If you’re considering an implantable collamer lens (ICL) to correct your vision, it’s perfectly natural to ask: Will this increase my risk of cataracts down the line? After all, cataracts are a serious, vision-impairing problem, and the idea of having an artificial lens placed into your eye might sound like it could accelerate or cause lens clouding. The good news is: the relationship between ICLs and cataract formation is well studied, and with modern designs and careful surgical planning, the risk is typically low — though not zero. In this article, I’ll walk you through exactly what we know, where caution is needed, how modern designs mitigate risk, and what you should ask your surgeon if you’re weighing this option.
What Is an ICL (Implantable Collamer Lens)?
Before we dive into the cataract question, let’s be clear on what an ICL is and how it works — so you understand where risk might emerge.
An ICL (implantable collamer lens) is a type of phakic intraocular lens — that means it is implanted in addition to your eye’s natural lens, rather than replacing it. Typically, the ICL is placed behind the iris and in front of your natural lens (in the posterior chamber of the eye). Its job is to correct your refractive error by bending light appropriately before it reaches your retina.
Because your natural lens remains intact, you retain accommodation (your ability to focus on near objects) and avoid removing a healthy lens prematurely. That is one advantage over doing a refractive lens exchange. But because you’re placing something inside the eye, complications are always possible. One of the most talked-about is cataract formation.
Cataracts: A Quick Refresher
To understand how ICLs might influence cataract risk, it helps to know what cataracts are and how they form in the first place.
A cataract is a clouding or opacity of the eye’s crystalline lens, leading to blurred or dimmed vision. There are various types of cataracts: nuclear (central, often associated with ageing), cortical (spoke-like opacities), posterior subcapsular, anterior subcapsular, and others. Several factors predispose someone to cataracts: age, UV light exposure, smoking, diabetes, certain medications, and other ocular surgery or trauma.
When cataracts become visually significant, they require surgical removal and replacement with an artificial intraocular lens. We usually hope that an ICL doesn’t precipitate or accelerate that process.
Theoretical Mechanisms: How Might an ICL Cause Cataracts?
Now, let’s talk about how an ICL could potentially contribute to cataract development. These are not guaranteed outcomes but theoretical or observed pathways.
- Contact or proximity to the natural lens
If the implanted ICL is too close or touches the anterior surface of the natural lens, that physical contact can cause cell damage, which may lead to opacities. - Disruption of aqueous flow
The crystalline lens depends on the circulation of the aqueous humour for nutrition and waste removal. If an ICL alters this flow, metabolic stress might promote cataract formation. - Surgical trauma or inflammation
Any intraocular surgery carries a risk of inflammation and oxidative stress. These can accelerate lens ageing or clouding. - Vaulting problems over time
If the “vault” (the clearance between ICL and the lens) is too low or reduces with time, that could elevate risk. Pigment release or debris may add to stress.
What the Research Shows: Incidence of Cataracts After ICLs
To give you a realistic picture, let’s look at what long-term studies have found about how often cataracts develop after ICL implantation.
Large studies with follow-up periods of over a decade suggest that a small percentage of eyes go on to develop cataracts after ICL implantation. The figures vary between studies, but rates of clinically significant cataracts have generally been reported at around 5% or lower after 10 years. Many more eyes may show small anterior subcapsular changes that never progress to visually significant cataract.
Earlier ICL models, particularly those without a central hole, carried higher risks because they altered fluid circulation around the lens. In those designs, rates of anterior subcapsular opacities were higher, though many did not impair vision. With the newer ICLs, particularly those with a central port to allow fluid flow, the rates of cataract formation are markedly lower.
Risk is not uniform across all patients. Older individuals, people with very high myopia, or those with shallower anterior chambers tend to be at higher risk. In younger patients with modern ICL designs and adequate vault, the risk is very low indeed.
