For about twenty years, LASIK was the answer to bad vision: book it in your twenties or thirties, toss the contacts, and assume you're finished with eye doctors for good. Some of us were told we weren't candidates at all. The rest found out in our mid-forties, when a pair of drugstore readers showed up in every handbag. If either sounds familiar, there are two alternatives worth knowing, and Dr. Omar Shakir of Coastal Eye in Greenwich performs both: EVO ICL and Refractive Lens Exchange, or RLE. Neither touches your cornea, and each is built for a different kind of patient.
LASIK works by reshaping the cornea, the clear window at the front of the eye, which is why it has limits. Corneas that are too thin don't qualify. Corrections can drift over time. And LASIK does nothing for the lens behind the cornea, which is the part that ages, loses its focus up close, and eventually clouds into a cataract. EVO ICL and RLE both work inside the eye instead, correcting exactly what LASIK can't reach.
EVO ICL keeps your natural lens, can be removed if needed, and is often the better fit for younger nearsighted patients.
At Coastal Eye, with boutique offices in Greenwich and New Canaan, Dr. Shakir performs both procedures. One is built for nearsighted patients who want to keep their natural lens. The other replaces that lens for good. Here is how to tell which one is yours.
Option One: EVO ICL. The EVO Implantable Collamer Lens is a very small, flexible lens placed inside the eye, in front of your natural lens and behind the iris. Think of it as a contact lens that lives inside your eye, one you can't see in the mirror or feel. It's made from Collamer, a collagen-based material that reads to the eye as natural tissue rather than a foreign object, which is part of why it's well tolerated long-term.
EVO ICL corrects nearsightedness, including high prescriptions, with or without astigmatism. Dr. Shakir recommends it as a strong option for patients who have been told LASIK isn't right for them, including those with thin corneas. He explains that it delivers sharp vision and excellent night vision, doesn't cause or worsen dry eye, and offers built-in UV protection.
Two details make it stand out. The newest EVO version eliminates a preparatory step that earlier ICLs required, so the whole process can be started and finished within 24 to 48 hours. And while it's designed to be permanent, the lens can be removed if it ever needs to be. Dr. Shakir and the Coastal Eye team have been performing ICL surgery for more than a decade.
Option Two: Refractive Lens Exchange. RLE replaces your eye's natural lens with a custom artificial implant called an intraocular lens, or IOL. It is the same procedure as cataract surgery, performed before a cataract has had a chance to form. It's designed for nearsightedness, farsightedness, presbyopia, and for corneas too thin for LASIK.
Dr. Shakir often points to RLE for patients in their forties and fifties. Because the aging lens itself is replaced, the right implant can restore vision up close as well as far away. He notes that once astigmatism is corrected with RLE it typically doesn't return, and your prescription should stabilize for life. Best of all, a cataract can't form in a lens you no longer have, so cataract surgery is off your calendar for good.
Patients choose between two main implants. Multifocal lenses work like progressive glasses built into the eye, focusing near and far at once — Dr. Shakir often recommends them when a patient wants the widest range of vision and hopes to rely on reading glasses as little as possible. The Light Adjustable Lens can be fine-tuned with non-invasive light treatments after surgery, once you've healed and are living with it. Both come in toric versions for astigmatism, and Coastal Eye includes the toric upgrade at no additional cost when it's needed.
So Which One Is for You? The simplest way to think about it is age and prescription. EVO ICL keeps your natural lens, can be removed if needed, and is often the better fit for younger nearsighted patients. RLE replaces the natural lens permanently and is often preferred in your forties and fifties, when reading vision is fading or you'd like to rule out cataracts altogether. Your consultation will settle the question for your eyes.
What the Day Looks Like: Both procedures happen in Coastal Eye's in-office surgical suite, and neither requires general anesthesia. EVO ICL takes about 5 to 10 minutes per eye, with a quick recovery. RLE takes about 15 minutes per eye; you're awake with numbing drops, oral sedation is available if you want it, and both eyes can be done the same day. Coastal Eye performs RLE with a femtosecond laser guided by augmented reality from LensAR, customized to each eye, and RLE patients often see clearly by the time the dilation wears off.
The Fine Print: Both are surgery inside the eye, and both carry risks Dr. Shakir will walk you through, including infection and increased eye pressure. With EVO ICL, your natural lens stays, which means a cataract can still develop later in life. RLE is permanent and can't be reversed, and its risks mirror cataract surgery, including glare or halos and, less commonly, retinal detachment. Most complications can be treated, and both procedures have high success rates. The consultation, which includes detailed measurements of your eyes, is where you find out which one fits.
If you were told years ago that you weren't a LASIK candidate, or you've started reading texts at arm's length, it's worth the conversation.