgery is a minimally invasive, outpatient procedure that typically takes only 10 to 15 minutes per eye.
Anesthesia: The surgery is usually performed under local anesthesia (eye drops and/or a regional block) to numb the eye completely, often supplemented with mild intravenous (IV) sedation to ensure patient comfort and relaxation. You will be awake but will feel no pain, only slight pressure or sensation.
The Procedure: The surgeon creates a tiny, self-sealing micro-incision on the edge of the cornea. The ICL, which is folded or rolled, is gently inserted through this incision. Once inside the anterior chamber, the surgeon carefully unfolds the ICL and positions its haptics (feet) behind the iris and in front of the natural lens.
Post-Procedure: The micro-incision is often so small that no stitches are required. An eye shield will be placed to protect the eye, and you will rest briefly before being discharged.
What is required after surgery?
The post-operative phase is crucial for ensuring proper healing and optimal placement of the lens.
Medication: You will be given a regimen of anti-inflammatory and antibiotic eye drops that must be used precisely as prescribed to prevent infection and control inflammation.
Follow-up Visits: Multiple follow-up examinations (typically the next day, one week, and one month) are required to monitor the lens position (vault), assess the Intraocular Pressure (IOP), and check for infection or inflammation.
Activity Restriction: You must avoid rubbing the eye, strenuous activities, heavy lifting, and swimming for a period specified by the surgeon. The eye shield must be worn, especially when sleeping, for the first week to prevent accidental trauma.
Risks and Benefits
Benefits
ICL surgery offers several compelling advantages, making it a preferred choice for many seeking permanent vision correction:
High-Definition Vision: ICLs often provide superior visual quality compared to glasses or contact lenses, delivering excellent clarity and contrast, especially for patients with high prescriptions.
Wide Treatment Range: ICL can safely correct much higher degrees of myopia than typically possible with laser surgeries.
Reversibility: The most significant advantage—the lens can be safely removed or exchanged if necessary due to an adverse event or future advances in ophthalmic technology, a safety net unavailable with LASIK.
Preservation of Corneal Tissue: The procedure does not remove any corneal tissue, making it ideal for patients with thin corneas.
Dry Eye Mitigation: ICL does not induce or exacerbate chronic dry eye symptoms to the extent that LASIK can.
Risks
While the procedure is highly safe, as with any surgery, certain risks are involved:
Cataract Formation: If the vault (the space between the ICL and the natural lens) is too small, the ICL can touch the natural lens, accelerating the formation of a cataract. Modern, precise sizing protocols significantly mitigate this risk.
IOP Elevation/Glaucoma: A vault that is too high, or a lens that is incorrectly positioned, can potentially impede the flow of aqueous humor, leading to increased IOP and, rarely, secondary glaucoma.
Infection (Endophthalmitis): A very rare but serious risk. Strict sterile techniques are used to minimize this.
Need for Repositioning: Rarely, the ICL may need to be slightly repositioned if the vault is suboptimal immediately after surgery.
Recovery Course
Visual recovery after ICL surgery is remarkably fast. Many patients notice a dramatic improvement in vision within the first 24 hours. The eye will continue to heal over the first week, but most individuals can return to non-strenuous work within a few days.
General Timeline:
Indication
ICL is generally indicated for patients who meet the following strict criteria (which are often applied more conservatively in Japan):
Age: 18 years or older (many Japanese clinics prefer 21+).
Stable Refraction: Prescription must have remained stable for at least one year.
ACD and ECC: Adequate Anterior Chamber Depth (ACD) and a healthy Endothelial Cell Count (ECC) are mandatory. Japanese protocols adhere to high ECC standards to ensure long-term corneal health.
Ocular Health: Absence of uncontrolled ocular diseases such as severe glaucoma, uveitis, or advanced diabetic retinopathy.
Contraindications to LASIK: Patients with thin corneas, high refractive errors, or severe dry eye often find ICL to be their best solution.
Cost
The cost of ICL surgery typically ranges significantly based on institution location, the surgeon's expertise, the use of Toric ICLs (for astigmatism), and the specific technology employed for pre-operative planning.
In Japan, while the initial cost may be slightly higher than in some neighboring countries, the investment reflects the Japan Standard of care: the use of advanced diagnostic equipment (ex, Anterior Segment OCT), the necessity of multiple precision measurements, the surgeon's high level of specialized training, and a comprehensive, long-term follow-up commitment. Patients are paying not just for the lens, but for the highest assurance of precision and safety available globally.
General Cost Range in Japan (as of mid-2025):
For both eyes, you can generally expect the cost of ICL surgery in Japan to range from approximately ¥800,000 to ¥1,000,000 JPY (Japanese Yen).
Comparison with other refractive surgeries (LASIK)
The choice between ICL and LASIK depends heavily on the patient's individual anatomical profile, prescription severity, and long-term priorities. ICL is consistently the safer and more effective solution for high prescriptions and for patients prioritized by Japanese specialists for their commitment to corneal preservation.
Ready to find out if ICL is your best path to clear vision?
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This article was reviewed by
Dr. Daiki Sakai, MD