How Modern Lens Design and Surgical Planning Reduce Risk
The design of ICLs has advanced significantly over the years. Modern versions include a small central hole that allows aqueous humour to flow more naturally around the lens. This reduces the likelihood of metabolic stress on the crystalline lens and lowers the chance of cataract formation.
Surgical planning also makes a major difference. Today, surgeons take detailed measurements of the eye — including anterior chamber depth, white-to-white distance, and sulcus anatomy — to select the correct ICL size. This ensures the vault is neither too shallow nor too high, both of which can lead to complications. Good surgical technique minimises trauma, reduces inflammation, and ensures the ICL is properly centred.
Cataract Risk Compared to Other Vision Correction Options
You might also be wondering: how does the cataract risk with ICLs compare to alternatives?
- LASIK and PRK: These procedures reshape the cornea and do not involve the crystalline lens at all. As such, they do not increase cataract risk.
- Refractive Lens Exchange (RLE): This involves removing the natural lens even if it is clear, essentially performing cataract surgery early. That guarantees no cataract can form — but it also means losing natural accommodation and exposing the eye to intraocular surgery risks earlier.
- ICLs: They preserve accommodation and avoid corneal reshaping, but do carry a small potential risk of cataract formation. For many patients, that trade-off is worthwhile.
What This Means for Patients
The takeaway is straightforward: ICLs may slightly increase the risk of cataracts, particularly in certain groups, but the overall risk with modern designs is low. Most patients who undergo ICL implantation enjoy excellent long-term vision without issues. Those who do eventually develop cataracts can have them treated with standard cataract surgery — often at the same time as removing the ICL.
The key is proper patient selection, precise measurements, and having the procedure performed by an experienced surgeon who understands how to minimise riskFAQs: Does ICL Increase the Risk of Cataracts?
1. Can ICL surgery directly cause cataracts?
ICL surgery does not directly create cataracts, but it can increase the risk in some patients. This usually happens if the lens sits too close to the natural crystalline lens, leading to contact or disruption of fluid circulation. Over time, this stress can cause small lens opacities to form. The good news is that with correct sizing, careful implantation, and the use of modern ICL designs, this risk is kept very low.
2. Are younger patients less likely to get cataracts after ICL?
Yes, younger patients are generally at lower risk of developing cataracts following ICL surgery. Their natural lenses are healthier and less vulnerable to the metabolic or mechanical changes that could trigger clouding. Most cases of cataract associated with ICLs are seen in older patients, where age itself is already a strong risk factor for lens opacification.
3. Does the size of the ICL make a difference?
The size of the ICL is one of the most important factors in minimising cataract risk. If the chosen lens is too small, the vault (the space between the ICL and the natural lens) will be reduced, creating the possibility of contact. If the lens is too large, it may cause other problems such as angle crowding. This is why surgeons perform highly precise measurements before recommending a specific ICL size.
4. How do modern ICLs reduce cataract risk?
Modern ICLs include a central hole that allows fluid to circulate naturally through the anterior chamber and across the surface of the crystalline lens. This circulation prevents the build-up of metabolic stress that was sometimes seen with older lens designs. As a result, the latest generation of ICLs is associated with a much lower incidence of cataract compared to the earlier models used two decades ago.
5. What symptoms might suggest a cataract is forming after ICL surgery?
Symptoms can include a gradual blurring of vision that is not corrected by glasses, sensitivity to light, glare, and halos around headlights when driving at night. Some patients also describe colours appearing duller or vision becoming more cloudy. Because these changes can be subtle at first, regular follow-up appointments after ICL surgery are important to detect any early signs.
6. Can cataracts that develop after ICL be treated in the usual way?
Yes, cataracts that occur in patients with an ICL are treated with standard cataract surgery. The ICL is typically removed during the same operation, and the cloudy natural lens is replaced with an intraocular lens implant. Most patients achieve excellent vision after this procedure, and having had an ICL previously does not prevent a successful cataract operation.
