Eyeworld

SUMMER 2025 | EYEWORLD | 45 R Contact Kitazawa: yoshihirokitazawa@gmail.com Lin: drlin@iqlaservision.com Malyugin: boris.malyugin@gmail.com and many patients gain lines of vision compared to their vision with glasses. However, he did note the more expensive price tag for the ICL compared to LASIK or SMILE. LASIK has been around for 30 years and is the standard in the U.S., Dr. Lin said, but in Asia, it's a different story. More than 70% of patients in Japan choose the ICL, compared to 30% for LASIK; SMILE was only recently ap- proved there. Taiwan doesn't have the ICL yet, but surgeons there are doing a lot of SMILE, which currently holds 70% market share. In his practice, Dr. Lin is treating around 25% with the ICL, less than 20% with LASIK, less than 20% with PRK, and the rest with SMILE. He said there is great potential for refractive procedures in the U.S., just looking at the large number of contact lens wears. With a contact lens dropout rate of 10%, there are millions of people who don't want to wear glasses who can benefit from procedures like ICL surgery, SMILE, and LASIK. Dr. Lin became interested in SMILE shortly after it was approved and learned how to do the procedure in China with a friend who had expe- rience with it. He noted that patient selection is key, especially for early cases. "You want to pick patients who won't do as well with LASIK." Most patients are referred by word of mouth, so they're coming in and asking it. "We're one of the few practices that is known for SMILE. We've done more than 25,000 SMILE procedures," he said. The EVO ICL was marketed more than SMILE in the U.S. The ICL was first approved in the U.S. in 2005, but there wasn't a good ver- sion, and there was a 1% incidence of cataracts forming, which is high when you perform so many cases, he said. Dr. Lin said the improved EVO ICL, ap- proved in the U.S. in 2022, can be a good option when patients don't qualify for LASIK or SMILE because there is no removal of corneal tissue. It also produces the best quality of vision, he said, especially in prescriptions over –6.00 D, Relevant disclosures Kitazawa: None Lin: ArcScan, STAAR Surgical, Zeiss Malyugin: None Input from industry Dr. Lin asked representatives from STAAR Surgical and Zeiss to share details on what they're seeing in the refractive market. EVO ICL (STAAR Surgical) The company noted that the growth of the EVO ICL outside the U.S. and the emergence of lens- based centers outside the U.S. is a signal the world is likely headed toward more lens-based procedures. They added that U.S. ICL sales were up 22% in Q4 of 2024 and 19% in FY24, which outpaced the refractive market. While the U.S. refractive procedure volumes are down, EVO ICL numbers continue to grow. The company said more than 3 million EVO ICLs have been sold worldwide. They also highlighted the education, learning opportunities, and onboarding to help oph- thalmic professionals successfully implement and use the EVO ICL. The company stressed the benefits of the EVO ICL, notably that it does not require removal of corneal tissue or the natural lens and can ultimately be reversed. It doesn't cause dry eye syndrome and has been shown to be safe and effective. SMILE (Zeiss Medical Technology) Zeiss Medical Technology was the first compa- ny to commercially introduce keratorefractive lenticule extraction (KLEx) performed with SMILE globally in 2011 and in the U.S. in 2017. During that time, data provided by Zeiss shows the rapid adoption of SMILE surgeries around the world. By 2024, more than 10 million pro- cedures had been performed with SMILE. The company launched its second generation of the VisuMax 800 in 2021. SMILE pro surgery is performed on the VisuMax 800, a femtosecond laser with robotic assistance for easy cyclotor- sion adjustment and centration aid. Zeiss sees patient education as a key factor going forward to ensure the market under- stands all of the options available. Beyond education efforts, SMILE has been supported by robust clinical evidence, including more than 500 peer-reviewed papers. SMILE procedures account for approximately one-third of the refractive laser market in China and approxi- mately 80% of the refractive procedure volumes in Korea, according to the company.

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