Eyeworld

48 appointed with the limited indica- tions of phakic IOLs. "I do a pretty reasonable vol- ume, but it has dropped," said Uday Devgan, M.D., Devgan Eye Surgery, Los Angeles. "There's no toric [pha- kic lens] in the U.S. still. The phakic IOL procedure is a more expensive procedure for the patient. LASIK is about $3,000 per eye, while a phakic IOL is $6,000 per eye. It's double the price." There are also concerns over where phakic IOLs should be im- planted. "I'm not a fan of surgeons doing this in their office in the back room," Dr. Devgan said. "If they're going into the eye intraocularly, they should go to a real OR." Douglas Katsev, M.D., Sansum Clinic, Santa Barbara, Calif., said he doesn't implant many phakic IOLs. "The reason is cost," he said. "Patients are a little concerned be- cause they know LASIK, but they don't know phakic IOLs. Still, I think it's a great procedure, and all my patients have done well who have had them." Dr. Katsev said he implants pha- kic lenses in patients who are above a –10 myope. "It makes a huge difference in their life," he said. "But I think it would be great for a toric [phakic lens] to come out." Boris Malyugin, M.D., Ph.D., chief, Department of Cataract and Implant Surgery, and deputy director general, S. Fyodorov Eye Microsurgery Complex State Institu- tion, Moscow, Russia, has had a cou- ple of years of experience with toric phakic IOLs already. "I like them very much," he said. "I have seen that in many pa- tients with high myopia, there is also astigmatism. That's why I find it useful to implant these lenses. Also, we are now implanting lenses in pa- tients with stable keratoconus." He explained that when an oph- thalmologist first stabilizes the kera- toconus process with crosslinking and sometimes segments, a patient will still have high residual refractive error. "This cannot be corrected with corneal procedures," he said, but a phakic IOL can be implanted "with great success." From the surgeon's perspective, phakic IOL implants do take more time than LASIK—and financial in- centives aren't always there. "I think we price it to choose it versus LASIK, so we try to keep the price down and end up making less money," Dr. Katsev said. "It does take more time. I have to follow the patients more. I don't think I'm los- ing money, but my hourly rate goes way down." Dr. Devgan added that his nor- mal cutoff for LASIK is a –8 myope. "If it's beyond that, go to a pha- kic IOL," he said. EW Editors' note: Dr. Assil has financial interests with AMO. Dr. Devgan has financial interests with Alcon and Bausch & Lomb (Rochester, N.Y.). Dr. Horn is a clinical investigator for the Cachet lens and has financial interests with Alcon. Dr. Katsev has financial interests with Alcon. Dr. Malyugin has no financial interests related to his comments. Contact information Assil: 310-453-8911, kassil@assileye.com Devgan: 800-337-1969, devgan@gmail.com Horn: 615-329-9575, jeff.horn@bestvisionforlife.com Katsev: 800-472-6786, katsev@aol.com Malyugin: boris.malyugin@gmail.com EW REFRACTIVE SURGERY 48 October 2011 Phakic continued from page 46 46-49 Refractive_EW October 2011-DL2_Layout 1 9/29/11 3:45 PM Page 48

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