REFRACTIVE EWAP MARCH 2023 27 Contact information Schoenberg: evan.schoenberg@gaeyepartners.com Shamie: ns@maloneyshamie.com Walton: drwalton@visiontexas.com Williamson: blakewilliamson@weceye.com Zaldivar: zaldivarroger@gmail.com T he EVO Visian ICL (STAAR Surgical) was recently approved for the treatment of myopia and astigmatism, with updates to the previous ICL technology. Several physicians discussed the technology with EyeWorld: what’s new, how they’re using the product, and results they’ve seen so far. Evan Schoenberg, MD, described himself as an “enthusiastic fan” of the EVO ICL. He’s been using it since its FDA approval in March 2022. “I stopped doing the previous version of the ICL about 3 months ahead of the FDA approval when it was clear it was coming down the pipeline because I thought it would be a better solution,” he said. “I start talking about the ICL with patients [with myopia of] The EVO ICL: What makes it different and results by Ellen Stodola Editorial Co-Director –7 or above who present for refractive surgery,” he said. “I consider it in lower myopes in certain situations — patients with lower degrees of myopia but who have some cornea contraindications to LASIK/ PRK or who are interested in the element of reversibility of the technology.” He added that if a –5 to –6 D patient is approaching cataract age but not quite ready for cataract surgery, he will use it as a bridge until they have surgery. You can do an ICL now and a lens procedure in 5–10 years. Bennett Walton, MD, has moved all ICLs to the new EVO ICL version. “I expect to be doing more EVO ICL procedures than I did with the former ICL model,” he said. “The optics remain great, but it’s easier on patients because the EVO ICL does not require a peripheral iridotomy (PI) due to its aqueous flow ports.” The EVO ICL and EVO+ ICL are indicated for patients with myopia or myopia with astigmatism who are 21 years or older and have a healthy corneal endothelium, with an open angle and a 3 mm aqueous depth (defined as endothelium to anterior lens capsule centrally). It’s approved for myopia correction from –3 D to –15 D and myopia reduction up to –20 D, with the toric version approved for up to 4 D of astigmatism in the spectacle plane. The EVO+ ICL has a larger optical zone than the EVO ICL, Dr. Walton said. In the refractive surgery world, larger optical zones provide better quality of vision. But just as a larger optical zone requires more tissue removal in LASIK, it requires the optical portion of the ICL to extend further. “Therefore, for lower powers of myopia, up to –14 D, the optical zone is increased to as much as 6.1 mm for the EVO+ ICL. For the higher powers, an EVO ICL is used,” Dr. Walton said. “The highest spherical equivalent power available in the U.S. is a –16 D lens, and many ICL surgeons use the –16 D lens to debulk the majority of high myopia. Then LASIK for the residual can be performed.” In his practice, there is an overlap in LASIK and EVO ICL This article originally appeared in the December 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Intraoperative photo of the EVO ICL. Note the visible aqueous ports, of which there are five total in the lens. Source: Bennett Walton, MD
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