Eyeworld

46 | EYEWORLD | SEPTEMBER 2023 R EFRACTIVE space. While the Light Adjustable Lens (LAL, RxSight) is available, Dr. Williamson said this can be a heavy lift for some surgeons and pa- tients in terms of the capital expense, the num- ber of visits required to lock in refraction, and the need to wear glasses in between treatments. "The thought is that we have another device we can use without having to spend any money on a machine, and it fits better into the workflow for those difficult to treat eyes," he said. Dr. Williamson has been combining the IC-8 Apthera in the non-dominant and the LAL in the dominant eye. "To me that's a wonder- ful opportunity for someone who has a cornea that's severely aberrated because of keratoconus or RK," he said, noting that surgeons using the IC-8 Apthera internationally are generally only using it bilaterally in extreme cases. There is the possibility of dimming, but Dr. Williamson said that this may be a small sacri- fice for good functioning vision in both eyes. "If you have someone not doing a lot of nighttime driving, usually they're willing to give that up. It's not dissimilar to having the halo/glare/ starburst talk with multifocal/EDOF patients," he said. "The vast majority are more than happy to deal with that to have the gain that they do have. I think that bilateral IC-8 Apthera is going to be more common for those eyes." "If you do an LAL in the first eye, you know what their reading is going to be like, and if you think they're not a monovision candidate, I might not put an LAL in second eye. I would do IC-8 Apthera on label," Dr. Stonecipher said. He added that if you have a patient in whom you're uncertain if monovision will work, and they haven't had it before, an LAL would be a bene- fit, and it helps the patient know what they're getting when choosing for the second eye. Dr. Williamson said that one thing that has surprised him is the lens only goes down to 10 D. For extreme myopes, particularly those with keratoconus, there might not be a lens power for that. However, Dr. Williamson noted that he did a case where he was anticipating a myopic surprise and was very straightforward with the patient about this. However, the patient came back 20/15 J2 several days postop with the IC-8 Apthera. "Sometimes that pinhole can gobble up a lot of refractive error, not just coma and astigmatism, but even sphere," he said. Dr. Cummings has about 8 years of experi- ence with the IC-8 Apthera. He said he mostly uses it when patients are dissatisfied with their quality of vision. "If someone had previous corneal refractive surgery and immediately after experienced glare and halos, it is likely from corneal origin," he said. "If they did well initially and only became symptomatic once continued from page 45 IC-8 Apthera at postop month 1 Source: Blake Williamson, MD " I think it's got an array of options available in the big picture. I find patients in whom I thought they would need something additional, and it's amazing how the pinhole effect makes a difference." —Karl Stonecipher, MD

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