In the field of vision correction, LASIK (Laser-Assisted In Situ Keratomileusis) has been a popular option since the late 1990s for those looking to free themselves from the constraints of glasses or contact lenses. However, as with any surgical procedure, LASIK is not without its risks and side effects. While the vast majority of people have excellent results, some experience problems such as dry eye (mostly older women and those in peri-menopause/menopause) and issues with night vision similar to contact lenses. Enter Staar Surgical’s EVO ICL (Implantable Collamer Lens), a relatively new to the USA and increasingly popular alternative that addresses many of the concerns associated with LASIK. In this blog, we’ll explain how EVO ICL can reduce or eliminate some of the issues of LASIK and why it’s becoming the preferred choice for many individuals seeking permanent vision correction.

Understanding LASIK and Its Side Effects

LASIK is a procedure that reshapes the cornea with an extremely precise laser. The cornea is the clear dome of collagen tissue that overlies the colored iris of our eye. This laser reshaping allows light to be properly focused onto the retina, thereby improving vision. The surgery has been effective for millions of people annually worldwide, helping them achieve 20/20 vision or better. However, the process is irreversible and has limitations. LASIK is most suited for young people in their 20s and early 30s with mild to moderate (under -6.00) amounts of nearsightedness. For older patients, the issue of reading glasses is not yet completely solvable without the RLE procedure. Dryness also increases in women, and as we age and produce fewer tears, which makes contact lenses more difficult to wear satisfactorily.

One of the most common side effects of LASIK is dry eyes. The procedure involves creating a laser flap in the cornea, which can disrupt the corneal nerves responsible for tear production. Many patients experience temporary dryness post-surgery as the eye is healing, but for some, it becomes a chronic issue, leading to discomfort and the need for artificial tears or other treatments.

Another significant concern with LASIK is night vision problems, which are very similar to vision with contact lenses. Some patients report seeing halos, glare, or starbursts around lights, particularly in low-light conditions. This is why this author strongly recommends taking a “mental snapshot” of your vision in dim light and after dark when you have your contact lenses in your eyes and remember that you have glare with contacts also. Imperfect night vision is present before and after vision correction, as well as with contacts and glasses. Glare is mostly due to dryness, and possibly from some residual prescription, which sometimes necessitates a laser touch-up called an enhancement. Glare tends to increase with increasing degrees of nearsightedness and is very uncommon in mild/moderate nearsightedness.

Regression can be another issue. While 96% of people achieve perfect 20/20 or better (about 78% can see the better 20/15 uncorrected) vision immediately after LASIK, some experience a gradual slipping back to slight nearsightedness. This is about 1% per year who need a laser touch-up. So in 5 years it’s about 1 of 20, and 10 years it’s about 1 of 10 who have needed a touchup laser.

In about 1 of 10,000 people, a condition called “ectasia” can occur where the cornea stretches outward slightly (not visibly) and may make vision blurry or distorted. There is a treatment for this condition called Corneal Cross-Linking, which may stop progression, but it may not reverse the condition. We also perform this procedure at SHARPEVISION SEATTLE-BELLEVUE.

What is EVO ICL?

EVO ICL is an advanced form of vision correction that involves the implantation of a lens inside the eye, between the iris and the natural lens. Unlike LASIK, EVO ICL does not involve altering the cornea. The lens is made from a biocompatible material called Collamer, which is designed to work harmoniously with the eye. The procedure is reversible, which means the lens can be removed or replaced if necessary.

The EVO ICL lens provides a permanent solution for correcting nearsightedness, with or without astigmatism. It is especially beneficial for those who have thin corneas, dry eyes, or other conditions that make them poor candidates for LASIK.

How EVO ICL Addresses the Side Effects of LASIK

One of the key advantages of EVO ICL over LASIK is its ability to avoid many of the side effects associated with corneal reshaping. Here’s how:

1. No Corneal Alteration, No Dry Eyes

Since EVO ICL does not involve the LASIK flap or reshaping the cornea, it significantly eliminates the risk of dry eyes due to the procedure (lots of people have dry eyes without any surgery). The procedure leaves the corneal nerves intact, preserving the eye’s natural ability to produce tears. For individuals who already suffer from dry eyes or are concerned about developing this condition, EVO ICL offers a compelling alternative.

