Eyeworld

54 | EYEWORLD | DECEMBER 2022 R HOT TOPICS IN OPHTHALMOLOGY EFRACTIVE by Ellen Stodola Editorial Co-Director About the physicians Evan Schoenberg, MD Georgia Eye Partners Atlanta, Georgia Neda Shamie, MD Maloney-Shamie Vision Institute Los Angeles, California Bennett Walton, MD Slade & Baker Vision Houston, Texas Blake Williamson, MD Williamson Eye Center Baton Rouge, Louisiana Roger Zaldivar, MD Instituto Zaldivar Mendoza, Argentina better quality of vision. But just as a larger optical zone requires more tissue removal in LASIK, it requires the optical portion of the ICL to extend further. "Therefore, for lower pow- ers of myopia, up to –14 D, the optical zone is increased to as much as 6.1 mm for the EVO+ ICL. For the higher powers, an EVO ICL is used," Dr. Walton said. "The highest spherical equiva- lent power available in the U.S. is a –16 D lens, and many ICL surgeons use the –16 D lens to debulk the majority of high myopia. Then LASIK for the residual can be performed." In his practice, there is an overlap in LASIK and EVO ICL candidacy. Between 7–9 D of myopia is where the ICL might be favored over LASIK. Once a patient is significantly higher than that, the ICL holds a strong advantage, Dr. Walton said. Neda Shamie, MD, said that the classic ICL candidate is someone with high myopic correc- tion who wouldn't otherwise be a candidate for LASIK/PRK. "In our practice, even if a patient has good corneal thickness, if their correction is more than –8.5, we don't think that the quality of vision that they can gain from corneal-based refractive surgery is good enough; when you change the contour of the cornea to correct –8.5 and more, the contrast and color perception are affected, quality of vision is affected, and glare and halos at night potentially become visually significant," she said. Dr. Shamie has implanted the EVO ICL for lower corrections if the patient has dry eye that does not respond to conservative measures. She has also had a number of patients who are excellent candidates for LASIK, but they don't like that LASIK involves tissue removal and don't like that it's not reversible, so they come in specifically asking for the EVO ICL. What's different now? Blake Williamson, MD, has been thrilled with the launch of the EVO ICL and said his practice was involved in the early stages of the ICL when it came out almost 20 years ago. But it was always challenging because you have to do PIs, he said. PIs are no longer needed with the EVO ICL. Dr. Williamson said his practice switched The EVO ICL: What makes it different and results T he EVO Visian ICL (STAAR Surgical) was recently approved for the treat- ment of myopia and astigmatism, with updates to the previous ICL technol- ogy. Several physicians discussed the technology with EyeWorld: what's new, how they're using the product, and results they've seen so far. Evan Schoenberg, MD, described himself as an "enthusiastic fan" of the EVO ICL. He's been using it since its FDA approval in March 2022. "I stopped doing the previous version of the ICL about 3 months ahead of the FDA approv- al when it was clear it was coming down the pipeline because I thought it would be a better solution," he said. "I start talking about the ICL with patients [with myopia of] –7 or above who present for refractive surgery," he said. "I consider it in lower myopes in certain situations—patients with lower degrees of myopia but who have some cornea contraindications to LASIK/PRK or who are interested in the element of reversibil- ity of the technology." He added that if a –5 to –6 D patient is approaching cataract age but not quite ready for cataract surgery, he will use it as a bridge until they have surgery. You can do an ICL now and a lens procedure in 5–10 years. Bennett Walton, MD, has moved all ICLs to the new EVO ICL version. "I expect to be doing more EVO ICL procedures than I did with the former ICL model," he said. "The optics remain great, but it's easier on patients because the EVO ICL does not require a peripheral iridotomy (PI) due to its aqueous flow ports." The EVO ICL and EVO+ ICL are indicat- ed for patients with myopia or myopia with astigmatism who are 21 years or older and have a healthy corneal endothelium, with an open angle and a 3 mm aqueous depth (defined as endothelium to anterior lens capsule centrally). It's approved for myopia correction from –3 D to –15 D and myopia reduction up to –20 D, with the toric version approved for up to 4 D of astigmatism in the spectacle plane. The EVO+ ICL has a larger optical zone than the EVO ICL, Dr. Walton said. In the refrac- tive surgery world, larger optical zones provide

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