Is ICL Surgery Suitable for Middle Eastern Patients?

ICL surgery, also known as implantable collamer lens surgery, can be suitable for Middle Eastern patients when your eye measurements meet the required safety criteria. The decision is not based on ethnicity alone. Instead, it depends on your prescription, corneal health, anterior chamber depth, endothelial cell count, eye pressure, retinal health, and whether there is enough safe internal space inside your eye for the lens to be implanted.

This topic is particularly relevant because some Middle Eastern populations may have higher rates of myopia in certain groups. Myopia levels can influence how often refractive surgery is considered, especially when prescriptions are too high for comfortable or safe laser correction. In these cases, ICL may become part of the discussion as an alternative approach.

Some studies have also reported relatively higher rates of keratoconus in parts of the Middle East. A 2025 review of keratoconus in the Eastern Mediterranean Region reported a prevalence of 3.96%, with factors such as family history, eye rubbing, and consanguinity described as common associations. These findings highlight why careful corneal screening is an essential part of pre-operative assessment.

For you as a patient, the key message is simple. ICL may be a useful option, particularly when laser eye surgery is not ideal, but suitability can only be confirmed through a detailed, individual examination of your eyes. Your treatment plan should always be based on your own measurements rather than assumptions about ethnicity or background.

What Is ICL Surgery?

ICL surgery involves placing a thin, custom-made prescription lens inside your eye to correct refractive errors such as myopia and astigmatism. Your natural lens is left in place, which is why this procedure is known as a phakic intraocular lens surgery. It essentially works alongside your eye’s existing focusing system rather than replacing it.

The ICL is typically positioned behind the iris and in front of your natural lens, in a carefully selected space within the eye. Once in place, it helps focus light more accurately onto the retina, improving the clarity of your vision without altering the natural structure of your eye.

Unlike LASIK, ICL surgery does not involve reshaping or removing corneal tissue. This makes it an alternative option for you if corneal-based procedures are not suitable due to factors such as thin corneas, high prescriptions, or dry eye concerns, provided your internal eye measurements are appropriate for safe lens placement.

Is ICL Suitable for Middle Eastern Patients?

Yes, ICL can be suitable for Middle Eastern patients if your eye anatomy and prescription meet the required safety criteria. Your ethnic background alone does not determine whether you are suitable or unsuitable for the procedure. Instead, suitability is based entirely on the specific characteristics of your eyes.

Your surgeon needs to confirm that there is enough internal space in your eye for the lens to sit safely. This includes assessing important factors such as corneal health, eye pressure, endothelial cell count, anterior chamber depth, and retinal health. Each of these measurements plays a key role in ensuring the procedure can be performed safely and effectively.

A good ICL consultation should always be based on detailed measurements and clinical findings rather than assumptions about ethnicity or background. This personalised approach helps ensure that the recommendation you receive is tailored specifically to your eyes and long-term visual needs.

Why ICL May Be Discussed More Often

ICL may be discussed more often if you have moderate to high myopia, especially when laser eye surgery could require removing more corneal tissue than is considered ideal for long-term safety. In these situations, ICL can sometimes offer an alternative because it corrects vision without reshaping the cornea.

A systematic review of school-age children in the Eastern Mediterranean Region reported a pooled childhood myopia prevalence of 5.23% from 2000 to 2022, with variation between countries and population groups. While this does not directly represent every Middle Eastern patient, it does highlight how myopia is an important and growing refractive health issue in the region.

For you as a patient, this context helps explain why ICL is often part of the discussion in higher prescriptions. It reflects the need to carefully balance effectiveness, corneal safety, and long-term eye health when choosing the most appropriate vision correction option.

High Myopia and Treatment Choice

If you have high myopia, your refractive surgery planning can become more complex because there is often more correction needed. Procedures like LASIK, PRK, and SMILE all involve reshaping the cornea, which means corneal thickness and how much tissue can be safely removed become important limiting factors.

ICL may be considered when your prescription is high or when your cornea is not ideal for laser-based correction. Because ICL works by placing a lens inside the eye rather than altering the cornea, it can preserve corneal tissue while still providing effective vision correction in selected patients.

