EyeWorld Asia-Pacific December 2011 Issue

39 EW DEVICES December 2011 potential downside is resulting endothelial cell loss. We’re looking to see if problems with endothelial cell loss are related to that lens. My experience is this is not the case, but the FDA needs to be sure before giving approval.” According to Alcon, patients with prescriptions between –6.0 D and –16.5 D may be candidates for the Cachet lens. Limited uses to some, excit- ing to others Still, some surgeons have been disappointed with the limited indications of phakic IOLs. “I do a pretty reasonable volume, but it has dropped,” said Uday Devgan, MD, Devgan Eye S urgery, Los Angeles, Calif., USA. “There’s no toric [phakic lens] in the U.S. still. The phakic IOL procedure is a more expensive procedure for the patient. LASIK is about $3,000 per eye, while a phakic IOL is $6,000 per eye. It’s double the price.” There are also concerns over where phakic IOLs should be implanted. “I’m not a fan of surgeons doing this in their office in the back room,” Dr. Devgan said. “If they’re going into the eye intraocularly, they should go to a real OR.” Douglas Katsev, MD, Sansum Clinic, Santa Barbara, Calif., USA, said he doesn’t implant many phakic IOLs. “The reason is cost,” he said. “Patients are a little concerned because they know LASIK, but they don’t know phakic IOLs. Still, I think it’s a great procedure, and all my patients have done well who have had them.” Dr. Katsev said he implants phakic lenses in patients who are above a –10 myope. “It makes a huge difference in their life,” he said. “But I think it would be great for a toric [phakic lens] to come out.” Boris Malyugin, MD, PhD, chief, Department of Cataract and Implant Surgery, and deputy director general, S. Fyodorov Eye Microsurgery Complex State Institution, Moscow, Russia, has had a couple of years of experience with toric phakic IOLs already. “I like them very much,” he said. “I have seen that in many patients with high myopia, there is also astigmatism. That’s why I find it useful to implant these lenses. Also, we are now implanting lenses in patients with stable keratoconus.” He explained that when an ophthalmologist first stabilizes the keratoconus process with crosslinking and sometimes segments, a patient will still have high residual refractive error. “This cannot be corrected with corneal procedures,” he said, but a phakic IOL can be implanted “with great success.” From the surgeon’s perspective, phakic IOL implants do take more time than LASIK— and financial incentives aren’t always there. “I think we price it to choose it versus LASIK, so we try to keep the price down and end up making less money,” Dr. Katsev said. “It does take more time. I have to follow the patients more. I don’t think I’m losing money, but my hourly rate goes way down.” Dr. Devgan added that his normal cutoff for LASIK is a –8 myope. “If it’s beyond that, go to a phakic IOL,” he said. EW Editors’ note: Dr. Assil has financial interests with AMO. Dr. Devgan has financial interests with Alcon and Bausch & Lomb (Rochester, NY, USA). Dr. Horn is a clinical investigator for the Cachet lens and has financial interests with Alcon. Dr. Katsev has financial interests with Alcon. Dr. Malyugin has no financial interests related to his comments. Contact information Assil: 310-453-8911, kassil@assileye.com Devgan: 800-337-1969, devgan@gmail.com Horn: 615-329-9575, jeff.horn@bestvisionforlife.com Katsev: 800-472-6786, katsev@aol.com Malyugin: boris.malyugin@gmail.com Age - from page 33 “If they see any tears or holes, those can be prophylactically treated with a retinal laser to weld the retina down to prevent that from happening,” he said. A young patient with a healthy cornea is a top candidate for LASIK, Dr. Probst said. “There’s no procedure that could possibly match the safety profile and the accuracy,” he said. “We’re always going to do LASIK if we can because of the advantages of it. The others only become considerations when you can’t.” There is one factor when deciding on surgery that is far more important than age or degree of correction, Dr. Desai said. The most important factor for any procedure, be it laser vision correction, refractive lens exchange, or refractive cataract surgery, is the patient, he said. “We have to be intimately familiar with the patient’s visual needs and lifestyle and make decisions based on that. It’s never going to be just based on the cornea or age or degree of correction. It’s all of these factors combined with a good assessment of the visual needs and lifestyle.” EW Editors’ note: Dr. Chu has financial interests with Bausch & Lomb (Rochester, NY, USA) and Abbott Medical Optics (Santa Ana, Calif., USA). Dr. Desai has financial interests with Alcon (Fort Worth, Texas, USA/ Hünenberg, Switzerland), Allergan (Irvine, Calif., USA), Bausch & Lomb, Bio-Tissue (Miami, Fla., USA), Inspire Pharmaceuticals (Raleigh, NC, USA), WaveTec Vision Systems Inc. (Aliso Viejo, Calif., USA), and TruVision (Santa Barbara, Calif., USA). Dr. Probst has no financial interests related to his comments. Contact information Chu: 952-835-0965, yrchu@chuvision.com Desai: 727-518-2020, desaivision@hotmail.com Probst: 708-562-2020, leprobst@gmail.com Tel: +65 64936953 Fax: +65 64936955