The Evolution of ICL Surgery: Refining Vision Correction Toward Perfection

The history of Implantable Collamer Lens (ICL) surgery is a story of ongoing improvement, driven by scientific breakthroughs, surgical advances, and many years of clinical experience. From early insights in aviation to today’s advanced phakic lens technologies, EVO ICL has become a leading option for vision correction.

Summary

ICL technology has progressed from early PMMA-based intraocular lenses to advanced posterior chamber designs, culminating in EVO models that improve safety and remove the need for iridotomy. STAAR’s Visian ICL and EVO ICL lines introduced key milestones (V4 FDA approval, V4c/EVO central port, EVO+ larger optic), while anterior chamber options like Artisan/Artiflex require iridotomy with potential long-term risks. BGSS Eye Clinic has led Korean ICL innovation since 2002, pioneering V-Toric ICL to enhance stability and astigmatism correction in collaboration with STAAR. The newest EVO Viva ICL adds presbyopia correction, underscoring BGSS’s commitment to precision, safety, and superior outcomes.

Early Discoveries That Changed Ophthalmology

The origins of ICL surgery date back to the 1940s, when researchers observed during wars that acrylic plastic (PMMA) fragments from aircraft canopies could remain in the eye without causing inflammation or rejection. This discovery marked a significant milestone in ophthalmology: the first intraocular lens (IOL) implantation using PMMA.

In 1953, the first phakic intraocular lens was introduced, placed in the anterior chamber (in front of the iris). Although revolutionary, early designs had limitations that encouraged further innovation. By the 1980s, posterior chamber IOLs, positioned behind the iris, had been developed, paving the way for modern ICL surgery.

The Birth and Evolution of the Visian ICL

A significant turning point occurred in 1990 with the development of the prototype ICL (V1). In 1993, STAAR Surgical released its first posterior chamber phakic IOL, later branded as the Visian ICL. Over the following years, the lens underwent continuous improvements, including refined positioning marks, adjustments to the optic diameter and vault, and an enhanced overall design to increase safety and stability. During this time, other phakic lens options also appeared.

Opthec introduced the Artisan/Verisyse iris-fixed lens, first implanted in 1986 and rebranded in 1997. In 2004, the foldable Artiflex lens was introduced. Although these anterior chamber lenses gained widespread use, they required an iridotomy, a procedure that creates small holes in the iris to allow aqueous humor flow. Over time, clinical experience has shown that these openings can narrow, potentially raising intraocular pressure and increasing the risk of glaucoma.

BGSS: Leading the Advancement of ICL in Korea

Seoul | Busan BGSS Eye Clinic began offering ICL surgery in Korea in 2002 and has since led the field. CEO Dr. Jong-Ho Lee was designated Korea’s first official ICL instructor and has achieved among the highest ICL case volumes nationwide, earning numerous academic and clinical awards.

In 2005, the Visian ICL V4 received FDA approval, marking a new chapter in international acceptance. The significant breakthrough occurred in 2010 with the launch of the V4c (EVO) ICL, which features a central port that eliminates the need for iridotomy. This feature simplified surgery, improved long-term stability, and significantly reduced postoperative risks. Soon after, EVO+ ICL was released with a larger optic diameter, further improving visual results.

Rethinking Toric ICL: The Birth of V-Toric Surgery

With the introduction of the Toric EVO ICL and EVO+ ICL, higher degrees of astigmatism can be corrected. However, traditional horizontal lens placement carries an inherent risk of rotation, which can compromise astigmatic correction accuracy. To address this, surgeons often chose larger lenses, but this increased the risk of elevated intraocular pressure and endothelial cell loss.

In 2020, CEO Dr. Jong-Ho Lee and senior surgeon Dr. Je-Myung Lee pioneered the V-Toric ICL surgical method at Seoul BGSS. Based on extensive clinical experience, this innovative technique places toric lenses vertically, using gravity to improve lens stability and reduce rotational risk.

Through a global collaboration with STAAR Surgical, toric lenses optimized for vertical placement are now available at BGSS, differing from conventional horizontally placed toric ICLs. This advancement marks a significant step toward precise, stable correction of astigmatism while protecting long-term ocular health.

