REFRACTIVE 30 EWAP MARCH 2023 no longer need to instill a miotic agent at the end of surgery, so it’s one less surgical step, and there are no induced headaches or additional costs. In addition, physicians might be more comfortable with a somewhat lower vault. The ICL comes with four physical sizes corresponding to how much the white-to-white or sulcus-to-sulcus distance is. Dr. Zaldivar said the surgery is faster than before, taking 4.5 minutes per eye in his hands. “I always check patients’ vault with intraoperative OCT, and I rotate the lens 90 degrees to decrease vault in the vertical meridian in cases of excessive vault,” he said. If you don’t have intraoperative OCT, check the patient at the slit lamp right after the procedure, Dr. Zaldivar said. Since the launch of the EVO ICL, he has abandoned the use of acetylcholine after the procedure and checks every patient’s IOP 4 hours after the procedure. Results Dr. Williamson said it’s rare to have a patient who isn’t better than 20/20 postop. “It seems like everyone bilaterally is 20/20, and the majority are better than 20/20. It has restored that ‘wow’ factor,” he said. “Most of these patients have been told that there’s nothing that can be done for them, so to tell them that there’s something we can do and have them seeing better than 20/20 hours after the procedure is life changing. “I think my EVO ICL patients are happier, that makes me happier, and that’s why I’m recommending it so much more,” Dr. Williamson said. He added that it’s nice to have an option that avoids the cornea, making a refractive procedure available to patients who might have a “suspicious cornea.” Dr. Schoenberg has been impressed so far with results and said that patients are thrilled as well. “I think the vision quality is very good. The reliability of the lens is excellent,” he said. “I love LASIK, but the more treatment you do, the less precise your treatment becomes. With the ICL, the surgery is the same whether you’re treating –3 or –16, so there’s a tight response curve.” The one thing that can throw off the results is the glare, and he said he has done one explant due to glare. Dr. Walton has also been having success with the EVO ICL. “The fact that the ICL can coexist in the moderate myopia world with as successful a procedure as modern LASIK speaks to the amazing optics and materials engineering,” he said. “In the high myopes who still have accommodation or aren’t ready for lens replacement, it’s a phenomenal way to improve quality of life.” He added that for cataract surgeons and refractive surgeons who are new to the ICL, it’s important to make sure the lens unfolds right side up, with a right-sided leading corner aqueous port. He also said to be gentle, and don’t chase bubbles at the end without viscoelastic in the eye, since a chamber collapse could result in touching the anterior capsule. In terms of refractive predictability, Dr. Zaldivar considers the ICL among the most predictable refractive procedure available, with 98.4% within 0.5 D of target. “In our hands, it has the highest level of satisfaction, with 99% of patients extremely satisfied,” he said. “Given the significant improvements in vision and quality of life made possible by the ICL, and the high degree of patient satisfaction, I think the benefits of ICL implantation outweigh the risks,” he said. EWAP Editors’ note: Dr. Schoenberg is in practice with Georgia Eye Partners, Atlanta, Georgia. Dr. Shamie is in practice at the Maloney-Shamie Vision Institute, Los Angeles, California. Dr. Walton is in practice at Slade & Baker Vision, Houston, Texas. Dr. Williamson practices at Williamson Eye Center, Baton Rouge, Louisiana. Dr. Zaldivar practices at Instituto Zaldivar, Mendoza, Argentina. Drs. Shamie and Williamson have interests with STAAR Surgical. The rest of the doctors declared no relevant financial interests. ADVERTISER LISTING Haag Streit Page 20 www.haag-streit.com Heidelberg Engineering Page 10 heidelbergengineering.com Oculus Page 48 corneal-biomechanics.com APACRS Page 2, 5, 51, 52 www.apacrs.org
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