Eyeworld

56 | EYEWORLD | DECEMBER 2022 R EFRACTIVE Relevant disclosures Schoenberg: None Shamie: STAAR Surgical Walton: None Williamson: STAAR Surgical Zaldivar: None You also want to make sure the patient has a healthy endothelium. Even with the larger op- tic/optical zone of the new ICL, Dr. Schoenberg noted the possibility of glare increases if the pupil dilates beyond the edges of the lens optic. Dr. Walton said that a patient with iris damage, zonule damage due to trauma, or moderate/severe glaucoma would not be a good candidate for the EVO ICL. Dr. Walton said that for sizing, ultrasound techniques for direct sulcus measurement are becoming increasingly popular. Dr. Williamson mentioned a few scenarios where he might be hesitant to use the EVO ICL. Again, small anterior chambers are one, with 2.79 mm being his cutoff. For patients close to age 45, you might want to think about a differ- ent option because the lens is undergoing some changes. He stressed that it's important to make sure patients understand how vision changes over a lifetime. Physicians also might want to think twice before using the EVO ICL in patients who have glaucoma, he said, explaining that while pressure spikes aren't common, they're possible. Dr. Williamson said UBM scanning would be helpful not only for sizing but to identify any irregular anatomy in the sulcus that could affect the ICL placement. If a patient has a ciliary body cyst, it could disrupt proper ICL positioning. He added that you don't have a to buy an expensive UBM; you can get started with biometry and manual calipers. Transitioning to the new ICL The EVO ICL is a minimally invasive procedure done through a small clear corneal incision and takes less than 10 minutes per eye, Dr. Shamie said. It can be done at an in-office surgery suite as well as a surgery center. Dr. Schoenberg said it has been an easy transition because the surgery is the same, but easier. Because there's no PI, you no longer need to instill a miotic agent at the end of surgery, so it's one less surgical step, and there are no induced headaches or additional costs. In addition, physicians might be more comfortable with a somewhat lower vault. The ICL comes with four physical sizes corresponding to how much the white-to-white or sulcus-to-sulcus distance is. add to the surgical armamentarium if you are a surgeon who has not done ICLs before. In the previous generation of ICLs, the PI and its associated comorbidities were limiting factors, Dr. Shamie said, and you couldn't tell a patient that this was minimally invasive. It was also previously more labor intensive, as patients had to come in for extra visits and had to potentially be put on steroid drops ahead of time to treat PI-related inflammation. Proceed with caution Dr. Zaldivar cautioned against using the EVO ICL in patients with shallow anterior chambers (less than 2.8 mm) or iridocorneal angles of less than 25/30 degrees. "It is slightly more com- plicated in these because you have to consider the power of the lens and lens rise," he said. "High power ICLs get thicker in the periphery and tend to need a bigger angle. To facilitate this surgeon decision-making process, we have created a machine-learning solution that will be available soon." Dr. Schoenberg also noted the importance of needing proper anatomy for the EVO ICL. It requires open angles and a good enough cham- ber depth, so the lens doesn't crowd the angle. continued from page 55 continued on page 58 Dr. Williamson implants the first EVO ICL in the state of Louisiana. Source: Blake Williamson, MD

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