However, if you have high myopia, your assessment should also include a careful retinal examination. This is important because higher levels of myopia can be associated with retinal thinning and other changes at the back of the eye, which need to be identified and managed as part of safe surgical planning.

Keratoconus Screening Is Essential

Keratoconus is particularly important to consider when discussing refractive surgery in Middle Eastern patients. Some regional studies have reported higher rates of keratoconus compared with other populations, although the exact prevalence can vary widely depending on the study design, diagnostic methods, and population sampled.

A 2022 epidemiology review noted that keratoconus prevalence can be highly variable and may be reported as high as around 5% in some Middle Eastern populations. This does not mean every patient is affected, but it does highlight why careful screening is important in refractive surgery assessments.

For you as a patient, this matters because keratoconus must always be identified before planning any vision correction procedure. If your cornea is unstable, laser eye surgery may not be safe, and even ICL planning requires extra caution to ensure your overall eye health and long-term visual stability are properly protected.

Keratoconus Does Not Automatically Mean ICL Is Suitable

If you have keratoconus, ICL may sometimes be considered as part of your overall vision correction options, but it is not automatically suitable. Your cornea needs a detailed evaluation, and the condition must be stable before any refractive surgery is discussed.

In many cases, you may first need corneal cross-linking to help stop progression of keratoconus before any further treatment is considered. Some patients may achieve better vision with specialist contact lenses, while others may require a combination of treatments depending on their individual situation.

The final decision depends on several factors, including how advanced your keratoconus is, whether it is stable or progressing, your visual needs, and the internal anatomy of your eye. Careful assessment is essential to ensure that any treatment plan is both safe and appropriate for your long-term eye health.

Corneal Shape and Thickness

ICL surgery does not involve removing or reshaping corneal tissue, which can make it a helpful option if your cornea is thin or not suitable for LASIK. However, your cornea still needs a detailed assessment before any decision is made about surgery.

Tests such as corneal topography and tomography help your surgeon examine the shape and thickness of your cornea in detail. These scans can detect irregular astigmatism, early keratoconus, thinning, or other structural changes that may affect whether refractive surgery is safe for you.

If you are from a Middle Eastern background, keratoconus awareness may be particularly relevant, so these checks should be taken seriously. Careful corneal screening helps ensure that any underlying conditions are identified early and that you are guided towards the safest and most appropriate treatment option for your eyes.

Anterior Chamber Depth

Anterior chamber depth is the space between the back surface of your cornea and the front surface of your natural lens. This measurement is very important in ICL planning because the lens needs enough internal space to sit safely inside your eye without affecting surrounding structures.

If your anterior chamber is too shallow, there may be a higher risk of angle crowding or pressure-related issues after surgery. In such cases, your surgeon may decide that ICL is not suitable for you, or they may recommend additional testing and a more cautious approach before making a decision.

This measurement is one of the key safety checks before ICL surgery. It helps your surgeon determine whether the internal anatomy of your eye can safely accommodate the lens and supports the overall planning for a safe and effective outcome.

White-to-White Measurement

White-to-white measurement estimates the visible horizontal width of your cornea from one edge to the other. It is commonly used as one of the baseline measurements when planning ICL surgery and helps give an initial guide for lens sizing.

However, white-to-white alone does not fully reflect the internal anatomy of your eye or the exact space where the lens will sit. That is why many surgeons also rely on additional tools such as anterior segment imaging, optical biometry, and more advanced sizing methods to build a more complete picture of your eye structure.

This is important because accurate lens sizing plays a key role in achieving a safe postoperative vault. Using multiple measurements together helps improve precision and supports better long-term safety and visual outcomes after ICL surgery.

What Is ICL Vault?

Vault is the space between the back surface of the ICL and the front surface of your natural lens. It is one of the most important measurements after ICL surgery because it shows how well the implanted lens is positioned inside your eye.

If the vault is too low, the ICL may sit too close to your natural lens, which can increase the risk of contact-related issues over time. If the vault is too high, it may reduce space in the front part of the eye and potentially lead to pressure or drainage angle concerns that need careful monitoring.

Good ICL planning aims to predict and achieve a safe and stable vault before surgery takes place. This is why detailed measurements, accurate lens sizing, and careful surgical planning are essential for long-term safety and good visual outcomes.

