26 EyeWorld Asia Pacific | June 2024 About the Physicians Scott D. Barnes, MD | Chief Medical Officer, STAAR Surgical, Colonel (retired), U.S. Army, Womack Army Medical Center, Fort Bragg, North Carolina, New York, New York. | sbarnes@staar.com Erik Mertens, MD | FEBOphth, Medical Director, Medipolis, Antwerp, Belgium | e.mertens@medipolis.be Audrey Rostov, MD | Cornea, Cataract, and Refractive Surgeon, Seattle, Washington | audreyrostov@gmail.com William Trattler, MD | Director of Cornea, Center for Excellence in Eye Care, Miami, Florida | wtrattler@gmail.com Blake Williamson, MD | Williamson Eye Center, Baton Rouge, Louisiana | blakewilliamson@weceye.com References 1. Rocamora L, et al. Postoperative vault prediction for phakic implantable collamer lens surgery: LASSO formulas. J Cataract Refract Surg. Feb 1 2023;49(2):126–132. Relevant Disclosures Barnes: STAAR Surgical Mertens: STAAR Surgical Rostov: STAAR Surgical, Carl Zeiss Meditec, Alcon, Bausch + Lomb Trattler: STAAR Surgical, Oculus, Carl Zeiss Meditec, CSO Williamson: STAAR Surgical This article originally appeared in the March 2024 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. “With anterior segment OCT measurements and UBM (VuMAX, Sonomed Escalon) to check the ciliary body and sulcus in combination with new calculation methods based on AI, we’re getting very good predictions in how the vault will be after surgery,” said Dr. Mertens who uses the LASSO formula to calculate his IOL sizes.1 “Lower vault, even down to 100 μm, is not considered an issue with ICLs with a central hole, and most of experts would only intervene if the ICL was touching the crystalline lens; otherwise, with good aqueous flow over the natural lens, monitoring is preferred.” Overall, Dr. Barnes said it’s important for surgeons using EVO to remember to track their data and their outcomes, adjusting, if necessary, when they see trends, similar to how they would adjust their surgeon factor and laser nomogram after tracking outcomes for cataract or laser refractive surgery. In the end however, he said that there is such forgiveness with EVO that even with vaults higher or shallower than we’d like, it may be like +0.25 D or –0.25 D after cataract surgery. “It’s different with EVO; high and low vaults with the legacy ICL were associated with clinical issues (IOP issues and/or lens opacities) more frequently than we are seeing with the EVO ICL,” Dr. Barnes said. The top image shows the ACD measured with Orbscan from the epithelium, which includes the corneal thickness, while the bottom image shows the ACD measured from the endothelium. Source: Scott D. Barnes, MD Sizing insights Dr. Rostov said she tends to size down with EVO, by one with non-toric versions, while with toric she’ll go with the size recommended by the STAAR calculator. “If a toric rotates, that’s more problematic,” she said. She has found cataract formation with EVO to be “quite low,” and stability and placement working well when downsizing non-toric versions. “Not everyone does this,” she said. “I like to be conservative and would rather undersize than oversize. I have had a couple of torics where I undersized and they did rotate.” Sizing down, when possible, she said, reduces the risk of having too high of a vault and the potential for angle closure, she said. Dr. Williamson said his practice also routinely sizes down. “Just remember low vault, low problems. Big vault, big problems.” His other pearl was to be consistent in the devices you’re using to obtain measurements among patients. “If you’re consistent and it’s working for you, stick with that,” he said. For more details and perspectives on EVO sizing, read “Taking a closer look at ICL sizing and vault concerns” on page 20. REFRACTIVE SURGERY
RkJQdWJsaXNoZXIy Njk2NTg0