Why high myopia needs a different conversation
Myopia above -6D or -7D presents a dilemma for refractive surgeons. Standard LASIK removes corneal tissue to flatten the cornea - but there is a limit to how much can safely be removed. Beyond a certain threshold (typically a residual stromal bed below 250 - 280 microns), LASIK risks corneal ectasia: a progressive thinning and bulging of the cornea that can cause severe, irreversible vision loss.
ICL - the Implantable Collamer Lens (specifically EVO Visian ICL) - bypasses this limitation entirely. Instead of reshaping the cornea, a thin, foldable lens is placed behind the iris in front of the natural crystalline lens. The cornea is untouched.
Key rule of thumb: If your myopia is above -8D, your cornea is thin (<500 microns), or your corneal topography shows any irregularity, ICL is likely the safer and more effective option. Your refractive surgeon will determine this at a free consultation with corneal mapping.
ICL vs LASIK: side-by-side comparison
| Factor | LASIK / Contoura | ICL (EVO Visian) |
|---|---|---|
| Myopia range | Up to -10D (cornea-dependent) | -3D to -18D |
| Astigmatism | Up to -5D | Up to -6D (toric ICL) |
| Corneal tissue removed | Yes | No |
| Reversibility | Irreversible | Fully reversible |
| Dry eye impact | Can worsen dry eye | No impact on tear film |
| Recovery | 24 - 48 hours | 24 - 48 hours |
| Night vision quality | Excellent (Contoura) | Excellent |
| Cost at Eye Veda | Rs 25,000 - Rs 65,000/eye | Rs 85,000 - Rs 1,10,000/eye |
| Minimum age | 18 years | 21 years |
| Stable prescription needed | Yes (≥1 year) | Yes (≥1 year) |
When to choose ICL over LASIK
Your surgeon will recommend ICL when any of the following apply:
- High myopia (above -8D to -10D) - insufficient corneal tissue remains after ablation
- Thin corneas - even moderate prescriptions may exhaust safe tissue limits
- Dry eye disease - LASIK severs corneal nerves, often worsening dryness for 6 - 12 months; ICL does not
- Irregular corneal topography - forme fruste keratoconus or suspicious maps contraindicate LASIK
- Large pupils - ICL maintains superior optics in low-light conditions for large pupil diameters
How ICL surgery works at Eye Veda
Pre-operative assessment includes AS-OCT or UBM to precisely measure the anterior chamber depth and sulcus-to-sulcus diameter. This determines the correct ICL size - critical for preventing elevated intraocular pressure or lens touch.
On the day of surgery, drops are instilled to dilate the pupil and anaesthetise the eye. A 2 - 3 mm incision is made at the corneal periphery and the folded ICL is injected into the anterior chamber, where it unfolds and is positioned behind the iris. The procedure takes 15 - 20 minutes per eye. No stitches are required.
What to expect after ICL surgery
Most patients notice dramatically improved vision within the first day. The lens does not require any maintenance - no cleaning, no solutions. UV protection is built into the EVO ICL material (CollaFlex hydrophilic collagen co-polymer). Routine follow-up is at 1 day, 1 week and 1 month.
The risk of cataract formation is approximately 1% over a 10-year period with modern EVO ICL designs, which have a central aqueous port (KS-Aquaport) maintaining natural aqueous flow without the need for pre-operative iridotomy.
The verdict
For patients with moderate myopia (-3D to -6D) and healthy, thick corneas, LASIK or Contoura Vision is an excellent choice. For anyone above -8D, or where corneal data is borderline, ICL is not just an alternative - it is often the superior option, delivering comparable visual quality without touching the cornea and with the safety net of reversibility.
The right answer depends on your specific corneal measurements, not just your prescription number. Eye Veda’s refractive surgeons run a comprehensive assessment at no cost before recommending either pathway.
