Your EVO ICL Handbook.
Everything I'd want my own family to know before their consultation.
Start reading Hi, I'm Dr. Kuriakose.
If you're reading this, you've scheduled a consultation with me, and I'm glad you did.
I've been nearsighted my whole life, so I know your side of the chair well. By 2017, my eyes couldn't tolerate contacts anymore. A couple of hours after putting them in, they'd be red and irritated. I went in hoping for LASIK and was told I wasn't a candidate. My corneas were too thin, and my prescription was high.
PRK was the best option available to me, so that's what I had, and it changed my life. Not having to think about where my glasses or contacts were is the reason I trained in cornea and refractive surgery. With the technology we have today, the EVO ICL is the option I would have chosen for myself.
Most people come in with the same few questions. What is this lens, exactly? Does it hurt? Am I a candidate? What will it cost? I wrote this handbook so you'd have those answers before we sit down together, in plain English.
Read it once and jot down anything you'd like to ask. There's a page at the back for that. Bring it with you.
Nothing in here replaces your consultation. I won't know what's right for your eyes until I've measured them and talked with you. That's what our time together is for.
I look forward to meeting you.
Robin Kuriakose, MD
Cornea, cataract & refractive surgeon · Optima Eye
Why things far away look blurry.
Your eye bends incoming light so it lands in sharp focus on the retina, the thin layer at the back of your eye that sends the picture to your brain.
In a nearsighted eye, the light comes into focus a little too soon, just in front of the retina. Things up close look fine, but anything far away goes soft. Usually that's because the eye is slightly longer than average.
Astigmatism is a little different. The front of the eye is curved more like a football than a basketball, so light focuses unevenly and things can look blurry or stretched.
Four ways to fix the focus
Glasses
Bend light before it reaches your eye. They sit on your face, fog up and slide down.
Contacts
Bend light on the surface of your eye. They come out every night and can dry out by afternoon.
LASIK & PRK
A laser reshapes the clear front window of your eye. Great procedures for the right eyes. I had PRK myself.
EVO ICL
A lens with your prescription works from inside your eye. Nothing is removed, and the front window keeps its shape.
Every option does the same job: it moves the focus back onto your retina. What changes is where the correction lives: on your face, on your eye, in the front window of your eye, or inside it.
A lens with your prescription, placed inside your eye.
The EVO ICL, enlarged. The real lens is about half an inch long and soft enough to fold.
The EVO ICL is a small, soft lens with your prescription built into it. I place it inside your eye, behind the colored part and in front of the lens you were born with.
Think of it as a contact lens that lives inside your eye instead of on it. You don't take it out at night, clean it or replace it. Once your eye has healed, you can't see it or feel it, and nobody can tell it's there.
Nothing is removed from your eye. Your cornea isn't lasered or reshaped, and your natural lens stays right where it is. Because the lens is added rather than shaped into your eye, a surgeon can take it out or swap it if your eyes ever change.
ICL originally stood for Implantable Contact Lens. Today the C stands for Collamer, a soft material that's part collagen, a protein your body already makes. It's been used inside human eyes for more than thirty years, and it doesn't wear out.
The EVO has a tiny opening in its center, about a third of a millimeter wide. It lets the fluid inside your eye keep flowing naturally, so it doesn't need the small laser opening in the iris that older versions of the lens required.
FDA-approved to correct nearsightedness up to −15 and reduce it up to −20, with 1 to 4 diopters of astigmatism. Lens count as reported by STAAR Surgical.
Inside your eye, and why that matters.
Your cornea keeps its shape.
Nothing is lasered or removed from the front of your eye, so corneal thickness isn't a factor, and the lens doesn't contribute to dry eye the way laser procedures can.
The world looks its real size.
Strong glasses sit about half an inch from your eyes and make everything look smaller. Correcting from inside removes that shrink, so people with strong prescriptions often say everything looks bigger afterward.
Your future options stay open.
Most people eventually develop a cataract. If you do, decades from now, the lens comes out during that same surgery, and your new lens is measured on a cornea that was never reshaped.
It can come out.
It isn't attached to anything inside your eye. If your eyes or your life change, a surgeon can take it out or swap it. Removing it is a short procedure, and your eye returns to about its earlier prescription.
People love knowing it can come out, even though very few ever need to.
Who it's for, and who it isn't.
The EVO ICL is a great fit for a lot of eyes, but not every eye. Part of my job is telling you when it isn't the right one, and what is.
- You're nearsighted and between 21 and 60, and your prescription has been steady for about a year.
- Your prescription is on the stronger side, with or without astigmatism.
- You were told no to LASIK because of thin corneas, a high prescription or dry eyes.
- Contacts leave your eyes dry, red or tired by the end of the day.
- You like the idea of a correction a surgeon can take out later.
- Your prescription is mild. LASIK or PRK is often the simpler route.
