EyeWorld Asia-Pacific December 2011 Issue

38 December 2011 EW DEVICES Phakic IOL update: Current technology, new uses, advantages, and drawbacks For some, these lenses are a welcome surgical option, but more from them is needed F or the average myope, LASIK continues to be an excellent surgical option. But for the more extreme myope, LASIK just shouldn’t cut it—the eye, that is. Phakic IOLs are becoming increasingly sophisticated, and while they aren’ t perfect, they do offer one of the best surgical options for patients with significant amounts of myopia. What’s available Two phakic lenses are currently approved in the United States: the Verisyse (Abbott Medical Optics, Santa Ana, Calif., USA) and the Visian ICL (STAAR Surgical, Monrovia, Calif., USA). Another lens, the AcrySof Cachet Phakic Lens (Alcon, Fort Worth, Texas, USA/Hünenberg, Switzerland), is awaiting US Food and Drug Administration approval. “From my perspective, phakic IOLs will be another tool in the tool kit of the eye surgeon … to correct patients not able to be corrected with LASIK,” said Jeffrey D. Horn, MD, Vision for Life, Nashville, Tenn., USA, a panelist at a phakic IOL discussion at the 2011 ASCRS•ASOA Symposium & Congress in San Diego. He also noted that each phakic IOL “tool” is very different. When asked about the Verisyse lens, Kerry Assil, MD, Assil Eye Institute, Beverly Hills, Calif., USA, said, “It’s a great choice for the patient with an anterior chamber depth of 3.2 mm or larger as measured by the orb scan. The Verisyse lens is easily implantable without damage to the iris and crystalline lens and, if necessary, is also easily removable without damage to the lens.” It is indicated for adults for reducing or eliminating myopia ranging from –5.0 to –20.0 D, with less than or equal to 2.5 D of astigmatism at the spectacle plane. Dr. Horn disagreed. From his perspective, the Verisyse makes the procedure challenging in the hands of surgeons because it has to be clipped to the iris. The lens is not available yet in the U.S. in a soft, foldable form. “It requires a relatively large incision that needs to be sutured,” Dr. Horn said. “For a procedure where we are trying to control refractive error, including astigmatism, that’s not an effective choice.” For Dr. Horn, the Visian lens is the superior choice. Dr. Horn said that one distinct advantage of the Visian ICL is the small incision size, which from his perspective can better control astigmatism. “It goes through a 3-mm or so incision,” Dr. Horn said, and “It’s not clipped to the iris.” Dr. Assil responded, “The super majority of extreme myopes have with-the-rule astigmatism and the entry site for the [Verisyse] lens serves to diminish the astigmatism. The dissolvable 10-0 vicryl eliminates the need to address sutures postoperatively.” Dr. Horn indicated that the risk of cataract formation with the Visian is higher, both in terms of surgically inducing it and post-op. “As the human lens gets thicker, the space between the human lens and the Visian lens decreases,” potentially inducing cataract, he said. The Visian ICL is used for treating adult patients with myopia between –3.0 D and –20.0 D (with minor or no astigmatism), and a hyperopic version is available internationally, but not in the United States. Dr. Assil said, “Having implanted both lenses [Visian and Verisyse], I agree that the Visian is a simple implantation; however, once properly implanted the Verisyse is more physiologically compatible for the longterm health of the eye. While it may weigh on the surgeon slightly more during surgery, the Verisyse lens will provide the surgeon with a better night of sleep following surgery.” The third phakic IOL option, the Acrysof Cachet lens, can be implanted through a small incision and thus also controls astigmatism well, Dr. Horn said. “It’s farther away from the human lens so it’s less likely to create cataract,” he said. “A by Matt Young EyeWorld Contributing Editor The Visian ICL, one of two phakic lenses with US FDA approval Source: STAAR Surgical The Verisyse IOL, 1 day post-op. This IOL is one of two phakic lenses currently approved by the US FDA Source: Jack A. Singer, MD,