18 EWAP MARCH 2024 REFRACTIVE a major advancement for patient comfort and the overall surgical experience. Peripheral iridotomies are a permanent alteration of iris tissue and sometimes had to be enlarged if initially too small and were sometimes a source of dysphotopsias. Although the EVO ICL can still result in some dysphotopsias, not having to remove iris tissue is a great benefit to the latest iteration of ICL technology, he said. “Additionally, the flow of aqueous humor through the ICL ports theoretically could lead to a buffer zone when it comes to ICL sizing,” Dr. Hura said. “As a surgeon, I would love to see more ICL sizes and an expanded range of refractive error that can be corrected [in the United States].” Dr. Hura noted that while complications are rare, there are some possible issues that can arise, including postoperative rotation of a toric ICL or a vault that is too shallow or too large. These are issues that are easily remedied in the hands of a skilled refractive surgeon, he said. Dr. Lin noted that patients still complain of glare and halos, though they may not be as bad as with the prior version of the ICL. “It’s still something that’s almost universally noticed by patients,” she said. “One thing that I learned after I put in my first EVO ICLs is that the glare and halos persist even beyond they’re not candidates for laser vision correction,” she said. As far as who to present it to, Dr. Parkhurst separates this into categories. The first, he said, are the lowest hanging fruit, or patients who come in seeking refractive surgery, and for one reason or another, they aren’t suitable candidates for laser vision correction. This could be because the magnitude of their myopia is very high, the cornea is very thin, or there’s something abnormal about the cornea, he said. “Those are the candidates in whom you can deliver the outcome the patient is seeking, which is to see without glasses or contacts, but we’re doing so in a way that doesn’t touch the cornea and doesn’t increase ectasia risk.” The second category, he said, is the group of patients who could otherwise have laser vision correction but want to hear about an alternative. They are interested in learning about the pluses and minuses of having refractive surgery by phakic IOL instead of laser vision correction. “[In] that category, we make sure there’s a lot of education and communication with the patient as early in the experience as possible,” he said. “When they call, our engagement center mentions that there’s more than one way to do this … so when they arrive at the practice, they’re not surprised at the possibility of hearing about different options; as they go through the consultation process, we tell them all the various procedures they’re a candidate for, including the EVO ICL when that’s the case.” He will judge patients’ response to this non-laser vision correction method. Some people will want to know more, and some may be fearful of something that they haven’t heard of before. If they’re open to hearing more, we continue to educate them, he said. “Some will choose the EVO ICL even if they’re a perfectly good candidate for laser vision correction.” Dr. Lin said that it’s a big advantage not having to do a peripheral iridotomy. “Before the EVO ICL, I would do an intraoperative peripheral iridotomy at the time of ICL surgery,” she said, adding that not having to perform iridotomies now helps save time in the OR. “I think patients also like the fact that they’re not getting an iridotomy, so not having that extra step is nice.” Dr. Parkhurst agreed that it’s a big advantage to not have to do the iridotomy before implantation. “That made the whole process in terms of the number of appointments, scheduling, and logistics simpler,” he said. When teaching fellows, he said they would occasionally see IOP spikes in patients having ICL procedures prior to the EVO ICL getting FDA approval. But since he began using the EVO ICL, there have been zero instances of this. “There have been no cases where we’ve had to come in to deal with an IOP spike on the night of surgery,” Dr. Parkhurst said. “We’re confident offering this technology.” Dr. Hura has also noticed the decreased incidence of postop IOP issues. “The EVO ICL has a central port, as well as four peripheral ports, that allow for constant flow of aqueous humor through the ICL. Based on the 10-year international data, this has led to a near zero incidence of significant postoperative IOP issues and early cataract formation,” he said. He also noted that obviating the peripheral iridotomy is Ultrasound biomicroscopy image to size an ICL. Source: Alexandra Wiechmann, OD
RkJQdWJsaXNoZXIy Njk2NTg0