Last month, I performed refractive lens exchange on a patient named Kathy M., who I had originally implanted with an Implantable Collamer Lens in 2006. She flew in from Honolulu to have the procedure done. She is 63 years old, and her vision is now 20/20 at distance, 20/20 intermediate, and reads at 20/20 in her left eye and 20/25 in her right.
This is her story, and it is the most compelling real-world evidence I can offer for why I recommend EVO ICL™ to so many of my patients.
Why Kathy Chose ICL in 2006
Kathy was 43 years old when she first came to me. Her refractive error was significant: -9.50 -0.75 x 180 in the right eye and -9.25 -0.75 x 175 in the left. That degree of myopia placed her at the upper limit of what LASIK could safely correct, and after a careful evaluation we identified another concern: her corneas, while structurally normal, did not have enough thickness to safely undergo LASIK at her prescription. Removing enough corneal tissue to correct her degree of myopia would have left her at meaningful risk of corneal ectasia, a progressive structural failure of the cornea that can cause permanent vision loss.
We discussed her options at length. The Implantable Collamer Lens, which had received FDA approval in 2005, was the right choice for her anatomy. It did not depend on her cornea. It could safely correct her full prescription. And critically, it was reversible. If anything ever changed, the lens could be removed.
She liked the reversibility, but I will be honest: she did not fully understand at age 43 how important that feature would eventually become. Most patients in their early 40s do not think much about presbyopia or cataracts. Kathy was no exception.
In 2006, we performed YAG laser iridotomies in both eyes two weeks before surgery (this was a standard step for the original Visian ICL, before EVO ICL’s central port eliminated the need). Then I implanted her lenses. She did beautifully.
Twenty Years of Stable Vision
For the next 20 years, Kathy lived her life. She did not need glasses or contacts for distance. She moved from Newport Beach to Honolulu when she retired. She never had a complication. The lenses sat exactly where I placed them, doing exactly what they were designed to do.
Then a few months ago, she called me from Hawaii.
She said she was tired of wearing reading glasses. Like every patient who lives long enough, she had developed presbyopia, and the natural lens inside her eye had begun the slow progression toward dysfunctional lens syndrome and ultimately cataracts. Her optometrist had already found 2+ nuclear sclerosis with trace cortical changes in both eyes. She wanted to know if I could fix her near vision.
My honest recommendation was that she find a qualified refractive surgeon in Honolulu and have the ICL removed and refractive lens exchange performed locally. She did not need to fly across an ocean for this.
Her response was immediate.
“You put these ICLs in my eyes 20 years ago and my vision has been perfect ever since. Now I want to get rid of my reading glasses. Nobody other than you is touching my eyes.”
So she flew back to Newport Beach.
What Happened in the Operating Room
This is the part of the story that matters most for any patient considering EVO ICL today.
Refractive lens exchange in a patient with a previously implanted ICL requires the surgeon to remove the ICL first, then proceed with the lens exchange. Before her surgery, her vision without glasses was still 20/20 in both eyes. Her refraction with the ICLs still in place was +0.50 -0.25 x 180 in the right eye and +0.25 -0.50 x 180 in the left. The ICLs were still doing their job perfectly after 20 years.
I made the incisions, filled the eye with viscoelastic gel, and reached for the ICL with microforceps. The lens floated up to the incision and came out in one smooth motion. From the moment I touched it to the moment it was out of the eye took less than one minute.
Then I inspected it under the operating microscope.
The lens was perfectly clear. No staining. No deposits. No visible defects of any kind. It looked exactly as it had on the day I implanted it in 2006, as if it had just been removed from its original sterile container. After 20 years inside a living human eye, the Collamer material had remained completely biocompatible, completely stable, and completely transparent.
I then proceeded with the refractive lens exchange. We had planned the IOL selection together in advance. In her dominant right eye I implanted a Clareon® Vivity®, an extended depth-of-focus lens that gives sharp distance and intermediate vision with minimal dysphotopsias. In her non-dominant left eye I implanted a Clareon® PanOptix® Pro, a trifocal that delivers a true reading range. The combination is called a “mix and match” strategy, and for the right candidate it can deliver an extraordinary range of functional vision.
Each eye took about 15 minutes. Both eyes were done the same day.
Her Result
At her postoperative visits:
- Distance vision: 20/20 OD, 20/20 OS
- Intermediate vision: 20/20 OD, 20/20 OS
- Near vision: 20/25 OD (Vivity), 20/20 OS (PanOptix Pro)
She is glasses-free for the first time in 50 years.