The Latest Innovation: EVO Viva ICL

STAAR Surgical continues to advance ICL technology with the launch of the EVO Viva ICL, which is intended to correct presbyopia in addition to myopia and astigmatism. BGSS Eye Clinic is proud to be the first clinic in Korea to perform EVO Viva ICL surgery, offering a new option for patients in their mid-40s and older who want clear vision at all distances without the need for reading glasses.

A Commitment to Precision and Patient Safety

The development of ICL is not just about new lens designs; it reflects decades of knowledge, surgical advances, and a dedication to patient outcomes. At BGSS Eye Clinic, innovation is driven by experience, and every advancement is carefully focused on patient safety and visual quality. As ICL technology continues to advance, BGSS remains dedicated to shaping the future of vision correction, fine-tuning each detail, one lens at a time.

Q&A

Question: How did ICL technology evolve from its early beginnings to today’s EVO models?

Short answer: The path began in the 1940s when PMMA fragments from aircraft canopies were found to be biologically tolerated in the eye, leading to the first PMMA intraocular lenses. In 1953, the first phakic IOLs were placed in the anterior chamber, and by the 1980s, posterior chamber designs (behind the iris) emerged, setting the stage for modern ICLs. STAAR Surgical developed a prototype ICL in 1990 and released its first posterior chamber phakic IOL in 1993, which was later branded as the Visian ICL. Continuous refinements followed—improving positioning marks, optic diameter, vault, and overall safety. Key milestones include FDA approval of the V4 in 2005, the V4c (EVO) central port in 2010, eliminating iridotomy, and the EVO+ larger optic for enhanced visual quality.

Question: Why is the EVO (V4c) central port significant, and how does it compare with anterior chamber lenses like Artisan/Artiflex?

Short answer: The EVO (V4c) ICL introduced a central port that allows natural aqueous humor flow, removing the need for a separate iridotomy. This simplification improves surgical efficiency and long-term stability and reduces postoperative risk. In contrast, anterior chamber iris-fixated lenses such as Artisan/Verisyse and Artiflex require iridotomy; with time, those openings can narrow, potentially elevating intraocular pressure and increasing glaucoma risk. EVO ICL’s design advances address these concerns while maintaining the benefits of posterior chamber placement.

Question: What problem does the V-Toric ICL technique solve, and how does vertical placement help?

Short answer: Traditional horizontally placed toric ICLs can rotate, degrading the precision of astigmatism correction. Surgeons sometimes selected larger lenses to counter rotation, but this approach increased risks, such as increased intraocular pressure and endothelial cell loss. Pioneered at Seoul BGSS in 2020 by Dr. Jong-Ho Lee and Dr. Je-Myung Lee, the V-Toric ICL technique places toric lenses vertically, using gravity to improve stability and reduce rotational risk. Through collaboration with STAAR Surgical, BGSS now uses toric lenses optimized for vertical placement, enhancing accuracy and long-term ocular safety.

Question: What role has BGSS Eye Clinic played in advancing ICL in Korea?

Short answer: Since 2002, Seoul | Busan BGSS Eye Clinic has led Korean ICL practice. CEO Dr. Jong-Ho Lee became Korea’s first official ICL instructor, accumulating one of the nation’s highest case volumes and earning multiple academic and clinical awards. BGSS pioneered the V-Toric ICL vertical placement method in 2020 and collaborates globally with STAAR to bring vertically optimized toric lenses to patients. The clinic consistently emphasizes precision, safety, and visual quality across evolving ICL technologies.

Question: What is the EVO Viva ICL, and who is it designed for?

Short answer: EVO Viva ICL is STAAR Surgical’s latest advancement that addresses presbyopia in addition to myopia and astigmatism. It offers clearer vision at all distances, making it a new option for patients in their mid-40s and older who want to reduce dependence on reading glasses. BGSS Eye Clinic is the first in Korea to perform EVO Viva ICL surgery, extending its commitment to innovation and superior outcomes.

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