Phakic lens implants (pIOLs) are increasingly being used to correct high refractive errors. Improved pIOL designs and outcomes may soon lead to their wider acceptance and use. These newer designs allow insertion through smaller incisions. Other advantages include minimal astigmatic effects, unchanged corneal aberrations, reversibility and lack of an effect on accommodation. However, all phakic lens implants can potentially increase the risk of endophthalmitis, endothelial damage, pupil ovalization and cataracts.