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STAAR ICL Asian Eyes

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STAAR ICL Asian Eyes Powered By Docstoc
					                                       INTRAOCULAR
                                           CONTACT
                                              LENS
                                HKMA Structured CME Program




                                                   John Chang, MD
                Director of Guy Hugh Chan Refractive Surgery Centre
                                Hong Kong Sanatorium and Hospital
9 August 2007
        LASIK is not the best option
             for every patient
• Dioptre removal/optical zone &
  quality of vision trade-off
• Large pupils
• Dry eyes
• Steep / flat corneas
• « Funny corneas » / Keratoconus
• Thin corneas

            We all have those patients !
                     Phakic IOLs
                         Advantages
– Preserves Corneal topography.
– No induced aberrations
– => Better quality of vision
– High predictability.
– Stable refractive outcome.
– Safe in eyes with suspicious corneas.
– Removable
– Minimal capital expenses.
                       Introduction

• Posterior Chamber Sulcus Fixated Lens

• Version 4

• Myopia -3.00 D to > -20.00 D

• Hyperopia +3.00 D to +17.00 D
                 Loading the ICL
• The ICL is marked to ensure proper orientation in the
  eye as it unfolds


        Lower left                 Leading
                                   right




                          Alignment
                          Marks
              Clear Corneal Incision




• Temporal, clear corneal incision orients best to iris
  plane
Video - ICL Injection
                 ICL Positioning




• Use the paracentisis
           Video: ICL Positioning

• Rotate using the
  edge of the lens or
  on the haptic
  “body”
• OK to use
  footplates
                         73 Eyes
Since 6th May 2002

• Age                :    23 to 47

• Mean age           :    34.33 ± 6.37 yrs

• Male               :    12

• Female             :    36
               Pre-Op MRSE

• Range   :   -7.00 D to -24.75 D

• Mean    :   -14.38 ± 3.45 D
                           Follow up

• 1 day, 1 week, 1 month, 3 month, 6 month,

  and 1 year and beyond

• Dilated slit lamp & fundus exam (DFE) for all eyes at 6 months

• Range:     2 weeks to 43.8 months

• Mean:      15.9 months
           Predictability of Refraction


  Planned Refraction
• Within ± 0.50 D      :   45   (61.6 %)

• Within ± 1.00 D      :   59   (80.8 %)
                   Post-Op UCVA

Those eyes with 20/20 or better Pre-Op BCVA
20/15                    19          (48.7 %)
20/20 or better          31          (79.5 %)
20/25 or better          36          (92.3 %)
20/40 or better          39          (100.0 %)
Worse than 20/40         0           (0 %)
Total                    39
                                 Stability of refraction

                                     Mean MSE at each follow up

           2

           -2                -0.23 -0.1    -0.1   -0.19    -0.3   -0.14   -0.39
Diopter




           -6
                                                                                  mean MSE
          -10

          -14       -14.38

          -18
                pre-op   1 wk      1m      3m      6m      12 m   18 m    24 m
                                          Follow up time
                         Safety

Pre- vs Post- BCVA
gained 2 or more lines   14   (19.2 %)
gained 1 line            39   (53.4 %)
no change                18   (24.7 %)
lost 1 line              2    (2.7 %)
Lost > 1 line            0    (0%)
                          Lost 1 line

• Age:                       39 M
• Pre-op MRSE:               -10 D          20/20
• Post-op MRSE:              +0.13 D        20/25
• Follow up:                 1 month
Patient complaint of difficulty with reading and elected to
  have ICL removed despite near VA J2 after 1 month.
                        Lost 1 line

• Age:                     39 F
• Pre-op MRSE:             -13.88 D      20/15
• Post-op MRSE:            -0.50 D       20/20
• Follow up:               14.9 months
Post-op BCVA varied between follow up visits from 20/15
  to 20/20. No other complication was noted.
                      Complications
Out of 73 eyes:
• 1 (1.4 %) ICL size too small – observe

• 1 (1.4 %) brow ache for 2 months

• 1 (1.4 %) ICL removed after 1 month ( pt didn’t like it)
              39 year old male, c/o near vision problem

