Author: Dr Val Phua
Estimated reading time: 16 minutes
A standard Implantable Collamer Lens—commonly known as an ICL—does not directly cure presbyopia or restore the natural focusing ability that is gradually lost with age.
Standard spherical and toric ICLs are primarily designed to correct:
- Myopia, or short-sightedness
- Regular astigmatism
- Distance vision
When both eyes are corrected fully for distance, a patient who has presbyopia will usually still require reading glasses for small print and other close work. Official safety information for the standard EVO ICL specifically states that distance correction does not eliminate the future need for reading glasses.
However, ICL-based strategies can reduce dependence on reading glasses in selected patients.
These include:
- Monovision or blended vision, in which one eye is corrected mainly for distance and the other retains some short-sightedness for near vision
- Mini-monovision, using a smaller difference between the eyes
- Presbyopia-correcting extended-depth-of-focus ICLs, such as EVO Viva, where these lenses are approved and available
- Standard distance ICL combined with reading glasses when maximum distance quality is the priority
These strategies compensate for presbyopia. They do not make the natural crystalline lens young or flexible again.
What Is Presbyopia?
Presbyopia is the gradual age-related loss of the eye’s ability to focus on nearby objects.
When a younger person looks at something close, the natural crystalline lens becomes thicker and more curved. This process, called accommodation, increases the eye’s focusing power.
With age:
- The natural lens becomes less flexible
- The lens changes shape less effectively
- Near focusing becomes more difficult
- Reading material must be held farther away
- More light may be needed to see small print
- Near vision becomes tiring or blurred
Presbyopia commonly becomes noticeable during the forties and continues to progress as the natural lens ages.
Does a Standard ICL Restore Accommodation?
No.
A standard ICL is a fixed-power lens implanted:
- Behind the iris
- In front of the natural crystalline lens
It corrects the eye’s refractive error but does not change shape when the patient looks from far to near.
The natural lens remains inside the eye and continues to age normally.
A standard ICL therefore does not:
- Restore natural accommodation
- Reverse hardening of the crystalline lens
- Prevent presbyopia from progressing
- Guarantee freedom from reading glasses
- Prevent future cataract
If both eyes are corrected fully for distance, reading glasses may be required even when distance vision is excellent.
Why Can Some Myopic Patients Read Without Glasses Before ICL Surgery?
A short-sighted person may be able to read by removing their distance spectacles.
For example, a patient with moderate myopia may have blurry distance vision but can hold a phone or book at the natural focal distance of the uncorrected eye.
This is not because the patient has escaped presbyopia.
Instead, the remaining myopia provides a near focus without the natural lens having to accommodate as much.
When ICL surgery corrects both eyes fully for clear distance vision:
- The myopia is removed optically
- The unaided near focal point is lost
- Existing presbyopia becomes more apparent
- Reading glasses may suddenly seem necessary
The ICL has not caused or accelerated presbyopia. It has removed the myopia that previously allowed the patient to read at close range without glasses.
Can ICL Make Presbyopia Worse?
ICL surgery does not normally make the natural lens age more rapidly.
However, patients may feel that their near vision has become worse because their previous unaided reading strategy no longer works.
Before surgery, a myopic patient might:
- Remove their spectacles to read
- Hold a phone close to the face
- Use the less short-sighted eye for intermediate work
After full distance correction, both eyes may focus clearly in the distance but require additional optical power for near tasks.
This effect should be explained carefully before surgery, particularly for patients in their late thirties, forties and fifties.
How Can ICL Reduce Dependence on Reading Glasses?
There are two main ICL-based approaches.
Monovision With a Standard ICL
One eye—usually the dominant eye—is corrected for distance.
The other eye is intentionally left mildly myopic so that it can focus better at an intermediate or near distance.
The brain learns to use:
- The distance eye for driving, television and outdoor vision
- The nearer eye for phones, menus and computer work
- Both eyes together across a functional range
Extended-Depth-of-Focus ICL
A specially designed ICL uses an optical profile intended to extend the range of clear focus.
Rather than giving each eye a completely different target, the lens aims to provide useful:
- Distance vision
- Intermediate vision
- Near vision
The evidence for these newer lenses is promising, but it is less extensive and has shorter follow-up than the evidence supporting standard monofocal EVO ICLs.
What Is Monovision?