Is EVO ICL Reversible? What Removal Actually Involves
Kathy’s outcome rests on a feature built into every EVO ICL: it is reversible. The lens sits in the posterior chamber, just behind the iris and in front of the natural lens, resting in position without bonding to or growing into the surrounding tissue. Nothing is sutured or anchored, and the cornea is never reshaped. That is why the lens can be lifted back out through a small incision if your needs ever change.
Removal or exchange is a brief procedure. After numbing drops and light sedation, the surgeon enters through a small opening at the edge of the cornea, gently frees the lens, and lifts it out. Because the lens is not attached to anything, this step is quick, exactly as it was in Kathy’s case. From there the eye can be left in its natural state, fitted with a different lens, or, as happened with Kathy two decades later, prepared for lens-based surgery.
Reversibility in the Broader Evidence
Kathy’s experience is not unusual. In published long-term studies, the implantable collamer lens is removed or exchanged in roughly 4 percent of eyes. In one review of 787 implants, 30 (about 3.8 percent) were explanted, most often simply to exchange the lens for a better-fitting size rather than because of any problem with the eye. A separate ten-year series reported a removal rate of about 4.7 percent. The point is that removal and exchange are established, routine parts of how this lens is managed, not rare emergencies. (Much of this data comes from earlier-generation lenses. The modern EVO design, with its central port, has reduced several of the reasons older lenses were removed.)
There is also a sizing point worth making here. Because incorrect sizing is the most common reason a lens is ever exchanged, getting the size right the first time matters, and modern planning has improved it considerably. I confirm lens sizing with UBM AI™ imaging and the ICLguru® planning platform, which predict where the lens will sit inside the eye before surgery and reduce the likelihood of a size-related exchange. You can read more about how I size every patient in our guide to EVO ICL for high prescriptions.
What This Case Proves About EVO ICL Reversibility
I am writing this case study because Kathy’s story validates something that I tell patients in consultation every single week, and that the EVO ICL clinical literature claims as one of its core advantages: EVO ICL reversibility is not theoretical. It is real, and it matters in ways most patients in their 20s, 30s, and 40s cannot yet imagine.
When Kathy chose ICL in 2006, she did so because her cornea would not have tolerated LASIK at her prescription. The reversibility was a footnote in our conversation. Twenty years later, that footnote became the most important feature of her entire vision journey.
Consider what would have happened if she had somehow undergone LASIK at her prescription in 2006 (in an alternate universe with thicker corneas):
- Her cornea would have been permanently reshaped
- IOL power calculations at the time of cataract or refractive lens surgery would have been less predictable
- Trifocal IOLs like PanOptix Pro, which deliver the highest rates of complete glasses independence, are typically not recommended for post-LASIK eyes due to the optical aberrations the laser leaves behind
- She would likely have been steered toward a monofocal lens or the Light Adjustable Lens, both excellent technologies but neither delivering the same range of vision she got from the Vivity / PanOptix Pro combination
Because she had ICL instead, none of those compromises applied. Her cornea was untouched. The lens calculations were as accurate as they would have been on any unoperated eye. Every premium IOL on the market was available to her. The result is the vision she has today: glasses-free across the full functional range.
This is what we mean when we say EVO ICL preserves your future lens options. It is not marketing language. It is what we observed in this operating room last month.
A Final Thought
Kathy returned to Honolulu with a big SMILE on her face, knowing she had not undergone prior PRK, LASIK, or SMILE.
She is right to feel that way. And that is the whole point.
Every vision-correction patient eventually develops presbyopia, then dysfunctional lens syndrome, then cataracts. It is not a question of if, only when. When that moment comes, the decision you made decades earlier shapes which technologies are still available to you. EVO ICL is the only refractive procedure that preserves every option.
If you are in your 20s, 30s, or 40s and you are weighing your options for vision correction, this is the case I would want you to remember. It is not an argument from theory. It is a 20-year clinical result, observed last month, in a patient who flew across an ocean to have her vision restored by the surgeon who originally gave it to her.
If you would like to learn whether EVO ICL is the right choice for your eyes, I would be glad to evaluate you personally. Every consultation at Feinerman Vision is conducted by me, not by a delegated team. You can learn more about EVO ICL, or request a consultation at FeinermanVision.com or by calling (949) 631-4780.