Eyeworld

48 | EYEWORLD | DECEMBER 2023 R EFRACTIVE Relevant disclosures Hura: STAAR Surgical Lin: None Parkhurst: STAAR Surgical Contact Hura: arjan.hura@gmail.com Lin: amylin78@gmail.com Parkhurst: gparkhurst@parkhurstnuvision.com to the latest iteration of ICL technology, he said. "Additionally, the flow of aqueous humor through the ICL ports theoretically could lead to a buffer zone when it comes to ICL sizing," Dr. Hura said. "As a surgeon, I would love to see more ICL sizes and an expanded range of refrac- tive error that can be corrected [in the United States]." Dr. Hura noted that while complications are rare, there are some possible issues that can arise, including postoperative rotation of a toric ICL or a vault that is too shallow or too large. These are issues that are easily remedied in the hands of a skilled refractive surgeon, he said. Dr. Lin noted that patients still complain of glare and halos, though they may not be as bad as with the prior version of the ICL. "It's still something that's almost universally noticed by patients," she said. "One thing that I learned after I put in my first EVO ICLs is that the glare and halos persist even beyond a month." For this reason, Dr. Lin said it's important to explain to patients that these will likely be an issue. The overwhelming response is that patients are still very happy with their ICLs despite the glare and halos, she said. While Dr. Lin doesn't have any specific contraindications for using the EVO ICL, she noted that she does see occasional cases of over- sized ICLs, despite all the different ways she is measuring white to white (including UBM). This issue was something that she also noticed in the previous ICLs as well. "I've had some cases of the ICL being over vaulted," she said. "I've been trying to use slightly smaller ICLs than the ones recommended by the nomogram." Dr. Lin noted that she does not do bilateral, same-day ICLs because if there is an over vaulted ICL, she will use a smaller size for the second eye. Dr. Parkhurst agreed that sizing strategy is extremely important for success with ICLs. "We've got some new nomograms we're work- ing on, with artificial intelligence and machine learning, to use diagnostic scans to predict the ideal size for the ICL," he said. "One of the most critical things in terms of having success is pick- ing the size right, and it's nuanced. It's not easy in the current state without the right diagnostic technology to size the lens properly. Because we're now confident with the way we're doing sizing with UBM technology and arc scans, we're finding that we're able to go to shallower anterior chamber depths than what we used to be comfortable with." For example, he said the minimum AC depth before the EVO ICL was 2.8 mm, but now he has even gone to 2.6 mm. "That is one area where we're finding that more patients qualify, whereas we would have turned them away in the past," he said. Dr. Parkhurst added that he wouldn't recommend surgeons new to the EVO ICL going this low in their first handful of cases until they are confident in their sizing strategy. continued from page 46 External image in slit lamp showing ICL vault Source: Alexandra Wiechmann, OD Multiple biometers and imaging modali- ties can help with ICL sizing, and utilizing different sizing nomograms can be beneficial in making a decision for cases that fall between two different sizes. Just as with IOLs, it is important to be able to explant an ICL if implanting one. Don't rush at the end of a case, and take time to thoroughly remove as much OVD as possible. Analyze your refractive outcomes and vaults to refine your sizing and power selection. LESSONS LEARNED with Dr. Hura

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