10 Questions to Ask Your Doctor Before Deciding on Phakic ICL Surgery

What Is Phakic ICL?

Phakic ICL is a refractive surgery technique that uses an ultra-thin, highly flexible implantable lens placed directly inside the eye, positioned behind the iris and in front of the natural crystalline lens. However, because it is an intraocular procedure involving the internal structures of the eye, deciding whether to undergo surgery requires thorough understanding and careful preparation.

10 Questions You Should Ask Your Doctor Before Deciding on Phakic ICL Surgery

To help you take control of your journey toward clearer vision, this article summarizes the 10 most important questions you should ask your ophthalmologist before deciding to undergo Phakic ICL surgery. Save this checklist and bring it with you to your upcoming comprehensive eye examination.

1. Am I Truly a Suitable Candidate for Phakic ICL?

This is always the first—and most important—question to ask your ophthalmologist after completing your comprehensive preoperative evaluation. Not everyone with high myopia or a desire to eliminate glasses is eligible for this procedure. To determine whether you are an ideal candidate, your ophthalmologist will carefully evaluate a combination of highly specific ocular biometric parameters, including:

• High myopia, astigmatism, or hyperopia that has remained stable (no increase greater than 0.50 diopters within the previous six months).
• Anterior chamber depth (ACD) should measure at least $2.8mm$ to $3.0mm$ to ensure there is sufficient space for safe lens implantation.
• Corneal endothelial cell density must fall within the safe range for your age (typically >2,000–2,500 cells/mm²) to help maintain long-term corneal clarity.
• A comprehensive assessment of the anterior chamber angle, peripheral retina, and the clarity of the natural crystalline lens.

If any of these parameters do not meet the required criteria, your ophthalmologist may advise against Phakic ICL surgery to minimize the risk of complications such as elevated intraocular pressure or corneal endothelial damage.

2. Why Do You Recommend Phakic ICL Instead of LASIK or SMILE Pro?

When visiting a refractive surgery clinic, you’ll likely hear about several vision correction technologies. Asking this question helps you understand why your eye anatomy may be better suited to an implantable lens rather than laser-based corneal procedures.

Why Does My Doctor Recommend Phakic ICL Instead of LASIK or SMILE Pro?

In most cases, your ophthalmologist may recommend Phakic ICL for one or more of the following reasons:

• Your cornea is too thin or has an abnormal shape: Laser procedures require removal of corneal tissue. If your cornea is naturally thin, laser treatment may weaken its structural integrity and increase the risk of corneal ectasia.
• Your myopia or astigmatism is too severe: Laser procedures have safe treatment limits (typically up to approximately -10.00 diopters of myopia), whereas Phakic ICL can correct up to approximately -18.00 diopters of myopia and 6.00 diopters of astigmatism.
• You wish to preserve your natural corneal structure: Phakic ICL does not remove corneal tissue or alter the cornea’s natural curvature, preserving its biomechanical strength.
• You want to minimize the risk of postoperative dry eye: Unlike LASIK, Phakic ICL does not disrupt the corneal nerve plexus, making it an excellent option for patients with pre-existing chronic dry eye.

3. What Level of Vision Can I Expect After Surgery?

Ask your ophthalmologist to provide realistic expectations based on scientific evidence and your individual eye condition, including:

• What is the best visual acuity I can realistically achieve? Is it possible to reach 20/20 vision—or even better?
• After surgery, will I still need prescription glasses for specialized tasks such as night driving, graphic design, or reading fine print?

Your ophthalmologist will explain that the maximum vision achieved after Phakic ICL implantation is generally comparable to—or even better than—the vision obtained with properly fitted contact lenses before surgery. If you have a history of amblyopia, retinal damage caused by high myopia, or congenital retinal disorders, your doctor will also explain the realistic visual limits that surgery can achieve, helping you develop appropriate expectations.

4. Do My Eyes Have Any Risk Factors That Could Increase the Chance of Complications?

Eye After Phakic ICL Implantation Surgery

No medical procedure is completely risk-free. A qualified ophthalmic surgeon will always discuss your individual risk factors honestly and thoroughly. Be proactive and ask whether your eyes have any underlying conditions that may increase the likelihood of complications, such as:

• Retinal degeneration or an abnormally thin retina.
• Elevated intraocular pressure (IOP) or a risk of glaucoma (Your ophthalmologist should carefully evaluate these conditions to select the most appropriate ICL design with optimal aqueous humor flow.)
• Systemic medical conditions (Autoimmune diseases, diabetes, or blood disorders may delay wound healing and affect postoperative recovery.)

