EyeWorld Asia-Pacific June 2012 Issue

June 2012 27 EWAP CATARACT/IOL Examples of the Verisyse phakic IOL Source: Sonia H. Yoo, MD Phakic lenses today by Enette Ngoei EyeWorld Contributing Editor of vision is better with these lenses than with LASIK,” he said. “That’s because we’re not changing the shape of the cornea, inducing a lot of aberration,” Dr. Yoo explained. “With the phakic IOLs, we’re simply implanting the lens inside of the eye.” Another potential advantage of phakic IOLs is that it’s not uncommon for high myopes who have a phakic IOL placed to have an improvement in their best corrected visual acuity because of the magnification effect of having the IOL in the eye, Dr. Yoo added. “I personally have had patients who had phakic IOLs [implanted] whose uncorrected vision is better than their best corrected vision pre-op, which you can imagine is something that makes the patients very excited,” she said. “That’s not usually something we see with LASIK or PRK.” EyeWorld gets an update on the advantages and long-term safety of phakic lenses H igh myopes who desire spectacle independence but aren’t good candidates for LASIK or photorefractive keratectomy (PRK) shouldn’t feel left out in the cold. Phakic IOL technology continues to advance, and the IOLs available today can be good options. According to Sonia H. Yoo, MD , associate professor of clinical ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Fla., USA, many studies have shown that there is a high quality of vision with phakic IOLs for moderate and high myopes. Studies comparing refractive surgery results of high myopes who underwent PRK, LASIK, or phakic IOL implantation showed that the quality of vision achieved with phakic IOLs is better than the quality of vision achieved with LASIK or PRK, Dr. Yoo said. Allon Barsam, MD , Moorfields Eye Hospital, London, England, UK, agreed. “In patients who are highly myopic, definitely with more than 12 D of myopia, probably with more than 10 D, and possibly with more than 8 D, the evidence suggests that their quality AT A GLANCE • Studies comparing refractive surgery results of high myopes who underwent PRK, LASIK, or phakic IOL implantation showed that the quality of vision achieved with phakic IOLs is better than the quality of vision achieved with LASIK or PRK • One advantage of the Visian ICL is it’s invisible to the naked eye. It sits behind the iris and does not reflect light. On the downside, it requires an iridectomy (or two) and causes cataract formation in a certain number of eyes • Other potential side effects with the phakic lenses are inflammation and intraocular pressure changes, but those are all treatable with drops • These phakic IOLs have long-term data and can be considered safe for long-term use. That does not mean they work in every patient forever FDA-approved lenses The two phakic IOLs that are approved in the United States are the Visian Implantable Collamer Lens (STAAR Surgical, Monrovia, Calif., USA) and the Verisyse (Abbott Medical Optics, AMO, Santa Ana, Calif., USA), Dr. Yoo said. A number of other lenses, including the AcrySof Cachet phakic IOL (Alcon, Fort Worth, Texas, USA/Hünenberg, Switzerland) and the Visian Toric ICL (STAAR Surgical), are awaiting FDA approval. The main difference between the two approved lenses is that the Verisyse is an iris-fixated phakic IOL, which clips on to the iris, and the Visian ICL sits in the posterior chamber, behind the pupil, Dr. Yoo explained. She uses both the Verisyse and the Visian lenses. The advantage of the Visian ICL, Dr. Yoo said, is that Kimiya SHIMIZU, MD, PhD Professor and chairman, Department of Ophthalmology Kitasato University 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, Japan 252-0374 Tel. no. +81 (0)42-778-8464 Fax no. +81 (0)42-778-2357 kimiyas@med.kitasato-u.ac.jp I t is a well-known fact that for correction of moderate and high myopia, the visual quality achieved with phakic IOLs is better than the quality of vision achieved with LASIK, which has been reported so many times. It should require a small incision and no iridectomy, and astigmatism correction is another important factor. There are two types of phakic IOLs, anterior and posterior types. In light of some possible severe complications such as corneal endothelial damage and glaucoma, the posterior type is preferable. I developed a Hole ICL which requires no iridectomy 4 years ago and have used them ever since, and obtained excellent visual quality with no occurrence of cataract formation. However, in case of posterior phakic IOL, a long-term observation for possible cataract formation is necessary. Another problem is the accurate sizing. If these problems are solved, the situation will be much better. Editors’ note: Prof. Shimizu is a consultant for STAAR Surgical. Views from Asia-Pacific continued on page 28