Innovative implantable collamer lens expands options for higher myopia

Intraocular lens surgical procedure was as soon as seen as a final resort for sufferers involved with spectacle independence, however that paradigm modified with the arrival of the EVO Visian implantable colamer lens.

Anu Ondhia

Created by STAAR Surgical, the lens has been a part of the refractive surgical procedure panorama exterior the US for over a decade. Throughout this time, we have now efficiently used this posterior chamber refractive intraocular colamer lens (ICL) at TLC Laser Eye Facilities in Ontario, Canada, to exceed the imaginative and prescient freedom calls for of 1000’s of sufferers.

Our EVO sufferers expertise the day 1 “wow” issue traditionally related to LASIK, with out the ocular floor points sometimes related to corneal refractive surgical procedure. Now that the EVO is on the market within the US following latest FDA approval, I want to share some pearls with my optometry colleagues, who can be very nicely aligned with their ability set and can lead the pre- and post-operative processes of this prolonged process. scope of right this moment’s optometrists.

Subsequent technology ICL

Earlier technology ICLs have been hampered by the chance of anterior subcapsular cataracts (ASCs), pupillary block (angle closure), and endothelial cell loss, amongst different issues, and are thus sometimes given to sufferers who aren’t appropriate candidates for LASIK.

FDA-approved for the therapy of 3D – 20 D myopia and 1 D – 4 D astigmatism, the EVO has overcome these boundaries to adoption with its superior design and confirmed outcomes. EVO is the subsequent technology model of the unique Visian ICL.

The important thing distinction between the EVO and its predecessor is the patented 360 µm central port, which eliminates the necessity for preoperative peripheral iridotomy (PI). This design nuance nearly eliminates the chance of EVO’s ASC and pupillary block. Outcomes from 4,000 sufferers – with as much as 5 years of follow-up – present that not one of the sufferers developed a visually important ASC (Kamiya Okay, et al).

Affected person choice and counseling

EVO ICLs obtain extraordinarily excessive ranges of postoperative uncorrected distance visible acuity, refractive predictability, and stability. Remarkably, the EVO ICL has been proven to provide post-operative imaginative and prescient that’s higher than pre-operative acuity resulting from its means to right such a wide range of average to excessive prescriptions with out altering corneal curvature and thickness (Kamiya Okay, et al.).

In a STAAR medical research, imply postoperative imaginative and prescient was higher than 20/20, and within the more moderen toric EVO ICL research, roughly 75% of sufferers gained a minimum of one line of sight. Whereas greater myopia is understandably appropriate for EVO, we have now discovered that sufferers with average myopia are wonderful candidates for this lens due to the superior visible outcomes.

One of many benefits of the EVO ICL that resonates with each sufferers and medical doctors is that it’s detachable. This turns into vital if – or extra doubtless when – the affected person develops an age-related cataract years after implantation. As a result of no tissue is eliminated, the virgin eye supplies the affected person and surgeon with higher flexibility when it comes to IOL choice and desired refractive final result. Whereas it is most likely not the very first thing that involves thoughts for youthful sufferers, these approaching presbyopia recognize the foresight.

Pre-operative and post-operative care

The steps taken to organize sufferers for ICL surgical procedure are just like these required for LASIK: Sufferers wean off contact lenses for per week, and in some instances, a steroid cone or punctal plug permits the ocular floor to be optimized for efficient diagnostic measures and first therapeutic.

The 2 most vital measurements used to measure EVO candidacy are obvious refraction and anterior chamber depth (ACD). The STAAR research required an ACD of a minimum of 3 mm from the posterior floor of the cornea to the anterior floor of the crystal lens.

Exact white-to-white measurements decide implant dimension. White to white could be measured with a wide range of devices reminiscent of calipers, Pentacam (Oculus Inc.) or Orbscan corneal topographer (Bausch + Lomb). With expertise, we have now discovered that Orbscan supplies essentially the most correct evaluation, and all different lens calculations are obtained by means of STAAR Surgical’s proprietary OCOS on-line calculation software program.

EVO implantation takes roughly 10 minutes beneath optionally available twilight sedation. The affected person is reassessed for additional analysis 4 to six hours after surgical procedure and the subsequent day to make sure there isn’t any IOP enhance. On this go to, we measure EVO positioning by means of the lens case, which ought to ideally be 250 to 750 µm (or 0.5 to 1.5 central corneal thickness). We verify that the angles could be closed within the 1st month management.

The advantages outweigh the dangers

Whereas sufferers aren’t significantly impressed by the truth that this lens doesn’t require a PI, surgeons are very impressed. Whereas the dangers related to PI for an infection, irritation, and dysphotopsia are low, they do exist and any alternative to eradicate the chance is advantageous.

Like many groups, ours was cautious of coming into the EVO realm. Now we have lengthy forgotten these days and we obtain overwhelmingly optimistic outcomes and suggestions from our ecstatic sufferers daily.

General, the EVO Visian ICL advantages sufferers with unparalleled visible outcomes, liberating surgeons to deal with surgical procedure, and offering optometrists with higher alternatives for medical administration.

References:

• Kamiya Okay et al. PLoS One. 2013;doi:10.1371/journal.pone.00666846.
• Kamiya Okay et al. J Cataract Refractory Surgical procedure. 2008; doi:10.1016/j.jcrs.2008.06.030.
• STAAR Visian Toric ICL post-approval research (TICL-PAS). https://clinicaltrials.gov/ct2/show/NCT04516772. Launched on August 18, 2020. Accessed September 22, 2022.

For extra info:

Anu Ondhia, OD, He’s medical director at TLC Laser Eye Facilities and glaucoma and anterior section surgical procedure staff associate at Prism Eye Institute in Ontario, Canada. He could be reached at anuondhia@gmail.com.