Monovision is a strategy in which the two eyes are deliberately given different refractive targets.
Typically:
- The dominant eye is corrected for distance
- The non-dominant eye retains some myopia for nearer tasks
The amount of myopia left in the near eye is individualised.
A stronger near target may improve close reading but may also cause more imbalance between the eyes. A smaller difference may preserve better binocular quality but provide less near vision.
What Is Mini-Monovision?
Mini-monovision uses a smaller difference between the distance and near eyes.
The near eye may be targeted mainly for:
- Computer distance
- Dashboard distance
- Food preparation
- Shopping labels
- Larger phone text
Fine print may still require reading glasses.
Potential advantages over stronger monovision include:
- Easier adaptation
- Better depth perception
- Better binocular distance quality
- Less imbalance between the eyes
- Fewer night-driving difficulties
The trade-off is that unaided very-near vision may be less strong.
Does Monovision ICL Work?
Published studies suggest that monovision using a central-port ICL can provide useful binocular vision from near to distance in selected presbyopic myopes.
A 2017 study reported good binocular near-to-far vision following monovision implantation with a central-port ICL.
A 2025 comparative study followed 24 patients with early presbyopia for an average of approximately four and a half years. Monovision using either an ICL or femtosecond LASIK provided good binocular vision across near, intermediate and distance ranges. The ICL group also had favourable safety, efficacy and contrast-sensitivity measurements, although the study was small and should not be generalised to every patient.
Monovision can be effective, but not everyone adapts comfortably.
What Are the Advantages of Monovision ICL?
Potential advantages include:
- Reduced dependence on reading glasses
- Preservation of the natural crystalline lens
- No central corneal tissue removal
- Correction of high myopia
- A toric option when astigmatism is present
- The possibility of adjusting the strategy through spectacles, contact lenses or ICL exchange
- Less reliance on multifocal optics
Monovision uses standard optical principles rather than dividing light into multiple focal points within each eye.
What Are the Limitations of Monovision?
The brain must combine two eyes that are focused at different distances.
Possible disadvantages include:
- Reduced depth perception
- Reduced stereoacuity
- Slightly reduced distance sharpness
- Reduced contrast in some conditions
- Difficulty with night driving
- Halos or glare
- Eye strain
- A sense that the eyes are unbalanced
- Inadequate near vision as presbyopia progresses
- Difficulty adapting to the visual difference
Monovision is a compromise rather than a complete recreation of youthful accommodation.
Who May Find Monovision Difficult?
Monovision may be less suitable for people who require precise binocular vision, including some:
- Pilots
- Professional drivers
- Surgeons
- Dentists
- Engineers
- Competitive athletes
- Photographers
- People working in low-light environments
- Individuals with poor vision in one eye
- Patients with significant strabismus or binocular-vision problems
The relevance depends on the person’s exact occupation and visual demands.
Should Monovision Be Trialled Before Surgery?
Whenever practical, yes.
A contact lens trial can simulate the planned distance and near targets before surgery.
The trial allows the patient to assess:
- Distance clarity
- Computer vision
- Phone and reading vision
- Night driving
- Depth perception
- Sports performance
- Visual comfort
- Adaptation between the eyes
Professional consensus on presbyopia assessment supports trialling unequal optics with contact lenses before a permanent surgical strategy when possible.
A successful contact lens trial does not guarantee an identical surgical result, but it provides valuable information about whether the patient can tolerate monovision.
What if the Patient Cannot Tolerate Monovision?
Options may include:
- Correcting both eyes for distance and using reading glasses
- Reducing the difference between the eyes
- Correcting the near eye with spectacles for selected tasks
- Using a contact lens on one eye
- Exchanging the ICL
- Considering another presbyopia-management strategy
ICL exchange is possible, but it requires another intraocular operation and carries additional surgical risks.
This is why careful preoperative simulation and counselling are preferable to relying on exchange as the primary adjustment method.
Can a Toric ICL Be Used for Monovision?
Yes.
A toric ICL can:
- Correct regular astigmatism
- Correct most of the myopia
- Intentionally leave a chosen amount of myopia in the near eye
The toric component must still be aligned accurately with the astigmatic axis.
The surgeon must therefore plan:
- The spherical target
- Cylinder power
- Toric axis
- ICL size
- Expected vault
- Which eye will be used for distance
- Which eye will be used for nearer tasks
Can Both Eyes Be Left Slightly Myopic?
