The contents of this article are informational only and are not intended to be a substitute for professional medical advice, diagnosis, or treatment recommendations. This editorial presents the views and experiences of the author and does not reflect the opinions or recommendations of the publisher of Ophthalmology 360.
By Joseph J. Ling, MD
With declining Medicare reimbursement, rising staffing costs, and increased administrative burdens, the economic foundation of ophthalmology is undergoing a shift. To thrive in this environment, it is beneficial for surgeons to expand beyond the traditional practice paradigm and adopt high-value, cash-pay procedures. For my practice, STAAR Surgical’s EVO Implantable Collamer Lens (ICL) has become a cornerstone of that model. What began as a surgical solution for LASIK-ineligible patients has evolved into a strategy that elevates clinical outcomes and enhances practice revenue.
EVO ICL fills a crucial gap in today’s refractive portfolio: It provides a premium, out-of-pocket option that doesn’t rely on third-party payers. Moreover, the clinical results consistently fuel patient satisfaction and drive organic growth through word-of-mouth referrals. Unlike LASIK or photorefractive keratectomy, EVO ICL is an additive procedure. It doesn’t involve the removal of corneal tissue, which helps preserve corneal biomechanics and long-term ocular surface health. While these features may not be the primary motivator for every patient, we have found that they matter to an increasing number of individuals who are becoming more educated and invested in the long-term impact of their refractive surgery choices.
From a clinical perspective, this lens-based, tissue-preserving approach has resulted in a lower risk profile and more predictable outcomes. It enables us to confidently expand our surgical offerings to a broader range of patients. Initially, we reserved EVO ICL for high myopes or patients with thin corneas. But as indications have expanded to include lower myopes (as low as –3.00 D), our potential patient pool has grown. We’re now treating patients who value future flexibility, professionals concerned about dry eye, and risk-averse individuals hesitant about laser-based surgery. These are patients who are motivated, discerning, and ready to invest in high-quality, upgradable vision. In other words, these are ideal candidates for cash-pay refractive procedures.
Positioning Our Practice
Rates of myopia are increasing globally and across the United States, particularly among younger people who are spending more time indoors and on screens. This trend suggests that the need for effective, flexible vision correction solutions like EVO ICL will continue to grow in the coming years. By offering this lens, we are positioning our practice to meet this rising demand with a technology that preserves ocular anatomy while providing excellent visual outcomes.
When considering EVO ICL for younger patients, I generally recommend waiting until around age 21, provided there is evidence of refractive stability. However, there is nuance in this decision-making, and I approach it as a sliding scale based on the patient’s degree of myopia and lifestyle needs. For highly myopic young adults, even when future refractive changes are possible, the immediate benefit of restoring uncorrected vision from –10.00 D often outweighs the incremental risk, especially when aligned with patient expectations. I have conversations with these patients about what it means to pursue vision correction at a younger age, including the possibility of minor laser enhancements or ICL exchanges in the future. When patients understand and accept these possibilities, I proceed confidently, ensuring our decision aligns with both immediate goals and long-term visual health.
Streamlined Integration
EVO ICL has been seamlessly integrated into our practice. The learning curve is short, and the procedure itself is efficient and reproducible. Preoperative planning—including sizing with a nomogram, white-to-white measurements, and the use of anterior segment optical coherence tomography—is now second nature to our team.
Marketability and Reputation
By offering EVO ICL alongside LASIK and SMILE, we have positioned ourselves as a practice that can deliver customized vision correction solutions based on each patient’s ocular anatomy, lifestyle, and long-term goals. Serving the global community in the San Francisco Bay Area, where we are located, further underscores the importance of offering EVO ICL. Many of our patients have cultural and family ties to regions across the world where EVO ICL is well established and already widely accepted as a primary vision correction procedure. Notably, patient groups from Asia often present with higher rates of moderate-to-high myopia, which aligns precisely with the strengths of EVO ICL in providing safe, effective, and reversible correction without compromising long-term ocular health.
Another important aspect of including this technology in our armamentarium is that it complements, rather than competes with, LASIK or SMILE. We give patients a comprehensive overview of their options and help them choose what aligns with their preferences and ocular anatomy. We’re seeing an increasing number of LASIK-eligible patients choose EVO ICL after understanding its advantages.
When I determine that EVO ICL is the best option for a patient, I stand by that recommendation with confidence. Patients come to us for guidance, and while I take the time to thoroughly explain their options, I do not leave the decision to them without direction. Once they understand the value proposition of EVO ICL—its reversibility, safety profile, and visual quality—I emphasize that this is the procedure I recommend based on their anatomy and lifestyle needs. This clarity helps patients feel supported and reassured, reinforcing the trust they place in our expertise.
A Practice-Building Platform
EVO ICL has evolved from a niche offering to a centerpiece of our refractive surgery practice. It enables us to continue growing our cash-based practice and deliver a differentiated experience to our patients. It attracts new patient demographics and stabilizes revenue as demand for non-laser refractive options grows. The reversibility and long-term stability of this lens also support lifetime patient relationships.
My advice to fellow surgeons? Don’t think of EVO ICL as just a clinical tool—embrace it as a growth engine that reflects the future of patient-centered, scalable refractive care. The future belongs to those who offer broad-spectrum and patient-centered solutions.
Joseph J. Ling, MD, is the Medical Director of Lens Procedures at the Laser Eye Center of Silicon Valley, San Jose, CA. He can be reached at [email protected]. Disclosure: Dr. Ling is a consultant to STAAR Surgical.
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