5. How Is My Phakic ICL Lens Selected?

An ICL is not a mass-produced product. Each lens is custom ordered and individually selected for each patient’s eye. Ask your ophthalmologist to explain the lens selection process, including:

• Which diagnostic devices are used to calculate the lens size and refractive power? (For example, corneal topography and high-frequency ultrasound biomicroscopy (UBM) to measure the anterior chamber angle.)
• How long does it take to order a custom lens from Switzerland (manufactured by STAAR Surgical)?
• In the rare event that the implanted lens is not an ideal fit (too tight, causing elevated intraocular pressure, or too loose, causing lens rotation), what is the hospital’s protocol for managing the situation or replacing the lens?

6. How Long Does the Surgery Take, and What Will I Experience?

Fear often comes from uncertainty. Understanding each step of the surgical procedure can help you feel much more confident and relaxed. Ask your ophthalmologist to briefly walk you through what to expect on the day of surgery:

• Procedure time: Phakic ICL surgery is very quick, typically taking only 10–15 minutes per eye.
• Pain level: Most patients experience little to no pain, only mild pressure while the surgeon inserts the lens into the eye.
• Anesthesia: The procedure is usually performed using topical anesthetic eye drops only. Patients remain awake throughout the surgery and simply follow the surgeon’s instructions, such as looking at the operating microscope light.
• Hospital stay: This is an outpatient procedure. After surgery, you will rest in the recovery area for approximately 1–2 hours while your intraocular pressure is checked before you are discharged on the same day.

7. What Activities Should I Avoid After Phakic ICL Surgery, and For How Long?

Postoperative care accounts for a significant portion of long-term surgical success. Rather than asking general questions, request a clear recovery timeline tailored to your lifestyle and work routine.

• When can I use a computer or smartphone normally again? (Most patients can resume light screen use after 1–2 days, provided they follow the 20-20-20 rule.)
• When can I shower and wash my hair normally? (Water should generally be kept out of the eyes for the first 3–7 days to reduce the risk of infection.)
• When can I wear eye makeup or eyelash extensions? (Typically after at least 2 weeks to 1 month.)
• When can I resume swimming, basketball, gym workouts, or other vigorous sports? (Swimming is usually postponed for about one month, while contact sports should generally be avoided for 1–3 months.)
• When can I drive at night or travel by airplane? (Night driving is recommended only after any mild halos or glare have stabilized. Air travel is generally safe a few days after surgery once intraocular pressure has normalized.)

8. What Is My Postoperative Follow-up Schedule?

Regular follow-up is essential to ensure that the implanted lens remains well-positioned and compatible with your eye. Understanding the follow-up schedule will also help you plan your work and personal commitments. A standard postoperative follow-up schedule typically includes:

1. Day 1: Examination of intraocular pressure, lens position, and the surgical incision.
2. Week 1: Assessment of visual recovery and evaluation for intraocular inflammation.
3. Month 1: Comprehensive eye examination, including measurement of the vault (the distance between the ICL and the natural crystalline lens).
4. Months 3–6 and annually thereafter: Monitoring of corneal endothelial cell density and overall ocular health.

Tip: If you live far from the surgical center, ask your ophthalmologist whether follow-up visits after the first month can be performed at a reputable ophthalmology clinic closer to your home.

9. If My Vision Changes or I Develop Eye Problems in the Future, Can the Phakic ICL Be Removed or Replaced?

This is one of the greatest advantages of Phakic ICL compared with laser vision correction procedures. Ask your ophthalmologist to explain the procedure’s reversibility in detail:

• If, 10 or 20 years from now, you develop age-related cataracts, your surgeon can remove the Phakic ICL through a small incision before performing standard cataract surgery with implantation of an artificial intraocular lens.
• If your myopia continues to progress over the years, the existing lens can be removed and replaced with a new lens that provides more appropriate refractive correction.

10. What Does the Total Treatment Cost Include?

Phakic ICL is a premium refractive procedure and represents a significant financial investment. Therefore, it is important to have complete transparency regarding the overall cost. Ask whether the quoted price is an all-inclusive package or whether additional charges may apply, such as:

• Are the comprehensive preoperative examination, corneal topography, and biometric measurements included in the package, or billed separately?
• Does the quoted price include the imported Phakic ICL lens and the surgeon’s professional fee?
• Are postoperative medications—including antibiotics, anti-inflammatory eye drops, and artificial tears for the first month—covered by the surgical package?
• Are routine follow-up visits during the first 6–12 months included, or will additional consultation fees be charged?

Conclusion

Choosing to undergo vision correction surgery is a life-changing decision. Equipping yourself with the right knowledge and discussing these 10 essential questions with your ophthalmologist before undergoing Phakic ICL surgery will not only help you determine the most appropriate treatment option, but also build a trusting, collaborative relationship with your surgeon. We wish you a smooth journey toward clearer vision and greater visual freedom.