Lens Replacement Surgery Abroad: RLE & ICL Guide for 2025

What Is RLE & ICL?

Refractive Lens Exchange (RLE), also called clear lens exchange or presbyopic lens exchange, is essentially the same procedure as cataract surgery — but performed on a clear lens to correct refractive errors rather than to remove a cataract. The natural lens is removed and replaced with an artificial intraocular lens (IOL) chosen to correct your specific vision needs. RLE is particularly attractive for patients over 45-50 who are developing presbyopia (age-related loss of near focus) and may have early cataracts forming, as it simultaneously corrects the refractive error and eliminates the possibility of future cataracts.

The Implantable Collamer Lens (ICL) takes a different approach: rather than removing the natural lens, a thin, biocompatible lens is placed in front of the natural lens (behind the iris) through a tiny incision. The Visian ICL by STAAR Surgical is the most widely implanted phakic IOL, with over 2 million lenses implanted worldwide. The ICL is particularly well-suited for younger patients (21-45) with high myopia (-3.00 to -20.00 diopters) or high hyperopia who are not good candidates for LASIK due to thin corneas or extreme prescriptions. Unlike LASIK, the ICL is reversible — it can be removed or exchanged if needed.

The latest generation of ICL — the EVO Visian ICL — features a central port (KS-AquaPORT) that eliminates the need for a peripheral iridotomy, simplifying the surgical procedure and reducing post-operative complications. The EVO ICL is made of Collamer, a proprietary biocompatible material that contains collagen, making it uniquely compatible with the eye's natural chemistry. This material also provides built-in UV protection, adding a long-term benefit beyond vision correction. Clinical studies have demonstrated that the EVO ICL achieves 20/20 vision or better in over 95% of properly selected patients, with extremely high patient satisfaction rates.

One of the most significant advantages of lens-based procedures over corneal laser surgery is the quality of vision achieved. Because RLE and ICL correct vision at the lens plane rather than by reshaping the cornea, they tend to produce fewer higher-order aberrations — the optical imperfections that cause halos, glare, and reduced contrast sensitivity. For patients with very high prescriptions, this difference in visual quality can be substantial. ICL patients, in particular, frequently report that their vision is sharper and more vivid than it ever was with glasses or contact lenses, because the ICL provides a wider effective optical zone and does not induce the spherical aberration that thick spectacle lenses create.

Who Is a Candidate?

• RLE Candidates: Patients over 45-50 with presbyopia and any refractive error; patients with high hyperopia (+3.00 or more) who are poor LASIK candidates; patients with early cataracts who want to address both the cataract and refractive error; patients who want to eliminate the need for reading glasses.
• ICL Candidates: Younger patients (21-45) with high myopia (-3.00 to -20.00 diopters); patients with thin corneas who cannot safely undergo LASIK; patients with moderate to high astigmatism (toric ICL available); patients seeking reversible vision correction.
• Not Suitable: Patients with active eye diseases (glaucoma, macular degeneration, diabetic retinopathy); patients with anterior chamber depth less than 2.8mm (for ICL); patients with endothelial cell count below safe thresholds.

The candidacy assessment for lens-based procedures is more nuanced than for LASIK, requiring careful consideration of the patient's age, visual demands, and long-term ocular health trajectory. A comprehensive evaluation at a specialized clinic includes not only standard refractive measurements but also anterior segment imaging (Pentacam or Orbscan), endothelial cell density measurement (specular microscopy), and detailed retinal assessment (OCT and dilated fundus examination). These tests help the surgeon determine whether ICL or RLE is the better option and identify any co-existing conditions — such as macular pathology or early glaucomatous changes — that might affect the choice of procedure or lens type.

Patients with very high myopia (greater than -10.00 diopters) deserve special attention when considering lens-based procedures. High myopia is associated with increased risks of retinal detachment, macular degeneration, and glaucoma — conditions that exist independently of the refractive surgery. An experienced ophthalmic surgeon at Anadolu Medical Center will perform a thorough retinal examination before proceeding with ICL or RLE to identify and treat any pre-existing retinal pathology (such as lattice degeneration or retinal holes) that could lead to complications after surgery. This proactive approach to retinal health is a hallmark of excellence in lens-based refractive surgery.

