Eyeworld

WINTER 2025 | EYEWORLD | 53 R OPENING DOORS by Ellen Stodola Editorial Co-Director About the physicians Drew Dickson, MD Cataract and Refractive Surgeon Kugler Vision Omaha, Nebraska Owner Modern Vision Centers West Des Moines, Iowa Luke Rebenitsch, MD Medical Director ClearSight LASIK and Lens Oklahoma City, Oklahoma, and Plano, Texas Carlos Rocha-de-Lossada, MD, PhD, FEBO Associate Professor University of Seville Head of the Ophthalmology Department Vithas Málaga Hospital Málaga, Spain W hile not a common approach or its primary indication, the ICL (STAAR Surgical) can be used as a supplementary/piggyback IOL in some patients. Drew Dickson, MD, Luke Rebenitsch, MD, and Carlos Rocha-de-Lossada, MD, PhD, FEBO, discussed how this off-label approach to using the ICL is opening doors to treat certain patients. Dr. Dickson said the ICL as a piggyback lens is a unique scenario because it would require a big refractive miss. For some people who are naturally near- sighted, sometimes the cataract surgeon might leave them fairly myopic, he said, adding that this doesn't happen as much anymore. To use the ICL in this way, the patient needs to have the right prescription because the ICL's lowest power is –3. For example, Dr. Dickson said he had a patient recently who was left at around –5/–6 intentionally. You can consider ICL if they're –2.5 or so. "That's when I would first start thinking about it," he said. "If there is a patient in that category, it's the ultimate piggyback lens. If we're planning to use a piggyback for patients now that's not an ICL, it's not as precise. There's typically not an IOL calculation you do. It's usually if they're hyperopic or myopic, you take the prescription and have some fudge factor on what you think it should be. With the ICL, you're still basing that just like you would with a normal ICL, so you're taking the prescription and plugging measurements into the STAAR Surgical online calculator." He said it's also nice because it's the only piggyback option with that sort of prescription where you can treat any astigmatism in the sulcus. "Up until recently, there was nothing even close," Dr. Dickson said, adding that physicians can now also consider the Light Adjustable Lens (LAL, RxSight) in the sulcus for certain patients. Another benefit of the ICL is its removabil- ity. "Patients like the idea that it's reversible or upgradeable over time," he said. You don't have to alter the natural anatomy of the cornea. Plus, Dr. Dickson said, it tends to have a high vision quality. "All those things that make us love the ICL in phakic patients apply to pseudophakic patients as well." Dr. Dickson said he's used the ICL previ- ously in patients with monofocal lenses, but it could be used in other cases, like with a trifocal. Dr. Rebenitsch stressed that using the ICL in this manner is considered off label, but he's used it this way a handful of times. He also noted that in the U.S., the ICL only goes down Using the ICL as a supplementary IOL continued on page 54 ICL piggyback deployment and positioning in a patient who was myopic and S/P ALK. The patient was post-YAG capsulotomy and not a good candidate for laser vision correction. Source: Luke Rebenitsch, MD

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