2. Enhanced Night Vision

All forms of vision correction, whether it be glasses, contacts, or LASIK/PRK/EVO ICL, will have some degree of glare, haloes, or starbursts in the patient’s perception of their vision. This is almost always in low-lighting conditions such as dusk or night time. The degree of dissatisfaction is related to a number of factors, including your degree of nearsightedness, your pupil size, your ocular surface dryness, your natural lens (cataract spectrum), and method of vision correction as well as patient expectations, level of observation, and vocational needs. There is ample evidence that in higher degrees of myopia, (above -6.00), EVO ICL delivers less glare, haloes, and starbursts. One phenomenon that happens with the EVO ICL is that there is a “ring-like dysphotopsia” which means there’s a ring around lights, due to the small hole in the center of the EVO ICL. The hole is necessary to allow fluid pressure regulation. The ring does seem to be innocuous, in that virtually everyone seems to get used to it and not be bothered by it after a few weeks or months. Because EVO ICL does not change the shape of the cornea, it preserves the eye’s natural light-processing capabilities. This means a lower likelihood of experiencing halos, glare, or starbursts around lights at night, making EVO ICL a better option for those who are more highly nearsighted, drive at night frequently, or have occupations that require optimal night vision.

3. Reversibility and Flexibility

One of the most appealing aspects of EVO ICL is its reversibility. Unlike LASIK, where the changes to the cornea cannot be reversed, the EVO ICL lens can be removed or replaced if necessary. This provides a safety net for patients, offering peace of mind that they can potentially opt for a different solution in the future, if their vision needs change.

4. Stable, Long-Lasting Vision

Vision regression is a concern for some LASIK patients, particularly as they age. Since EVO ICL does not rely on altering the corneal structure, the results tend to be more stable over time. The lens provides a long-lasting correction that remains effective for distance vision, even as the natural aging process affects vision up-close, a condition called presbyopia which affects us all at about age 45+. Additionally, because the lens is removable, adjustments can be made if the patient’s vision changes due to presbyopia or other age-related conditions. The lens can easily be removed when the patient needs cataract surgery, which is about 70 years old, give or take a few years.

5. Safety for Thin Corneas

Patients with thin corneas are often deemed unsuitable for LASIK because the procedure requires sufficient corneal thickness to create the flap and reshape the cornea safely. This occurs in about 5% of patients seeking vision correction surgery. EVO ICL, on the other hand, does not involve corneal thinning, making it a viable option for those who would otherwise be disqualified from LASIK. This expands the pool of candidates who can achieve clear vision without the need for glasses or contact lenses. Alternatively, about 5% of patients don’t have enough room in their eyes for the EVO ICL to be safely placed and so PRK would be the best option. This is we do a free comprehensive exam to measure these variables and recommend which procedure is best for you.

Why EVO ICL is the Future of Vision Correction

The advantages of EVO ICL over LASIK are not just limited to the absence of side effects; they extend to a broader range of benefits that make it a superior choice for many individuals.

1. Customization and Precision

EVO ICL lenses are custom-made to fit each patient’s eye, ensuring a precise correction tailored to their specific vision needs. There are 4 different diameters of lenses to allow for different anatomy of the patient. There are 8 different astigmatism amounts from -1.00 to -4.00, and nearsighted correction from -3.00 up to -15.00 by half diopter steps. This level of customization leads to better visual outcomes and higher patient satisfaction. The lens is designed to correct a wide range of prescriptions, including those with high levels of nearsightedness that LASIK may not adequately address. A word on EVO+. EVO+ is the term for the slightly larger size of the optic of the lens. In the USA, the “plus” was dropped, because all the lenses have the larger size up to -12. Above -12, the lens optic must be made in the previous slightly smaller optic because the edges become too thick to allow the bigger optic.