- You're farsighted. The EVO ICL treats nearsightedness.
- The space inside your eye is too shallow, or the cell count on the inside of your cornea is too low. I measure both.
- You're pregnant or nursing. It's best to wait until after.
- Certain eye conditions, like glaucoma, call for a different plan.
A vision correction practice, not a LASIK practice.
I perform LASIK, PRK, the EVO ICL and lens replacement, so I'm not committed to any one procedure. I'm committed to finding the safest, best option for your eyes, the one I'd feel comfortable choosing for my own family.
I believe in it enough that I trusted vision correction with my own eyes, and I personally performed my brother's.
A typical cornea is about half a millimeter thick, roughly five sheets of printer paper. LASIK needs enough of that thickness to work with, which is part of why I wasn't a candidate. The EVO ICL doesn't remove any of it, so corneal thickness isn't a factor.
There's no single best procedure for everyone, only the right one for your eyes.
Over 45? You may have two good options.
Somewhere in your forties, the lens you were born with starts to stiffen. It can't change focus the way it used to, so reading up close gets harder. It happens to everyone. The EVO ICL corrects your distance vision, so after your mid-forties you'll likely still use readers for small print.
The FDA approved the EVO ICL for adults up to age 60, so you're not too old to consider it. For some eyes past the mid-forties, though, a different procedure is the better answer: lens replacement, also called clear lens exchange. Instead of adding a lens, I replace the one that's stiffening with a new lens that can be set up for distance and reading.
I perform both, so you don't have to figure out which one you need. At your consultation, I'll check your natural lens, measure your eyes and tell you which one fits.
- Your natural lens
- Stays in place
- Up close
- Readers likely for small print
- Often the fit when
- Your natural lens is still clear
- Your natural lens
- Replaced with a new lens
- Up close
- Can be set up to help with reading
- Often the fit when
- Your natural lens has started to change
Already using readers? Bring them along with your regular glasses. They show me how you use your eyes up close, which helps me point you to the right procedure.
One hour, and you'll know where you stand.
Your consultation is free and takes about an hour. Here's what happens, so nothing catches you off guard.
- 1
Check in
Come a few minutes early to fill out a short form.
- 2
Measurements with my team
We measure your prescription, the shape and thickness of your cornea, the space inside your eye, the cells on the inside of your cornea and your pupils in low light. You may get drops that widen your pupils. None of it hurts.
- 3
Time with me
I go over your results, check the health of your eyes and ask about your day. Then I tell you what I'd recommend: the EVO ICL, a different procedure, or nothing at all.
- 4
Your plan, in writing
If surgery makes sense, you'll get your exact price in writing, along with your financing options.
- 5
Decide when you're ready
There's no pressure to decide that day. If you're ready, my team can help you pick a surgery date before you leave.
- A clear answer on whether you're a candidate, and for what
- Your measurements, explained in plain English
- My recommendation
- Your exact price, in writing
- Your financing options
Wear your glasses, not your contacts. Contacts can change the shape of the front of your eye for a while, and I want to measure your eyes as they naturally are. We'll tell you how many days to leave them out.
Drops can blur things for a few hours. Bring sunglasses, and a driver if you'd rather not drive home.
Bring someone. A partner, family member or friend is welcome to sit in with me. Two sets of ears catch more than one.
Driving in from the Central Valley? Plenty of my patients do. Leave a little extra time for traffic.
What surgery day actually feels like.
Most people are more nervous about this part than anything else, so here it is, step by step.
- 1
Where
Right here at Optima Eye, in our own federally certified surgery center in Hayward.
- 2
Comfort
Your eyes are numbed with drops, and many patients take a mild relaxing tablet. You're awake the whole time, and I talk you through each step.
- 3
What you'll feel
Most people feel some pressure, not pain. What patients mention most is the bright light of the microscope, and it's over quickly.
- 4
How long it takes
The surgery itself takes about 5 to 10 minutes per eye. Plan to be with us for a few hours that day, because we check the pressure inside your eye before you go home.
- 5
Your second eye
We'll plan the timing together at your consultation. A heads-up most people appreciate: the second eye can feel more nerve-racking than the first, not because it hurts, but because you know what's coming.
- 6
Getting home
Someone will need to drive you. Most people rest that evening, and many already notice clearer vision by then.
- 7
The next day
We see you for a quick check-up to make sure your eyes are healing well.
Most patients tell me the nerves in the waiting room were the hardest part.
What recovery really looks like.
Same day
Things look hazy from the drops at first. Many people see more clearly by that evening.
Next day
Your first check-up. Most people are already seeing much better. Halos and light sensitivity are normal early on.
First week
Most people are back at work within a couple of days. You'll use eye drops, avoid rubbing your eyes and keep water out of them.
First month
Your vision keeps sharpening, and early halos usually ease. Most people finish their drops within a few weeks.
