Eyeworld

DECEMBER 2022 | EYEWORLD | 55 R Roger Zaldivar, MD, said that this is a huge step forward for the ICL safety profile because it avoids the most common complications of an- terior subcapsular cataract formation, pigment dispersion, and pupillary block. "Perhaps the most important fact to empha- size in the EVO ICL design is the zero cataract formation experienced during the last 10 years," Dr. Zaldivar said. Patients' surgical experience has improved remarkably, too, he said. He also noted that the hole in the lens might cause some minor glare. "We've found that 30% of patients experience moderate glare at night in the first 3 months, and it improves considerably in the following months," he said. Dr. Shamie said that the EVO ICL is easy to recommend to patients and much easier to to doing ICLs on the same day bilaterally. These patients, at the 4-hour pressure check, are rou- tinely better than 20/20, he said. With LASIK, there might be flap edema and vision might not be totally crisp right away, Dr. Williamson said. With the ICL, there is no pain the first day, and quality of vision is spectacular, he said. "You're not altering the shape of the cornea, it's just enhancing the vision patients already have." Because of that, Dr. Williamson will offer the EVO ICL in situations he otherwise reserved for LASIK. "It used to be my cutoff was –8.75 to –9 to say we can't get it all with LASIK," he said. "I've come down to –7, so if a patient is –7.5 and a good candidate for the EVO ICL and has the correct anterior chamber depth, I'm talking to them about the EVO ICL because that's what I would want in my eye." He recently did a –3 patient as well; the patient had corneas too thin even for PRK. As far as the EVO ICL eliminating the need for PIs, Dr. Schoenberg said there is a small hole in the center of the lens, which prevents the possibility of pupillary block. "That sounds like a small thing, but it's a big deal," Dr. Schoen- berg said. It simplifies the procedure, eliminates one possible source of risk perioperatively, and eliminates long-term risk of the PI occluding, leading to pupillary block. Additionally, data out of Europe demonstrated that the addition of this flow port in the middle of the ICL reduced the rate of some isolated complications. Cataract formation dropped to almost zero. It's also safer to do a lower vault, which reduces the risk of an angle closure, Dr. Schoenberg said. However, this does present a potential complication, as the small hole in the center of the lens could be a source of glare. "I treat it as a definitive source of glare for patients," Dr. Schoenberg said. "I tell patients 'You're going to see a circular glow on day 1 and probably for a couple of weeks.'" In most patients, it fades and they stop noticing it, Dr. Schoenberg explained. There is the possibility that patient may not adapt to the glare and would have the visual disturbance long term, but if you were to remove the lens, the glare goes away. continued on page 56 Intraoperative photo of the EVO ICL; note the visible aqueous ports, of which there are five total in the lens Source: Bennett Walton, MD

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