Cost Comparison

Lens Replacement Surgery Cost Comparison 2025 (Per Eye)

RLE = Refractive Lens Exchange. ICL = Implantable Collamer Lens (Visian ICL by STAAR Surgical). Prices include consultation, surgery, lens implant, and standard post-operative care. Both eyes typically treated 1-2 weeks apart.

Turkey offers exceptional value for both RLE and ICL procedures, with specialized eye centers providing the full range of premium lens options at 60-75% lower cost than the US. Dünyagöz Eye Hospital performs both RLE and ICL procedures at high volume, offering patients access to the latest premium IOLs (PanOptix, Synergy, Vivity) for RLE and the Visian ICL/EVO+ for phakic implantation. Their extensive experience with lens-based procedures ensures precise lens power calculations and optimal visual outcomes.

Veni Vidi Eye Clinics in Istanbul specializes in refractive surgery and offers comprehensive evaluation to determine whether LASIK, PRK, ICL, or RLE is the best option for each patient's unique eyes and lifestyle. The clinic's thorough approach — including advanced biometry, corneal tomography, and lifestyle assessment — ensures that patients receive the most appropriate treatment rather than a one-size-fits-all recommendation. For patients seeking hospital-level care, Anadolu Medical Center provides RLE and ICL services within its fully equipped ophthalmology department.

RLE vs. ICL

The choice between RLE and ICL depends primarily on age, prescription, and whether the natural lens is still functioning well. For patients over 50, RLE is generally preferred because it simultaneously addresses presbyopia (age-related near vision loss) and prevents future cataract development. Since the natural lens would eventually need to be replaced due to cataracts anyway, RLE essentially 'solves two problems at once.' For younger patients (21-45) with high myopia, ICL is typically preferred because it preserves the eye's natural focusing ability (accommodation) and is reversible.

There is also a middle ground for patients aged 40-50 where the decision requires careful analysis. In this age group, accommodation is declining but not yet completely lost, and early lens changes may be present but not yet causing significant symptoms. An experienced refractive surgeon will consider the patient's occupational demands, tolerance for glasses, and long-term visual trajectory when recommending RLE versus ICL. In some cases, a 'bioptics' approach — combining ICL implantation with a minor LASIK enhancement — may achieve the most precise visual outcome. At Veni Vidi Eye Clinics, the emphasis is on personalized treatment planning that accounts for both current and future visual needs.

An increasingly popular option for patients in this intermediate age group is the toric ICL, which simultaneously corrects high myopia and astigmatism. The toric Visian EVO ICL can correct up to 4 diopters of astigmatism alongside high myopia, which is a combination that LASIK struggles to address effectively in patients with thin corneas. For patients considering toric ICL abroad, the rotational stability of the lens is critical — a well-positioned toric ICL must remain within 5 degrees of the intended axis to deliver optimal astigmatism correction. Leading clinics use intraoperative digital marking systems and image-guided alignment to ensure precise toric lens positioning. At Memorial Şişli Hospital, ophthalmic surgeons employ Verion or Callisto digital guidance platforms during toric ICL implantation, ensuring that the lens aligns perfectly with the patient's astigmatic axis for the sharpest possible vision.

The psychological impact of transitioning from thick glasses or contact lens dependency to unaided clear vision should not be underestimated. For patients with high myopia who have worn glasses since childhood, the transformation following successful ICL or RLE can be profoundly life-changing. Activities that were previously impossible without corrective lenses — swimming, playing sports, waking up and seeing the clock — become effortless. Many lens replacement patients report significant improvements in self-confidence and quality of life, and satisfaction surveys consistently show that ICL and RLE patients rank among the most satisfied recipients of any refractive surgery procedure.