Lens Sizing and Vault Prediction

ICL sizing is highly personalised, and your surgeon uses detailed measurements from your individual eye to select the lens size that is most likely to sit safely and perform well. The aim is to achieve the right balance inside your eye so that the lens corrects your vision while maintaining long-term stability.

A review of ICL planning and sizing explains that several different approaches can produce good outcomes. However, the most appropriate method depends on the diagnostic technology available, the surgeon’s experience, and the analytical tools used in the clinic. This means there is no single “one-size-fits-all” approach to ICL planning.

For you as a patient, this highlights an important point: ICL planning should always be detailed and based on your own measurements. It should never rely on ethnicity or prescription alone, but instead focus on precise anatomical data to guide safe and effective treatment decisions.

AI and Modern ICL Planning

Artificial intelligence and machine learning are increasingly being explored in ICL surgery to improve vault prediction and lens sizing. These tools can help analyse multiple eye measurements together in a more structured way, which may support surgeons when planning complex or borderline cases.

For you as a patient, this could eventually mean more accurate predictions and greater confidence in lens selection before surgery. In particular, it may help improve planning in eyes with more complex anatomy, where traditional formulas alone may be less precise.

However, AI is still a supportive tool rather than a replacement for clinical judgement. Your surgeon’s experience, careful examination, and interpretation of your individual eye measurements remain the most important factors in ensuring safe and effective ICL outcomes.

Eye Pressure and Drainage Angle

Because ICL is placed inside your eye, checking eye pressure and the drainage angle is an important part of your pre-surgery assessment. Your surgeon needs to make sure that fluid inside the eye can continue to circulate normally after the lens is implanted, helping to maintain healthy and stable eye pressure.

If your drainage angle is narrow or your eye pressure is already high, ICL surgery may require extra caution. In some cases, your surgeon may decide that the procedure is not suitable for you and may recommend a different option that carries less risk for your long-term eye health.

This is why eye pressure testing and detailed angle assessment are a routine and essential part of responsible ICL planning. These checks help ensure that the treatment is not only effective for your vision, but also safe for the overall function of your eye.

Endothelial Cell Count

The corneal endothelium is the thin inner layer of cells at the back of your cornea, and it plays an important role in keeping your cornea clear and healthy. These cells help control fluid balance inside the cornea, and unlike other cells in the body, they do not regenerate easily. That is why checking them before ICL surgery is an important safety step.

• What the Endothelium Does: This inner cell layer helps keep your cornea clear by controlling fluid levels and preventing swelling.
• Pre-Surgery Safety Check: Before ICL surgery, your endothelial cell count is measured to make sure your cornea has enough healthy cells for an intraocular lens procedure.
• Helps Guide Suitability: If the cell count is too low, your surgeon may reconsider ICL or suggest alternative options for safety reasons.
• Important for Long-Term Health: Because these cells do not naturally regenerate, protecting them is a key part of long-term eye health.
• May Need Follow-Up Monitoring: After surgery, you may need periodic checks to ensure your cornea remains healthy over time.

Overall, endothelial cell count is a crucial part of ICL planning because it helps your surgeon ensure your cornea can safely support the procedure. It is not just a one-time measurement but part of ongoing eye health assessment, both before and sometimes after surgery.

Retinal Health in High Myopia

If you have high myopia, you may have a higher risk of retinal thinning, lattice degeneration, retinal tears, or other changes at the back of the eye. These changes are linked to the longer shape of the highly myopic eye itself rather than the ICL procedure.

Before ICL surgery, you should usually have a careful retinal examination to check the health of the back of your eye. This helps your surgeon identify any areas that may need treatment, monitoring, or further assessment before proceeding with surgery.

If any retinal concerns are found, they may need to be managed first to reduce the risk of complications. This step is especially important if you have a strong prescription, as higher levels of myopia can place additional stress on the retina over time.

ICL for Astigmatism

Many patients have both myopia and astigmatism together, and in suitable eyes, toric ICL lenses can be used to correct both at the same time. This can help reduce your dependence on glasses or contact lenses while providing clearer and more stable vision.