Yes, in selected patients.
Rather than full monovision, both eyes may be targeted for mild residual myopia.
This may provide:
- Good intermediate vision
- Some functional near vision
- Better symmetry between the eyes
However, distance vision may be less sharp, particularly for:
- Driving
- Road signs
- Theatre or lecture viewing
- Sports
- Low-contrast conditions
Spectacles may then be needed for the clearest distance vision.
What Is a Presbyopia-Correcting ICL?
A presbyopia-correcting phakic lens is implanted while the natural crystalline lens remains inside the eye.
Unlike a standard monofocal ICL, its optics are designed to provide a broader range of focus.
Different presbyopia-correcting phakic-lens designs include:
- Extended-depth-of-focus optics
- Multifocal or trifocal optics
- Aspheric optics
- Diffractive optics
- Iris-fixated multifocal lenses
These lenses are not all ICLs, and they have different materials, positions and risk profiles.
What Is EVO Viva ICL?
EVO Viva is a presbyopia-correcting ICL with an aspheric extended-depth-of-focus optical design.
It is intended to correct or reduce:
- Myopia
- Presbyopia
- Dependence on spectacles across a range of distances
Like a standard ICL, it is positioned behind the iris and in front of the natural lens.
Official Australian patient information describes EVO Viva as intended for myopic and presbyopic patients aged 21 to 60 years, within its labelled refractive range. Approval, indications and availability vary by country and should be confirmed locally.
EVO Viva is not the same as the standard distance-correcting EVO or EVO+ ICL.
Does EVO Viva Restore Natural Accommodation?
No.
EVO Viva does not make the natural lens flexible again.
It uses an extended-depth-of-focus optical profile to increase the range over which images appear acceptably clear.
This is known as pseudoaccommodation.
The patient may achieve useful vision at several distances without the lens physically changing shape.
What Does the Evidence Show for Extended-Depth-of-Focus ICL?
A prospective multicentre study evaluated an extended-depth-of-focus ICL in presbyopic patients with myopia.
At six months, the study reported:
- Improved uncorrected distance vision
- Improved intermediate vision
- Improved near vision
- No significant reduction in measured contrast sensitivity
- Improved vision-related quality of life
- Satisfaction with vision in 91.2% of participants
The study was encouraging but relatively small and had short follow-up.
A 2023 study of 80 eyes from 40 patients supported the potential of EVO Viva for myopia and presbyopia correction in patients aged 45 to 55 years. The authors noted that additional research was needed, including assessment of the effect of lens misalignment on visual quality.
A 2026 systematic review of presbyopia-correcting phakic lenses found favourable early functional and short-term safety results across several designs. However, the overall body of evidence remains smaller and less mature than that for standard monofocal phakic lenses or established cataract-lens technologies.
What Are the Potential Advantages of an Extended-Depth-of-Focus ICL?
Potential benefits include:
- Useful distance, intermediate and near vision
- Less dependence on readers
- Preservation of the natural crystalline lens
- No central corneal tissue removal
- Avoidance of refractive lens exchange in selected younger patients
- A removable or exchangeable implant
- Maintenance of future cataract-surgery options
These advantages may be particularly attractive to a myopic patient in their forties or early fifties with:
- A clear natural lens
- Suitable internal eye anatomy
- A desire to preserve the natural lens
- Significant myopia
- Limited suitability for corneal laser surgery
What Are the Limitations of a Presbyopia-Correcting ICL?
Possible limitations include:
- Glare or halos
- Reduced clarity in dim lighting
- Variability in near performance
- Continued need for reading glasses for fine print
- Dependence on pupil size and lens position
- Sensitivity to decentration or tilt
- Limited toric options depending on the model
- Progressive presbyopia
- Future cataract
- Less long-term evidence than standard ICL
- Country-specific availability and regulatory approval
Patients should not assume that an extended-depth-of-focus ICL guarantees perfect vision at every distance.
Can an Extended-Depth-of-Focus ICL Cause Halos?
Yes.
Extending depth of focus involves changing the way light is distributed.
Possible symptoms include:
- Halos around lights
- Glare
- Starbursts
- Rings or arcs
- Reduced quality in dim lighting
- Difficulty with fine near detail
Some symptoms improve through neural adaptation, but persistent visual phenomena can occur.