Patients should also understand the risk profiles of each procedure. ICL surgery carries a small long-term risk of cataract development (estimated at 1-3% over 10 years with the latest EVO ICL design), which would require the ICL to be removed and cataract surgery performed. However, this risk is significantly lower with the current-generation EVO ICL compared to earlier designs. RLE carries the same risk profile as cataract surgery — primarily posterior capsule opacification (PCO), which occurs in 10-20% of patients within 5 years and is easily treated with a painless YAG laser capsulotomy. Both procedures are considered very safe at high-volume centers with experienced surgeons.

Best Destinations

Turkey and South Korea lead in lens replacement procedures, with both countries offering extensive experience with premium IOLs and ICL implantation. Turkey's Çağın Eye Hospital provides comprehensive refractive lens surgery services with personalized IOL selection based on advanced diagnostic imaging. South Korea has the highest per-capita rate of ICL implantation globally, with Seoul clinics performing thousands of ICL procedures annually. India offers the most affordable options, while Czech Republic and Spain serve European patients seeking premium lens surgery at lower costs.

Thailand has also established itself as a quality destination for lens replacement surgery, with Bangkok's leading eye centers — including those affiliated with Bumrungrad International Hospital — offering both RLE and ICL procedures with the latest lens technologies. Thailand's appeal lies in the combination of experienced ophthalmologists, modern facilities, competitive pricing, and the opportunity to recover in a tropical environment. Thai eye clinics are particularly popular among Australian and New Zealand patients, for whom Bangkok is a relatively short flight compared to European or Middle Eastern destinations.

For European patients considering ICL or RLE surgery, Memorial Şişli Hospital in Istanbul provides an attractive option. As a JCI-accredited multi-specialty hospital, Memorial Şişli offers the security of full hospital-level backup — including emergency departments, intensive care, and all medical specialties — while its ophthalmology department maintains the latest diagnostic and surgical equipment for lens-based procedures. The hospital's international patient department coordinates every aspect of the patient journey, from visa support documentation to post-operative hotel arrangements, ensuring a stress-free experience for patients traveling from abroad.

Procedure & Recovery

Both RLE and ICL procedures are outpatient surgeries performed under local anesthesia (numbing drops). RLE takes 15-20 minutes per eye and follows the same technique as cataract surgery — phacoemulsification to remove the natural lens, followed by IOL implantation through a 2-3mm incision. ICL implantation takes 15-30 minutes per eye — the surgeon creates a tiny incision, folds the ICL, and places it behind the iris in front of the natural lens. Both procedures are painless during surgery, with mild discomfort for 1-2 days afterward.

Recovery timelines differ between the two procedures. After ICL surgery, most patients experience rapid visual recovery — clear vision within 24-48 hours — because the cornea is not altered and the natural lens remains intact. The tiny incision heals quickly, and patients can typically resume normal activities within 2-3 days. After RLE, recovery is similar to cataract surgery: vision improves quickly but may fluctuate for 1-2 weeks as the brain adapts to the new IOL. If both eyes require treatment, the second eye is typically operated on 1-2 weeks after the first, allowing the first eye to stabilize. Plan for a total trip duration of 10-14 days if treating both eyes.

Post-operative care for both procedures involves antibiotic and anti-inflammatory eye drops for 2-4 weeks, with gradual tapering as healing progresses. Patients should avoid rubbing their eyes, swimming, and heavy exercise for 2-4 weeks. Regular follow-up examinations are needed at one day, one week, one month, and three months after surgery. International clinics typically handle the immediate post-operative checks before your departure and provide detailed records for your home ophthalmologist to continue monitoring. Many clinics also offer virtual follow-up consultations via video call for international patients who have returned home.

At -14.00 diopters, I was told LASIK was impossible. I had ICL surgery in Istanbul — the entire process from consultation to surgery took two days. I went from being legally blind without glasses to seeing 20/20. It was like seeing the world for the first time.

Hannah S., ICL surgery in Turkey