Toric ICL planning requires very precise alignment because the lens must sit at a specific angle inside your eye. If the lens rotates after surgery, it can reduce the effectiveness of astigmatism correction and affect visual quality. For this reason, surgeons carefully consider lens stability and positioning during the planning stage.

Before recommending a toric ICL, your surgeon will assess your prescription in detail, examine your corneal shape, and estimate how stable the lens is likely to remain once implanted. This is a technical consideration based entirely on your individual eye anatomy rather than any external factors, and careful planning is key to achieving the best possible outcome.

Dry Eye and Allergy Considerations

If you are from a Middle Eastern background, you may be more likely to experience dry eye or allergy symptoms, especially in hot, dry, or dusty environments. These conditions can make your eyes feel irritated, watery, or itchy, and in some cases may increase the urge to rub your eyes.

ICL surgery does not involve creating a LASIK flap or removing corneal tissue, which can make it a helpful option for some patients who already struggle with dry eye. However, it is still important that your dry eye is properly assessed and managed, because it can affect your comfort and the quality of your vision before and after any refractive procedure.

If you find yourself rubbing your eyes due to itching or allergy symptoms, it is important to treat the underlying cause rather than the symptom alone. Managing allergy and dryness effectively before and after surgery can help protect your eyes and support better long-term outcomes.

Comparing ICL With LASIK

ICL and LASIK are both popular vision correction procedures, but they work in very different ways. LASIK improves vision by reshaping your cornea with a laser, while ICL corrects vision by placing a specialised lens inside your eye. The best option for you depends on your prescription, corneal measurements, eye health, and individual visual needs.

• Different Treatment Approaches: LASIK reshapes the cornea permanently, whereas ICL corrects vision by implanting a lens inside the eye without removing corneal tissue.
• ICL May Suit Certain Eyes Better: You may be considered for ICL if you have a high prescription, thin corneas, significant dry eye symptoms, or if corneal screening suggests laser surgery is not the safest option.
• LASIK Can Be an Excellent Choice: If your corneas are healthy and your prescription falls within a suitable range, LASIK may provide excellent visual outcomes with a relatively quick recovery.
• Corneal Health Is a Key Factor: Conditions such as keratoconus or suspicious corneal scans may make laser procedures less appropriate and increase interest in ICL.
• All Suitable Options Should Be Discussed: A thorough consultation should explain the advantages, limitations, and risks of both procedures so you can make an informed decision.

Overall, there is no single vision correction procedure that is best for everyone. The right choice depends on the unique characteristics of your eyes and your personal priorities. If you are considering vision correction, your consultation should compare ICL, LASIK, and any other suitable options openly and objectively, helping you choose the treatment that offers the safest and most appropriate outcome for your situation.

Is ICL Riskier in Middle Eastern Patients?

ICL is not automatically riskier if you are from a Middle Eastern background. The safety of the procedure depends on your individual eye anatomy, overall eye health, and whether the necessary safety criteria are met. Ethnicity alone does not determine your risk level or whether you are a suitable candidate for treatment.

If your anterior chamber is deep enough, your endothelial cell count is healthy, vault prediction is appropriate, eye pressure is normal, and your retina is healthy, ICL may be a suitable option. On the other hand, if any of these factors raise concerns, your surgeon may recommend additional investigations, delay treatment, or suggest a different vision correction procedure that is safer for your eyes.

Research can help identify factors that may be more common in certain populations, but treatment decisions should always be based on your own measurements and clinical findings. In practical terms, ethnicity can guide awareness and screening, but your eye anatomy is what ultimately determines suitability and safety.

What Tests Are Needed Before ICL?

Before ICL surgery, you should expect a detailed assessment rather than a simple vision test. This may include prescription testing, corneal topography, corneal tomography, anterior segment imaging, endothelial cell count measurement, eye pressure assessment, pupil size evaluation, and a thorough retinal examination. Each test provides important information about the health and structure of your eyes.

These investigations help your surgeon determine whether ICL is a safe option for you and which lens size is likely to be most appropriate. They can also identify conditions such as keratoconus, abnormal corneal shape, retinal problems, or other eye health issues that could influence treatment planning or long-term outcomes.