The 2020 extended-depth-of-focus ICL study found high overall satisfaction and no significant measured contrast-sensitivity reduction, but glare was among the vision-quality considerations assessed.
Will Reading Glasses Still Be Needed?
Possibly.
Reading glasses may still be needed for:
- Very small print
- Prolonged reading
- Dim lighting
- Medicine labels
- Detailed craftwork
- Fine professional tasks
- Periods of fatigue
- Further progression of presbyopia
The realistic objective is often reduced dependence on reading glasses rather than guaranteed complete spectacle independence.
What Happens as Presbyopia Progresses?
Presbyopia is progressive.
A strategy that provides adequate near vision at age 43 may be less effective at age 50 or 55.
With standard monovision:
- The near eye’s fixed myopic target does not change
- The natural lens continues losing accommodation
- Stronger reading glasses may eventually be required
With an extended-depth-of-focus ICL:
- The optical design remains stable
- Natural accommodation continues to decline
- Fine near tasks may become more difficult
- Cataract or other natural-lens changes may later affect vision
Long-term planning should take into account the likely future evolution of the natural lens.
Does ICL Prevent Cataract?
No.
The natural crystalline lens remains inside the eye after ICL surgery.
It continues to age and may eventually become cloudy.
A study of central-port ICL implantation in middle-aged patients found generally favourable refractive and visual outcomes, but cataract development remained an important consideration during follow-up.
When a visually significant cataract develops:
- The ICL is removed.
- The cloudy natural lens is removed.
- A cataract intraocular lens is implanted.
When Is Cataract Surgery Better Than ICL?
Cataract surgery may be more appropriate when the patient has:
- Visually significant cataract
- Early cataract already causing glare
- Reduced corrected vision from the natural lens
- Significant natural-lens opacity
- A shallow anterior chamber
- Inadequate endothelial cell density
- Anatomy unsuitable for ICL
- A strong desire for a cataract-lens-based presbyopia strategy
Implanting an ICL in front of a lens that is already becoming cloudy may provide only temporary benefit before another intraocular operation is required.
What About Refractive Lens Exchange?
Refractive lens exchange removes the clear natural lens before a visually significant cataract has developed.
It may offer:
- Correction of myopia
- Correction of astigmatism
- Multifocal or extended-depth-of-focus lens options
- Elimination of future cataract in the operated lens
However, it also:
- Permanently removes natural accommodation
- Is not reversible
- Introduces cataract-surgery-related risks
- May increase retinal-detachment concern in younger, highly myopic patients
- Requires careful intraocular-lens selection
For a younger highly myopic patient with a clear natural lens, preserving that lens with an ICL may be preferable. For an older patient with early cataract, lens extraction may be more logical.
Is ICL Suitable for Everyone With Presbyopia?
No.
Suitability depends on:
- Age
- Degree of myopia
- Astigmatism
- Prescription stability
- Natural-lens clarity
- Anterior chamber depth
- Drainage-angle anatomy
- Endothelial cell density
- Eye pressure
- Glaucoma risk
- Retinal health
- Visual occupation
- Night-driving needs
- Willingness to accept optical compromises
Patients must also understand that presbyopia correction is less predictable than simple distance correction because near-vision satisfaction depends on the brain, pupil, lighting and visual tasks as well as the measured prescription.
Who May Be Suitable for Monovision ICL?
A potential candidate may have:
- Stable myopia
- Early or established presbyopia
- A clear natural lens
- Suitable internal eye anatomy
- Adequate endothelial cell density
- A successful monovision contact lens trial
- Realistic expectations
- No major binocular-vision disorder
- No occupation requiring maximal stereopsis
- Willingness to use readers for demanding tasks when needed
Who May Be Suitable for an Extended-Depth-of-Focus ICL?
A potential candidate may have:
- Myopia with presbyopia
- A clear natural crystalline lens
- Suitable anterior chamber depth and drainage angles
- Adequate endothelial cell density
- No significant cataract
- Realistic expectations regarding halos and readers
- A desire for a continuous functional range of vision
- Understanding that long-term evidence is still developing
- Access to an approved lens in their jurisdiction
Who May Be Unsuitable?
