Eyeworld

46 | EYEWORLD | DECEMBER 2023 R EFRACTIVE The second category, he said, is the group of patients who could otherwise have laser vision correction but want to hear about an alterna- tive. They are interested in learning about the pluses and minuses of having refractive surgery by phakic IOL instead of laser vision correction. "[In] that category, we make sure there's a lot of education and communication with the patient as early in the experience as possible," he said. "When they call, our engagement center men- tions that there's more than one way to do this … so when they arrive at the practice, they're not surprised at the possibility of hearing about different options; as they go through the con- sultation process, we tell them all the various procedures they're a candidate for, including the EVO ICL when that's the case." He will judge patients' response to this non-laser vision correction method. Some people will want to know more, and some may be fearful of something that they haven't heard of before. If they're open to hearing more, we continue to educate them, he said. "Some will choose the EVO ICL even if they're a perfectly good candidate for laser vision correction." Dr. Lin said that it's a big advantage not having to do a peripheral iridotomy. "Before the EVO ICL, I would do an intraoperative peripheral iridotomy at the time of ICL surgery," she said, adding that not having to perform iridotomies now helps save time in the OR. "I think patients also like the fact that they're not getting an iridotomy, so not having that extra step is nice." Dr. Parkhurst agreed that it's a big advan- tage to not have to do the iridotomy before implantation. "That's made the whole process in terms of the number of appointments, schedul- ing, and logistics simpler," he said. When teaching fellows, he said they would occasionally see IOP spikes in patients having ICL procedures prior to the EVO ICL getting FDA approval. But since he began using the EVO ICL, there have been zero instances of this. "There have been no cases where we've had to come in to deal with an IOP spike on the night of surgery," Dr. Parkhurst said. "We're confident offering this technology." Dr. Hura has also noticed the decreased in- cidence of postop IOP issues. "The EVO ICL has a central port, as well as four peripheral ports, that allow for constant flow of aqueous humor through the ICL. Based on the 10-year interna- tional data, this has led to a near zero incidence of significant postoperative IOP issues and early cataract formation," he said. He also noted that obviating the peripheral iridotomy is a major advancement for patient comfort and the overall surgical experience. Pe- ripheral iridotomies are a permanent alteration of iris tissue and sometimes had to be enlarged if initially too small and were sometimes a source of dysphotopsias. Although the EVO ICL can still result in some dysphotopsias, not having to remove iris tissue is a great benefit continued from page 45 continued on page 48 Ultrasound biomicroscopy image to size an ICL Source: Alexandra Wiechmann, OD Anterior segment OCT of OD measuring ICL vault on 1 day postop Source: Alexandra Wiechmann, OD

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