A quick glasses prescription check is not enough when considering an intraocular procedure. Good ICL planning requires a comprehensive understanding of your eye anatomy and overall eye health so that treatment decisions are based on accurate measurements rather than assumptions.

When ICL May Not Be Suitable

ICL may not be suitable if your eye anatomy does not meet important safety requirements. This can include a shallow anterior chamber, a low endothelial cell count, uncontrolled eye pressure, narrow drainage angles, or retinal conditions that require treatment or monitoring before refractive surgery is considered.

It may also be unsuitable if you have active or progressing keratoconus. In these situations, stabilising the cornea and protecting long-term eye health are usually more important than proceeding directly with vision correction surgery. Treatments such as corneal cross-linking may need to be considered before any refractive procedure.

A responsible surgeon should explain clearly when ICL is not the safest option for you. Good refractive care is not about recommending surgery to everyone it is about identifying the treatment that offers the best balance of safety, effectiveness, and long-term eye health for your individual circumstances.

What Middle Eastern Patients Should Ask

If you are considering ICL surgery, it is worth asking whether your corneal scans show any signs of keratoconus or other conditions that could affect your suitability for treatment. You may also want to ask about your anterior chamber depth, endothelial cell count, eye pressure, retinal health, expected postoperative vault, and whether a toric ICL is needed to correct astigmatism.

It is also helpful to ask how ICL compares with other vision correction options in your specific case. Depending on your prescription, corneal measurements, and eye health, alternatives such as LASIK, PRK, SMILE, corneal cross-linking, or even continued contact lens wear may be more suitable. Understanding the reasons behind a recommendation can help you make a more informed decision.

A good consultation should be personalised to your eyes and your visual goals. Your surgeon should explain your measurements, discuss the benefits and risks of each option, and answer your questions clearly. The best consultation should leave you feeling informed and confident about your choices, not overwhelmed or confused.

Future Research in Middle Eastern Patients

Future research should include more data on ICL outcomes in Middle Eastern populations. This could help specialists better understand whether factors such as lens sizing, vault prediction, keratoconus screening, anatomical measurements, or refractive patterns influence surgical planning and outcomes in different patient groups.

More research is also needed into conditions that may affect your suitability for refractive surgery, including myopia, high myopia, keratoconus, allergy-related eye rubbing, and other regional risk factors. Current evidence already suggests that these are important considerations when planning vision correction procedures and assessing long-term eye health.

For you as a patient, the goal of this research is not to create treatment decisions based on ethnicity alone. Instead, it is to provide a better understanding of the factors that affect individual patients, helping surgeons offer more accurate assessments, safer treatment plans, and more personalised care. Ultimately, better evidence can help ensure that you receive recommendations based on your own eyes and needs rather than broad population averages.

FAQs:

1. Is ICL surgery suitable for Middle Eastern patients?
   Yes. ICL surgery can be suitable for Middle Eastern patients if their eye measurements meet the required safety criteria. Suitability depends on factors such as prescription strength, anterior chamber depth, corneal health, endothelial cell count, eye pressure, and retinal health rather than ethnicity alone. Every patient requires an individual assessment to determine whether ICL is the safest option.
2. Why is keratoconus screening especially important for Middle Eastern patients?
   Some studies have reported relatively high rates of keratoconus in certain Middle Eastern populations. Keratoconus causes progressive thinning and irregular shaping of the cornea, which can affect refractive surgery planning. Detailed corneal topography and tomography scans are essential before ICL surgery to identify any signs of keratoconus or corneal instability.
3. Can patients with keratoconus have ICL surgery?
   In some cases, yes. However, keratoconus does not automatically make someone suitable for ICL surgery. The condition must be carefully assessed, and if keratoconus is progressing, treatment such as corneal cross-linking may be required first. The final decision depends on corneal stability, visual needs, and internal eye anatomy.
4. Is ICL better than LASIK for Middle Eastern patients?
   Not necessarily. ICL and LASIK are different procedures designed for different situations. ICL may be considered when prescriptions are high, corneas are thin, dry eye symptoms are significant, or laser surgery may not be ideal. LASIK may still be an excellent option when corneal thickness and other measurements are suitable.
5. Can ICL help patients with high myopia?
   Yes. ICL is commonly used for moderate to high myopia and is often considered when laser procedures would require excessive corneal tissue removal. Because ICL corrects vision with an implanted lens rather than reshaping the cornea, it can be a useful option for patients with stronger prescriptions.
6. What tests are required before ICL surgery?
   A comprehensive assessment typically includes refraction, corneal topography, corneal tomography, anterior chamber depth measurement, endothelial cell count, intraocular pressure testing, pupil assessment, retinal examination, and anterior segment imaging. These tests help determine both suitability and the safest lens size.
7. What is anterior chamber depth and why is it important?
   Anterior chamber depth is the distance between the cornea and the natural lens inside the eye. This measurement helps determine whether there is enough space for the ICL to sit safely. If the chamber is too shallow, the risk of complications may increase and ICL may not be recommended.
8. Can ICL surgery affect eye pressure?
   Yes, it can. Since the lens is placed inside the eye, surgeons must ensure that fluid drainage pathways remain open and healthy. Proper lens sizing and careful monitoring help reduce the risk of pressure-related complications. Eye pressure checks are therefore an important part of both the pre-operative assessment and follow-up care.
9. Is ICL surgery a good option for patients with dry eyes or allergies?
   It can be. Because ICL does not create a corneal flap or remove corneal tissue, it may be considered for some patients who have dry eye symptoms or contact lens intolerance. However, dry eye and allergy problems should still be properly managed before surgery, especially if frequent eye rubbing is present.
10. What should Middle Eastern patients ask during an ICL consultation?
    Patients should ask whether their corneal scans show any signs of keratoconus, whether their anterior chamber depth and endothelial cell count are suitable, what vault is expected after surgery, and whether their retina is healthy. It is also worth asking how ICL compares with LASIK, PRK, SMILE, or other treatment options based on their individual eye measurements and visual goals.

Final Thoughts: Personalised Assessment Matters More Than Ethnicity

ICL surgery can be a suitable and effective vision correction option for many Middle Eastern patients, particularly those with moderate to high myopia, thin corneas, or circumstances where laser eye surgery may not be the most appropriate choice. However, suitability should never be based on ethnicity alone. Factors such as corneal health, keratoconus screening, anterior chamber depth, endothelial cell count, eye pressure, retinal health, and accurate lens sizing are far more important when determining whether ICL is a safe option. Every patient requires a thorough assessment to ensure treatment decisions are based on their individual eye anatomy and visual needs.

The current evidence supports a personalised approach to refractive surgery planning, with careful testing and long-term follow-up helping to maximise safety and visual outcomes. If you are considering ICL surgery in London, you can contact Eye Clinic London to arrange a specialist consultation and find out whether the procedure may be suitable for your individual eyes.

References:

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2. Montés-Micó, R., Ruiz-Mesa, R., Rodríguez-Prats, J.L. and Tañá-Rivero, P. (2021) Posterior-Chamber Phakic Implantable Collamer Lenses with a Central Port: A Review, Acta Ophthalmologica, 99(3), pp. e288–e301. Available at: https://pubmed.ncbi.nlm.nih.gov/32841517/
3. Wei, Q., Ding, X., Chang, W., Zhou, X., Jiang, R., Zhou, X. and Yu, Z. (2024) Corneal Sub-Basal Nerve Plexus Regeneration Pattern following Implantable Collamer Lens Implantation for Myopia: A Prospective Longitudinal In Vivo Confocal Microscopy Study, Biomedicines, 12(3), 555. Available at: https://www.mdpi.com/2227-9059/12/3/555
4. Lee, H., Kang, D.S.Y., Choi, J.Y., Ha, B.J. and Kim, E.K. (2019) Ten-year clinical outcomes after implantation of a posterior chamber phakic intraocular lens for myopia, Journal of Cataract & Refractive Surgery, 45(11), pp. 1555–1561. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0886335019304894
5. Wannapanich, T., Kasetsuwan, N. and Reinprayoon, U. (2023) Intraocular Implantable Collamer Lens with a Central Hole Implantation: Safety, Efficacy, and Patient Outcomes, Clinical Ophthalmology, 17, pp. 969–980. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10046236/