ICL-based presbyopia correction may be unsuitable when there is:
- Significant cataract
- Moderate or advanced glaucoma
- Narrow drainage angles
- A shallow anterior chamber
- Inadequate endothelial cell density
- Active uveitis
- Active eye infection
- Unstable refraction
- Vision-limiting retinal disease
- Significant macular degeneration
- Severe binocular-vision dysfunction
- Unrealistic expectations
- Inability to attend long-term reviews
Why Is Retinal Assessment Important?
Many ICL candidates have high myopia.
High myopia increases the lifetime risk of:
- Retinal holes
- Retinal tears
- Retinal detachment
- Myopic macular degeneration
- Myopic traction maculopathy
- Macular haemorrhage
ICL surgery corrects the refractive blur but does not shorten the elongated eye or remove these risks.
A dilated retinal examination is therefore important before surgery and during long-term follow-up.
What Tests Are Needed Before Presbyopia-Correcting ICL Surgery?
Distance, Intermediate and Near Refraction
The assessment should determine:
- Distance prescription
- Astigmatism
- Near addition
- Preferred reading distance
- Computer-working distance
- Best-corrected vision
Ocular Dominance
Dominance testing helps identify which eye may be preferred for distance in a monovision strategy.
Dominance can vary according to the test and should not be treated as the only deciding factor.
Monovision Contact Lens Trial
A trial is particularly useful for assessing:
- Adaptation
- Depth perception
- Night vision
- Reading comfort
- Computer performance
- Occupational suitability
Binocular-Vision Assessment
Testing may include:
- Ocular alignment
- Fusion
- Stereoacuity
- Suppression
- Eye movement control
Pupil Measurement
Pupil size can influence:
- Halos
- Glare
- Depth-of-focus optics
- Night vision
- Visual quality
Corneal Topography and Tomography
These tests assess:
- Corneal shape
- Corneal thickness
- Regularity of astigmatism
- Keratoconus risk
- Suitability for future enhancement
Anterior Chamber Measurements
These determine whether there is adequate space for an ICL.
Endothelial Cell Count
The corneal endothelium must have an adequate reserve before intraocular implantation.
Natural-Lens Examination
The surgeon must look carefully for:
- Early cataract
- Anterior subcapsular opacity
- Nuclear lens change
- Other causes of glare or reduced vision
Eye Pressure and Glaucoma Assessment
This may include:
- Eye-pressure measurement
- Gonioscopy
- Optic nerve examination
- OCT
- Visual-field testing when indicated
Dilated Retinal Examination
This is particularly important in moderate and high myopia.
Which Strategy Provides the Best Distance Vision?
Full bilateral distance correction with standard monofocal ICLs generally prioritises the clearest and most symmetrical distance vision.
This may be preferable for patients whose priorities include:
- Night driving
- Sport
- Precise depth perception
- Fine distance detail
- Low-light performance
- Maximum binocular contrast
Reading glasses can then provide clear and flexible near vision.
Which Strategy Provides the Most Reading Freedom?
A stronger monovision target or a presbyopia-correcting extended-depth-of-focus lens may provide greater independence from readers.
However, increased near range may involve trade-offs in:
- Distance sharpness
- Contrast
- Night quality
- Stereoacuity
- Halos
- Adaptation
The best strategy depends on the patient’s priorities rather than on achieving the broadest possible range at any cost.
Is Reading-Glasses Use a Failure?
No.
Reading glasses provide:
- High-quality near focus
- Adjustable strength
- Symmetrical binocular vision
- Flexibility for different working distances
- No added intraocular optical compromise
A patient may choose standard distance ICLs and use readers because this combination provides the most reliable overall visual quality.
The goal of refractive surgery is not necessarily to eliminate every pair of glasses. It is to choose the balance of vision, quality and risk that best suits the individual.
Can Presbyopia Correction Be Changed Later?
Possibly.
After monovision ICL, options may include:
- Distance spectacles over both eyes
- Reading glasses
- A contact lens on one eye
- ICL exchange
- Corneal laser enhancement in a suitable cornea
- Cataract surgery later in life
After a presbyopia-correcting ICL, options may include:
- Reading glasses
- Distance glasses
- Lens exchange or removal
- Cataract surgery when required
Any secondary intraocular procedure carries additional risk.
Is Presbyopia-Correcting ICL Reversible?
The implanted lens can usually be removed or exchanged.