7. Do all ICL patients eventually end up with cataracts?
No, not every patient with an ICL will go on to develop cataracts. Many people maintain clear natural lenses for decades after their ICL procedure. Cataract risk increases naturally with age in everyone, but the ICL itself does not mean cataracts are inevitable. With proper follow-up, most patients enjoy long-term vision without major lens changes.
8. Is the cataract risk with ICL higher than with LASIK?
Yes, but only slightly. LASIK and PRK reshape the cornea and do not involve the crystalline lens, so they carry no additional cataract risk. Because ICLs sit close to the natural lens, there is a small associated risk of cataract formation. However, for patients with prescriptions too high for corneal laser surgery, the benefits of ICLs usually outweigh this consideration.
9. How long after ICL surgery might cataracts appear?
If cataracts do occur after ICL implantation, they usually develop years later, often after a decade or more. The risk is very low in the early years following surgery, particularly with modern lens designs. This is why regular long-term follow-up visits are recommended, so that any changes can be monitored and addressed at an early stage.
10. Should I avoid ICL surgery because of the risk of cataracts?
For the right candidate, ICL surgery is an excellent option that provides sharp, stable vision without altering the cornea. The small risk of cataracts should be weighed against the limitations of alternative treatments and the natural likelihood of developing cataracts with age. With good planning and an experienced surgeon, ICL remains a safe and effective solution for many patients.
Final Thoughts
So, does ICL increase the risk of cataracts? The straightforward answer is that there is a small risk, but it is far lower today than it used to be thanks to advances in lens design and surgical technique. Most patients who choose ICLs enjoy years of clear, sharp vision without any lens problems, and those who do eventually develop cataracts can be treated successfully with standard cataract surgery.
The key is to work with an experienced surgeon who will carefully measure your eyes, select the correct ICL size, and ensure you are the right candidate for the procedure. Your age, prescription strength, and eye anatomy all play a role in deciding whether an ICL is the safest and most effective choice for you.
If you are weighing up the pros and cons of ICL surgery, it’s worth remembering that cataracts can develop naturally as you age whether you have an ICL or not. The surgery does not guarantee cataracts, nor does it prevent them completely — but for many people it offers an excellent long-term solution for freedom from glasses or contact lenses.
To explore whether ICL surgery is the right option for you, you can book a consultation with the team at the London Cataract Centre, where experienced specialists can guide you through your choices and provide a tailored treatment plan.
References
- Alfonso, J.F., Fernández-Vega, L., Lisa, C., Fernandes, P., González-Méijome, J.M. & Montés-Micó, R. (2012). Long-term evaluation of the central vault after phakic Collamer lens implantation using OCT. Graefe’s Archive for Clinical and Experimental Ophthalmology, 250(12), pp. 1807–1812. Available at: https://pubmed.ncbi.nlm.nih.gov/22371020/ [Accessed 2 October 2025].
- Packer, M. (2018). The implantable Collamer lens with a central port: review of the literature. Clinical Ophthalmology, 12, pp. 2427–2438. Available at: https://pubmed.ncbi.nlm.nih.gov/30568421/ [Accessed 2 October 2025].
- Packer, M. (2016). Meta-analysis and review: effectiveness, safety, and central port design of the intraocular Collamer lens. Clinical Ophthalmology, 10, pp. 1059–1077. Available at: https://www.dovepress.com/meta-analysis-and-review-effectiveness-safety-and-central-port-design–peer-reviewed-fulltext-article-OPTH [Accessed 2 October 2025].
- Guan, N., et al. (2021). Correlation between intraoperative and postoperative vaulting in posterior chamber phakic Collamer lens implantation. BMC Ophthalmology. Available at: https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-021-02237-2 [Accessed 2 October 2025].
- Wannapanich, T., et al. (2023). Intraocular implantable Collamer lens with a central hole: longitudinal outcomes and cataract formation. Clinical Ophthalmology. Available at: https://www.tandfonline.com/doi/full/10.2147/OPTH.S379856 [Accessed 2 October 2025].