Months 3 to 6
Your eyes finish settling, and night vision keeps improving for some people. After that, we check your eyes once a year.
Driving. Most people can drive again within a day or two, once we've checked their eyes.
Your do's and don'ts. I'll give you a short list, like when you can swim, exercise and wear eye makeup again.
What the U.S. clinical trial found
U.S. FDA clinical trial of the EVO ICL, 629 eyes. 20/20 figure is for eyes able to reach 20/20, at six months; "on target" means within half a diopter of the plan. Individual results vary.
For a lot of people, the moment it sinks in is the first morning they wake up and can read the clock.
Safety comes first, so here's the full picture.
This is real surgery inside the eye, and every surgery carries some risk. I'd rather you hear it from me, plainly, before we meet. Here's what the studies show and what I do about each one.
Halos and rings at night
Early on, some people notice rings or halos around lights. For most, they fade over the first few months. Your pupil size in low light is one of the things we measure, so I can tell you ahead of time where you're likely to land.
Eye pressure
Pressure inside the eye can rise for a few hours after surgery, which is why we check it before you go home. In the long-term studies, pressure has stayed stable, and we check it every year.
Infection
Serious infection is rare: about 1 in 6,000 in a large survey, and none in the U.S. clinical trial. You'll use antibiotic drops, and we see you the next day.
Cataract
With the current lens, a cataract linked to it showed up in about 1 in 600 eyes over three years. If you ever develop one, the lens comes out and cataract surgery goes ahead like anyone else's.
The cells inside your cornea
There's a layer of cells on the inside of your cornea that doesn't grow back. We count them before surgery, and if the count is below the line for your age, I won't recommend this lens. Afterward, we check them every year.
Your retina
Strong prescriptions carry a small lifetime risk to the retina, with or without surgery, and the studies don't show the lens adding to it. I examine your retina before I recommend anything.
New flashes of light, a sudden shower of floaters, a dark curtain over part of your vision, or eye pain that's getting worse means call us the same day: (510) 886-3937.
Figures from the U.S. FDA clinical trial of the EVO ICL and published studies. For important safety information, visit EVOICL.com.
The questions I hear most.
Does it hurt?
Your eyes are numbed with drops, and most people feel pressure, not pain. The bright light of the microscope is what people remember most.
Can I feel it or see it?
No. Once you've healed, you won't feel it, and nobody can tell it's there.
Can it move or fall out?
It rests in a space behind the colored part of your eye and stays in place. Rarely, a lens that corrects astigmatism turns slightly, and we rotate it back.
How long does it last?
It's designed to stay in place for decades. The material doesn't wear out.
Will I still need glasses?
For distance, most people don't. For reading, everyone's eyes start needing help in their forties, and this lens doesn't change that.
What if my eyes change later?
A surgeon can swap the lens for a different power, or a small laser touch-up can be done over it. If you need cataract surgery someday, the lens comes out during that surgery.
Is it better than LASIK?
Neither is better for everyone. LASIK is a great procedure that reshapes the front of the eye. The EVO ICL adds a lens inside instead. Your prescription and your cornea decide which one fits, and I perform both.
What will it cost?
Here's the straight answer. At Optima Eye, the price is the same for every EVO ICL patient, whatever your prescription. It costs more than LASIK because it's a custom lens placed in an operating room. You'll get your exact price in writing at your consultation.
What does the price include?
Your surgery, your lenses, the surgery center and your follow-up visits for the first year. If a laser touch-up is ever needed, that's included too.
Does insurance cover it? Can I finance it?
Insurance doesn't cover it, because it's elective. Many patients use monthly financing through CareCredit, including plans with no interest if paid in full within 24 months, for those who qualify. HSA and FSA dollars can be used too.
How soon could I have surgery?
Standard lenses are often in stock. Lenses that correct astigmatism are made to order and can take a few weeks to arrive. If you're planning around a trip or a busy season, tell me at your consultation and we'll plan backward from it.
What if I'm nervous?
Most people are, at first. Bring your questions and someone you trust, and we'll take it one step at a time.
One surgeon, from your first visit on.
When you come in, you meet me. I'm the surgeon you'll see from your first visit through surgery and follow-up.
I grew up in New York in a healthcare family. My dad was a respiratory therapist and my mom was an emergency room nurse. I trained in Virginia, Southern California and Chicago, and now I'm proud to call the Bay Area home.
I'm also a bit of an eye nerd. I publish research, write for other eye doctors, and I've built apps, including one that helps people with digital eye strain.
- Medical degree
- Virginia Commonwealth University, combined BS/MD program, summa cum laude
- Residency
- Ophthalmology, Loma Linda University
- Fellowship
- Cornea, cataract and refractive surgery, Northwestern University
- Board certification
- American Board of Ophthalmology
- Memberships
- American Academy of Ophthalmology · American Society of Cataract and Refractive Surgery
- Practice
- Optima Eye, Hayward, since 2023