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    > safer than laser surgery

Is this statement backed by peer reviewed science? I could not find anything. When I Google for "safer than laser surgery", 100% of the results say that ICL (implantable contact lens) are riskier than laser (LASIK).

They probably just mean in terms of reversability; LASIK is obviously permanent, but ICL can be undone.

Both procedures are relatively low risk; each has their own set of drawbacks and qualifying conditions (eg - ICL isn't recommended for people who are over 45 years old).

    > They probably just mean in terms of reversability

No, everything I read says the ICL procedure is higher risk than LASIK. The risk is infection after the surgery.

45 years old is bizarre FDA restriction rationalizing that you might need lens replacement or +glasses soon anyway. Other countries don’t have this limit for ICL.

Over 45 you would do RLE (refractive lens exchange) which also protects against cataracts... since you are replacing the lens.

There are a lot of 45-year olds that won’t need RLE until 65, if ever. Why do they need to travel to Mexico to get ICL instead of doing it in US? Same thing with modern multi-focal RLE lenses. They got approved in US just couple years ago, and people used to go to Tijuana just to get access to them for years before that.

It has less side-effects because incision is way smaller.

Incision? Ha! I got PRK in which they just ablate the entire eye, it feels like. Took a week to be able to see again.

How far we've come.

Isn't PRK safer because there's no permanent flap, instead removing outer layer that can regrow?

Yes.

The flap created for LASIK (and LASIK-like surgeries, such as SMILE or LASEK) heals, but doesn't have the structural integrity that occurs when the epithelium has to fully regrow like for PRK. So that flap becomes a semi-permanent weakness that can be dislocated down the road and cause problems.

In general PRK is still considered the safest laser surgery option, but trades off the long-term risk of the epitheium flap for a much longer initial post-op recovery time. With PRK you have to be careful that there's no hazing as the epithelium regrows, but once it's regrown it's as good as it ever was. So for folks with a high risk of future eye injuries, PRK tends to be preferred (or required, in some instances like the special forces).

> I’m no longer limited to using those annoying clip-on sunglasses, over my (former) Rx glasses.

On the subject of clip-on sunglasses, nowadays some brands are offering prescription glasses that work with magnetic sunglasses covers. The sunglasses cover seats flush to the prescription glasses, and just make the package marginally thicker. They really look like you are using regular sunglasses when moutned on. I am also a contact lense user, specifically on days I might use cycling sunglasses, but those magnetic sunglasses are my goto solution for everyday use. Mine are from the Afflelou Magic collection.

Here is an ad showing how it looks and works: https://www.youtube.com/watch?v=Xa-80ezvni4

The good thing with those magnetic sunglasses is they don't have arms so they take very little room in a pocket or a bag and they are inexpensive so you can keep spare everywhere: house, car, office, backpack...

The only downside I could find is when you are driving a motorbike you have to think about putting your helmet visor down before you reach a certain speed, around 55-60mph (might be lower on windy days) otherwise your sunglasses might fly away. The magnet is simply not strong enough. But my main helmet has its own internal sun visor

My surgeon was willing to do contact lens implants, but was very adamant that lasik was a more appropriate course of action. Despite being more than willing to pay the price premium. So I went with lasik, as recommended.

Unfortunately, that left me with all of the negative side effects (halos at night, dry eyes) I was hoping to avoid by choosing an implanted lens. While I don't regret getting lasik, hearing someone who had a successful ICL surgery makes me wish I had taken that route instead.

Who knows what your doc was thinking but I figure they knew more about you and your personal situation than a random hacker news commentor. Medicine often times has trade offs so there's a chance you'd regret lens implants in one way or another if anything financially. Anyways, hope your vision is good now.

Lasik isn't always the best for astigmatism.

>halos at night

I have ICLs and suffered from those too, along with other internal reflections at night. It will get better with age as your pupils get smaller, but it takes years.

As for ICLs don't be fooled by the marketing too much. I've read countless medical studies since having them and I'm reading about all sorts of increases in risks for eye issues. Btw dry eyes are a possibility too, as with any cut into the eye. Long-term studies are rare too, as 5 or 10 years is already considered long. I expect to live a lot longer than that.

Not to mention that while "reversible" is true, the procedure is not as easy as putting them in and you really don't want to take them out it unless you absolutely have to. It's a rather substantial cut they have to make to take the unfolded ICL out again.

I did ICL a few years ago, had a good experience. I did a fair amount of research. One interesting thing to note is that the FDA is often several years behind for both ICL and Laser tech (eg, it looks like the EVO/EVO+ (V4c, V5) lenses finally got approved in 2022 but was originally introduced in 2008 and approved in many other parts of the world in 2011. For lasers, Canadian lasers/TransPRK procedures generally seemed a generation or two better than what was being offered in the US as well).

While TransPRK (or LASIK) was an option for me, I decided to go with ICL:

* No flap or corneal ablation (so is still an option in the future, I suppose), just a 3mm incision that completely heals

* no eye dryness risk (corneal nerves not damaged); in general less reported complications post-surgery from my research. generally proper placement, and also making sure you have a good first week of recovery/good followup are the big things

* V4c/V5 (w/ KS-Aquaport) does not have fluid flow issue older gens did, and had a larger exit pupil hole (although my left eye even years later still has some haloing in low light due to it opening a bit bigger)

* the ICL can be removed or replaced in the future for upgrades or prescription changes

* ICL is an actual outpatient surgical procedure, is more expensive than most modern laser options and you should use an experienced/good surgeon. I went w/ Dr Kimiya Shimizu, one of the most experienced in the field (and is the KS in the KS-Aquaport, invented the injector technique as well). There are other Dr's as well who have done thousands of procedures, it's probably worth going for more experience. With proper insertion, he was actually able to use a regular (non-Toric) implant to correct for my slight astigmatism in both eyes.

Obviously, having work on your eyes is a serious thing, so I'd recommend everyone do their own research, but ICL for me was a big QoL improvement.

ICL is relatively new and is surprisingly little known. I learned about it by chance from friend, did it, and it worked out great, beyond any expectations. I see way better than with any glasses or contacts.

I went with “mono vision”, i.e. my eyes are preset for different distances - one for close, one for far. This takes some time to get use for, but I consider it more convenient for me as I get older. I wouldn’t recommend this setup for a younger person, obviously.

For younger people they leave the bodies own lenses in, so there's no restrictions on focusing.

Downside is that there is an additional risk of glaucoma if the bodies lenses interact with the ICLs.

Just did the exact same as you. Love the result. Life changing.