In an uncomplicated eye, removing the ICL largely removes its optical effect and returns the underlying myopic prescription.
However:
- Removal requires another intraocular operation
- A small peripheral corneal incision remains
- The eye may have changed naturally
- Cataract or endothelial loss may not reverse
- The natural presbyopia remains
The optics are removable, but the ageing process that caused presbyopia is not reversed.
What Questions Should You Ask Your Surgeon?
Useful questions include:
- Is my natural lens completely clear?
- Am I better suited to standard distance correction, monovision or an extended-depth-of-focus ICL?
- What near target would you recommend?
- Which eye would be used for distance?
- Can I trial the proposed correction with contact lenses?
- How will monovision affect depth perception?
- How might it affect night driving?
- Will I still need reading glasses?
- Is a presbyopia-correcting ICL approved and available locally?
- How extensive is the long-term evidence for that lens?
- What are the risks of halos or reduced contrast?
- What happens as my presbyopia progresses?
- How soon might I develop cataract?
- Would cataract surgery or lens replacement be more appropriate?
- What happens if I cannot adapt?
- Can the ICL be exchanged?
- What long-term follow-up will I need?
Frequently Asked Questions About ICL and Presbyopia
Can a Standard ICL Cure Presbyopia?
No.
A standard ICL corrects myopia and astigmatism but does not restore natural accommodation.
Will I Need Reading Glasses After ICL?
Possibly, especially when both eyes are corrected fully for distance.
Official standard EVO ICL information states that distance correction does not eliminate the future need for reading glasses.
Does ICL Cause Presbyopia?
No.
Presbyopia is caused by age-related changes in the natural crystalline lens.
Why Could I Read Without Glasses Before Surgery?
Your uncorrected myopia may have provided a natural near focal point.
Correcting that myopia for distance removes this unaided reading advantage.
Can One ICL Be Set for Near Vision?
Yes.
The non-dominant eye can intentionally be left mildly myopic as part of monovision.
Is Monovision Permanent?
The optical target remains while the ICL is in place, but the effect can be modified with spectacles, contact lenses, laser enhancement or ICL exchange.
Any additional surgery has risks.
Does Everyone Adapt to Monovision?
No.
Some patients adapt easily, while others dislike the imbalance or reduction in depth perception.
Should I Trial Monovision First?
A contact lens trial is strongly advisable whenever practical.
Can Toric ICL Correct Presbyopia and Astigmatism?
A toric ICL can correct astigmatism while leaving a planned degree of myopia in one eye for monovision.
A standard toric ICL does not itself create an extended range of focus.
What Is EVO Viva?
EVO Viva is an extended-depth-of-focus ICL designed to correct myopia and presbyopia in selected markets.
It is not the same as the standard distance-correcting EVO ICL.
Is EVO Viva Available Everywhere?
No.
Regulatory approval and availability vary by country. Local availability should be confirmed with the treating clinic and relevant regulatory information.
Does EVO Viva Restore Accommodation?
No.
It extends the range of focus optically rather than restoring movement or flexibility of the natural lens.
Will EVO Viva Eliminate Reading Glasses?
Not necessarily.
It may reduce dependence on readers, but fine print and low-light tasks may still require additional correction.
Is EVO Viva Better Than Monovision?
Neither strategy is universally better.
EVO Viva aims to provide a broader range in each eye, while monovision relies on different focal targets between the eyes.
The preferred option depends on visual priorities, anatomy, availability and tolerance for the different optical trade-offs.
Can I Have ICL After Age 40?
Possibly.
The natural lens must be sufficiently clear, and presbyopia, cataract risk and near-vision expectations require careful discussion.
Can I Have ICL After Age 50?
Selected patients may remain suitable, but early cataract and the likely time before cataract surgery become increasingly important.
Is Cataract Surgery Better After 50?
Not automatically.
The decision depends on natural-lens clarity, retinal risk, anatomy and visual goals rather than age alone.
Does ICL Prevent Cataract?
No.
The natural lens remains and continues to age.
What Happens When Cataract Develops?
The ICL is removed, the cloudy natural lens is removed and a cataract intraocular lens is implanted.
Can ICL Treat Presbyopia in Someone Without Myopia?
Most established ICL presbyopia strategies are aimed at myopic patients.
Suitability and approved refractive ranges vary by lens and jurisdiction.
