Eyeworld

AT A GLANCE EW FEATURE 56 Refractive corrections • March 2019 • Approval of the Visian Toric ICL in the U.S. provides another vision correction option for high myopes with astigmatism. • Use of the lens can potentially give a "wow" factor to patients and help protect the cornea. • Sizing and alignment require different finesse and technique than a traditional IOL. • Surgeons should let patients know how their visual quality will be different with the ICL, especially if the patient has used a scleral or gas permeable contact lens before. by Vanessa Caceres EyeWorld Contributing Writer stable quality of vision," said Erik Mertens, MD, Medipolis, Antwerp, Belgium. Best candidates U.S.-based surgeons are still tweak- ing their recommendations for who is best suited for the lens. Paul Dougherty, MD, clinical instructor, Jules Stein Eye Institute, University of California, Los Ange- les, finds that the best candidates for the toric ICL are those with more than a diopter of cylinder and a re- fraction of more than –8 D. "I think patients who are a –8 D benefit from an ICL over LASIK because of the sharper vision, having the correc- tion closer to the nodal point, and the contrast sensitivity at night is better in the moderate myopes." Gregory Parkhurst, MD, San Antonio, recommends starting with the "low-hanging fruit" of patients who do not qualify for laser vi- sion correction (LVC). He gave the example of a patient he recently saw for a consultation who was a –16 D. The toric ICL ranges from –3 to –16 D so the patient will have the highest correction possible, but she likely will be able to drive herself to the day 1 postop appointment, and there will be no tissue removal or altering, Dr. Parkhurst said. Correction in these patients often provides a "wow" factor that is associated with higher patient satisfaction, surgeons said. After starting with non-laser candidates, Dr. Parkhurst found that choosing an ICL (including a regular ICL before the toric was available) has become a top-line solution even in patients who qualify for LVC. He cited his own research that found slightly better night vision quality in patients who had ICLs versus LASIK, although both groups per- formed better than in their glasses. 1 There is another advantage that Dr. Parkhurst sees. "Doing phakic IOLs preserves the cornea for future milestone de- velopment, such as presbyopia in a patient's 40s and 50s and a cataract later on," he said. Dr. Parkhurst will add a per- sonal touch when necessary by Now approved in the U.S., toric ICL offers a correction option for high myopes with astigmatism A pproval of the Visian To- ric Implantable Collamer Lens (ICL, STAAR Surgi- cal, Monrovia, California) in the U.S. gives refractive surgeons another option to correct high myopia and astigmatism. The toric ICL was approved by the U.S. Food and Drug Administra- tion in September of last year and became available to surgeons in the fall. "We have been anxiously await- ing the approval for many years," said Lance Kugler, MD, Omaha, Nebraska. Before the approval, the typical surgical option for Dr. Kugler's patients with high myopia and astigmatism was treating the myopia with an ICL and the astig- matism with a corneal procedure such as LASIK. Although effective, "many patients are not candidates for LASIK, and the staged procedure adds logistical complexity, so an all-in-one solution is a welcome addition to our vision correction surgical options." "Being able to correct myopia and astigmatism with a phakic IOL does not compromise the integri- ty of the cornea, does not induce dry eye, and gives excellent and Making room in the toolbox for the toric ICL Visian ICL Source: STAAR Surgical continued on page 58

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