Eyeworld

42 | EYEWORLD | SUMMER 2025 R EFRACTIVE by Ellen Stodola Editorial Co-Director About the physicians Yoshihiro Kitazawa, MD Chief Medical Director Eye Clinic Tokyo Tokyo, Japan Robert T. Lin, MD Founder, IQ Laser Vision Assistant Clinical Professor Emeritus David Geffen School of Medicine at UCLA Los Angeles, California Boris Malyugin, MD, PhD Professor of Ophthalmology UCLA Department of Ophthalmology Stein Eye Institute Los Angeles, California W hen it comes to refractive pro- cedures, there are many options available. Several physicians discussed what they're using and the options available, notably market penetration of the Implantable Colla- mer Lens (ICL, STAAR Surgical) and SMILE in different areas and how this has changed over the years. They also discussed how other pro- cedures, particularly LASIK, still fit in as newer options become popular. Yoshihiro Kitazawa, MD Dr. Kitazawa shared his experiences in Japan. He noted that the ICL had the highest number of cases in all refractive surgeries in 2023 in the country, performed in 70% of cases, followed by LASIK. In 2024, Zeiss SMILE pro on the Zeiss VisuMax 800 received regulatory approval in Japan, which may drive broader adoption of SMILE. Dr. Kitazawa said that LASIK is the most performed refractive surgery not only in the U.S. but also outside the U.S. However, in Korea, the most common refractive surgery is SMILE. "In Japan, LASIK has been declining for the past 10 years due to infection cases, price reduction competition by ophthalmology clinics owned by cosmetic surgery clinics, and negative campaigns," Dr. Kitazawa said. "Many Japanese ophthalmologists have a bad image of LASIK as a commercial venture by cosmetic surgeons. The ICL is rapidly increasing in popularity." Dr. Kitazawa thinks patient comfort and education play a role in which procedures are used more often. Patients are becoming more informed on the technologies. Many who have researched refractive surgery think the ICL is safe and reliable, he said. Dr. Kitazawa said the updated EVO ICL has also helped with the surgery gaining popularity. The EVO ICL is FDA approved to treat myopia ranging from –3 to –20 D and up to 4 D of astig- matism. The development of the EVO ICL with a central hole has contributed to the widespread use by reducing postoperative complications such as cataracts and glaucoma, he said. ICL surgery can be performed by any cata- ract surgeon with a phaco machine. In Japan, an increasing number of doctors have given up LASIK because of the difficulty of maintaining expensive excimer lasers, and the number of new laser purchasers is almost zero. Boris Malyugin, MD, PhD Dr. Malyugin spoke about his knowledge of re- fractive procedures in several countries, notably Russia and China. He said that ICL surgery is a big business in China. They are implanting ICLs in numbers exceeding any other country in the world, not only because it's a vast country but also due to the population's predisposition to develop myopia at a young age. Myopia is a growing problem in the Asia-Pacific region, he said. New technology, like the EVO ICL, has helped the growth of this as well because surgeons are more confident with an easier and safer procedure and not having to create an iridotomy, he said. In Russia, the market penetration of ICLs is minimal. There are alternatives to ICLs from several local manufacturers. In China, some companies are now starting to produce pha- kic lenses as well, inspired by the ICL market success. Most of the novel phakic IOLs are made of hydrophobic acrylic materials, he said, noting that these do not have quite the same great track record as the ICL yet. Concerning SMILE and intrastromal lenticular procedures, Dr. Malyugin said these procedures are not yet widely adopted in Rus- sia, in his experience. "Femto LASIK is still the procedure of choice for most of the surgeons," he said, adding that one reason for this could be that the difference in visual outcomes is not dramatically different between femto LASIK and SMILE. "Surgeons like SMILE because they think that it's less invasive with less induced dry eye and potentially affects corneal biomechanics less." In Russia and China, companies and clinics are advertising quite heavily. "They want to distinguish themselves, and utilizing these lenticular procedures is an opportunity to gain attention and promote the latest, cutting-edge technologies." The penetration of lenticular procedures in Russia is around 20%, while in China, in many The penetration of refractive procedures in various markets

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