Patients seeking a surgical solution for myopia likely have one procedure in mind: LASIK. Yet STAAR Surgical’s EVO/EVO+ Implantable Collamer Lens (ICL) can, for certain patients, present an attractive solution for myopia correction. (See “FDA approval of EVO/EVO+.”)

This article introduces the EVO ICL, discussing patient education, lens construction, how it compares with LASIK, preoperative and surgical information, and more.

Patient education

Staff dealing with myopic patients who want LASIK may well have to educate their patients on the EVO ICL. At Parkhurst NuVision, staff counsel patients that “you really want to correct your vision with whatever is the best option for you,” says Joshua Fosmire, MBA, surgery scheduling manager.

“What we've seen that makes us very successful is we don't wait for the doctor to introduce the ICL and let that be the very first time they've ever heard it,” Mr. Fosmire says. “If you let the counselor introduce it and kind of ease them into the thought process of this procedure, they're more accommodating and accepting of that recommendation. The counselors in our clinic have a really good understanding of what the baselines need to be in order for a patient to be a candidate for the EVO product.”

“For staff, the biggest thing is, everybody has a fear of having anything done to their eyes,” says Dallas Logan, MBA, chief operating officer, ClearSight LASIK, Oklahoma City, OK. “Hearing about the EVO ICL is new for a lot of patients. It's really important to tell patients about the safety of it, about the excellent outcomes, how great your surgeons are, and how simple the procedure is.”

Arjan Hura, MD, a refractive, cataract, & anterior segment surgeon, at the Maloney-Shamie Vision Institute in Los Angeles, CA, says that his practice provides their staff with as much knowledge as possible to help with the screening process so that by the time a surgeon sees the patient, the patient has already been extensively educated on the appropriate options for vision correction. “We've found that by educating our staff and even local doctors that we work with in the community, we're seeing more and more patients coming in asking for the ICL instead of for LASIK.”

Benefits of a central port

The EVO/EVO+ features a central port, one of five ports in the lens. That central port leads to at least two benefits. First, it eliminates the need to perform a laser peripheral iridotomy, avoiding a step required in a previous version of the lens.

“You don’t have to set up for a peripheral iridotomy. The iridotomy is completely eliminated,” says Jonathan D. Solomon, MD, FWCRS, director, refractive, cornea & lens implantation, Solomon Eye Physicians & Surgeons, Bowie and Greenbelt, MD.

Second, the central port eliminates two potential complications: pupil block angle closure and early anterior subcapsular cataract formation, according to Gregory D. Parkhurst, MD, FACS, founder and physician CEO, Parkhurst NuVision, San Antonio, TX. With these five ports, aqueous can travel from the posterior chamber to the anterior chamber. “That fluid dynamic is creating an environment where the EVO ICL is effectively floating in front of the crystalline lens,” he says.

With prior iterations of the ICL, surgeons used to worry about potential pupillary block causing an IOP spike and the risk of the ICL touching the natural crystalline lens and causing an early cataract, notes Dr. Hura. “Based off of international data, the incidence of both of those issues with the EVO ICL over the past decade has been extremely low,” he says.

Keeping corneal tissue

Unlike laser vision correction, no corneal tissue is removed with the EVO ICL. “What's nice about the EVO ICL is it allows you to keep the integrity of your cornea,” says Mr. Fosmire. In addition, he says, the lens “allows you to keep all of your options for future vision correction procedures.” For instance, if a patient develops cataracts, the surgeon can remove the EVO ICL and perform a cataract procedure at the same time, he notes.

“Some patients like the idea of no tissue being removed from the cornea,” says Dr. Hura. For some patients, he notes, “permanence is a scary concept.” If the surgeon does have to explant the EVO ICL, he notes, it's usually because the ICL is a little bit too big or too small and is exchanged for a more appropriate-sized ICL.

The EVO ICL may also be a terrific option for patients with questionable diagnostic findings, such as keratoconus or thin corneas — when it's not safe to proceed with laser vision correction, notes Dr. Hura.

Streamlined surgery

At her office, every patient who may have an EVO ICL implanted is given a full ocular analysis, notes Ms. Logan. That can include such tests as wavefront autorefraction, tomography, and white-to-white for sizing. “Getting correct and accurate maps is really important for the surgeons to order the lenses,” Ms. Logan says.

As for the surgery itself, “for anyone who's not currently doing ICL surgery, if you're doing cataract surgery, the EVO ICL is well within your skill set,” says Dr. Hura. Compared with cataract surgery or refractive lens exchange, implanting the EVO ICL uses fewer instruments in the OR.

“The staff like it because there's fewer instruments to open, fewer things to set up. The surgery is just loading the ICL and inserting it into the eye,” says Dr. Hura. “The longest part of the procedure is loading the ICL; then after it's in position, the last step is just irrigating out the viscoelastic that was used to safely implant it.”

“The staff really doesn't have to do anything from a handling standpoint, because it's the surgeon who's taking the ICL out of the vial and loading the ICL,” adds Dr. Hura. “The staff for the most part are just handing the surgeon the necessary instruments.”

Also, staff may want to have a good amount of BSS on standby, because the surgeon is likely to go through several syringes of BSS if not utilizing I/A for removal, notes Dr. Hura.

Happy tears

Those interviewed noted the positive patient response to the lens.

“The cool thing about the EVO is they see better immediately, and their vision just continues getting better,” says Ms. Logan. “A lot of times we'll have a patient sit up from the table and tears run down their eyes when they can read something for the first time without their glasses or contact lenses.”

At Parkhurst NuVision, where EVO ICL patients are seen one-day postop, one-week postop, and one month postop, “it’s not uncommon to see these patients seeing 20/20, if not better, at that one day,” says Mr. Fosmire.

“It's not uncommon that when I talk to patients after surgery in the recovery area, they're already saying ‘Wow, I can actually see your face, doctor. I wasn't able to see it when we were in clinic,’” says Dr. Hura.

“Our EVO ICL patients are some of our most happy patients,” adds Ms. Logan. “There's nothing more fun than seeing someone in their one-day post-op seeing better than 20/20.” OP