Can ICL Treat Hyperopia and Presbyopia?
Some phakic-lens models for hyperopia exist in selected markets, but standard EVO ICL indications and presbyopia-correcting options vary. A comprehensive assessment is required.
Is Presbyopia Treatment Guaranteed to Last?
No.
The natural lens continues to age, presbyopia progresses and cataract may eventually develop.
Do I Still Need Long-Term Eye Checks?
Yes.
Monitoring may include:
- Eye pressure
- Drainage angles
- ICL position
- Vault
- Endothelial cell count
- Natural-lens clarity
- Retina and macula
- Optic nerve health
Key Takeaway
A standard ICL does not directly cure presbyopia or restore natural accommodation.
When both eyes are corrected fully for distance:
- Distance vision may become excellent
- Previous unaided reading vision from myopia is lost
- Reading glasses may be required
- Presbyopia continues to progress naturally
ICL can nevertheless reduce dependence on reading glasses through:
- Monovision
- Mini-monovision
- Presbyopia-correcting extended-depth-of-focus ICLs in selected markets
Monovision uses one eye mainly for distance and the other for nearer tasks. It can provide useful binocular vision across several distances, but it may reduce depth perception, contrast or night-time visual quality. A contact lens trial is advisable before surgery.
Extended-depth-of-focus lenses such as EVO Viva aim to provide distance, intermediate and near vision in each eye. Early studies report encouraging visual outcomes and high satisfaction, but the evidence base remains smaller and shorter-term than that for standard monofocal ICLs.
Neither strategy restores youthful accommodation.
The appropriate choice depends on:
- Age
- Natural-lens clarity
- Degree of myopia and astigmatism
- Ocular dominance
- Binocular vision
- Night-driving needs
- Occupation
- Tolerance for optical compromises
- Willingness to use reading glasses when necessary
- Local lens availability and approval
For some patients, standard bilateral distance ICL with reading glasses provides the best visual quality.
For others, carefully trialled monovision or an approved presbyopia-correcting ICL may provide greater spectacle independence.
References
- STAAR Surgical. Important Safety Information for the Standard EVO Visian ICL. The standard lens corrects distance myopia and does not eliminate the future need for reading glasses.
- US Food and Drug Administration. EVO and EVO+ Visian Implantable Collamer Lens: Patient Information and Professional Labelling.
- Kamiya K, et al. Monovision by Implantation of a Posterior-Chamber Phakic Intraocular Lens With a Central Hole. 2017. PMID: 28900204.
- Ye Y, et al. Comparison of Monovision Surgery Using ICL V4c or Femtosecond LASIK for Myopia Correction in Patients of Presbyopic Age. Scientific Reports. 2025;15:7629. PMID: 40038326.
- Wolffsohn JS, et al. BCLA CLEAR Presbyopia: Evaluation and Diagnosis. 2024. PMID: 38641525.
- Mahrous A, et al. Revisiting Monovision for Presbyopia. 2018. PMID: 29708928.
- Evans BJW. Monovision: A Review. 2007. PMID: 17718882.
- Packer M, Alfonso JF, Aramberri J, et al. Performance and Safety of the Extended-Depth-of-Focus Implantable Collamer Lens in Phakic Subjects With Presbyopia. Clinical Ophthalmology. 2020;14:2717–2730. PMID: 32982164.
- Alfonso JF, Fernández-Vega-Cueto L, Lisa C, et al. Clinical and Aberrometric Outcomes of a New Implantable Collamer Lens for Myopia and Presbyopia Correction in Phakic Patients. Journal of Refractive Surgery. 2023;39:589–596. PMID: 37675906.
- González-Lugo JH, Zhang H, Alió JL, et al. Phakic Presbyopic Intraocular Lenses: A Systematic Review. Journal of Cataract & Refractive Surgery. 2026. PMID: 41860842.
- STAAR Surgical. EVO Viva Patient Information Booklet: ICLs for Nearsightedness and Presbyopia. Australian patient information, 2024.
- Igarashi A, et al. Multicentre Clinical Outcomes of Central-Port ICL Implantation in Middle-Aged Patients. 2022.
- Ma Y, et al. Long-Term Visual Quality in Patients With Myopia and Presbyopia After ICL V4c or Femtosecond LASIK. 2025. PMID: 40694076.