              MRSE at 1 month: +0.13 D

• 1 (1.4 %) overcorrect by +1.5 D (VD not at 12mm)
                      Complications
• 1 eyes (1.4 %) complained of seeing extra light from P.I.
• 17 eyes (23.3 %) developed transient IOP rise within 2
  month post op;
    – range 23 to 30 mmHg;
    – all controlled by timolol;
    – all resolved by 1 month;
    – only 3 eyes in 2006, all other before 2005
                      Complications
  • 2 eyes (2.7 %) developed ASC
Mean pre-op MSE     -9.28 D             -11.25 D

MSE at last visit   -3.00 D 20/20       -1.25 20/20

UCVA                20/150              20/25

ACD                 3.2                 3.18

WTW                 11.5                11

Lens type           ICM125V4            ICM115V4

Comment             onset at 20 month   onset 13 days, visually
                                        significant at 18
                                        months
                 Early result: Toric ICL
25 eyes (since June 2004)

•   Age range:        23 to 44
•   Mean age:         32.0 ± 6.8 yrs
•   M:F               4 : 14
•   Mean follow up:   7.5 ± 4.4 months
                      (range 1.4 to 18.8 months)
                Early result: Toric ICL
Mean ICL power:    Sphere          -18.44 ± 3.22 D
                   Cylinder        +3.68 ± 1.20 D

                  Pre-op               Post-op

Mean sphere       -13.85 ± 3.20 D      -0.20 ± 0.51 D

Mean cylinder     +2.95 ± 1.07 D       +0.64 ± 0.47 D

Mean MSE          -12.36 ± 3.06 D      +0.03 ± 0.34 D
                                Early result: Toric ICL

                             Post-op mean MSE at each follow up

           4

           0
                               0.36   0.21      0.18   0.03   -0.06
Diopter




           -4
                                                                      mean MSE
           -8

          -12       -12.36

          -16
                pre-op       1 wk     1m       3m      6m     12 m
                                        Follow up
                  Early result: Toric ICL
 Cumulative post-op BCVA and UCVA
                    20/20 or better pre-op BCVA

100.00%

80.00%

60.00%
                                                          Post-op UCVA
                                                          Post-op BCVA
40.00%

20.00%

 0.00%
          20/15   20/20     20/25      20/30      20/40
                        Advantages
ICL vs LASIK
• No / Minimal night vision problems
• Stability /Faster recovery.
• Correct much higher ranges of myopia (-3.0 D to -20.0 D)
• Also correct hyperopia (+3.0 D to +17.0 D)
• Reversible
• No ectasia
                          Advantages
ICL vs LASIK

• 2 patients had ICL in one eye (-19 D, -17 D) and LASIK
  in the other eye(-14 D, -13 D)

• Higher myopia in the eyes with ICL

• Both patients report better quality vision with ICL
  despite the higher myopia

• Stability – no initial overcorrection.
                        Advantages
ICL vs ACIOL

• No endothelial cell loss, no AC reaction

• Small self-sealing incision

       -No/less induced astigmatism

• No need to pre-cut flap in bioptics

• Can correct astigmatism at the same time

       -(LRI or Toric ICL)
                      The Verisyse anterior-chamber Lens




Picture from www.gutsehen.de/gfx/iol_verisyse.jpg
                                              Disadvantages

       • Clinically significant ASC 1.3%*
       • Sizing can be difficult, Orbscan not always reliable
       • Glaucoma? Pigment dispersion?
       • Expensive
       • 2 Procedures: Laser P.I. First (uncomfortable), then
         lens implantation


*5 year follow up US FDA MICL Clinical Trial – in press
                         Conclusion
• ICL and Toric ICL results very encouraging
• Transient IOP rise 2° to Occucoat?
• Accuracy as good / better than LASIK for high myopia
• Much better immediate and long term stability than
  Lasik.
• Technically not difficult (Avg surgery time 25 mins)
• No / Minimal night vision problems
• Short learning curve –easier than Phaco
 What if one develops a
cataract extraction leads to
  immediate presbyopia?
        Multi-Focal IOL




*Diagrams from AMO
                     Refractive IOL - Array




*Diagrams from AMO
*Diagrams from AMO
*Diagrams from AMO
*Diagrams from AMO
*Diagrams from AMO
Adjustment by
human eye
to Multi-Focal IOL




                     *Diagrams from AMO
                                  Basic Theory

       • Diffractive MIOL - Tecnis MF




                     near focus              far focus



*Diagrams from AMO
*Diagrams from AMO
          TecnisMF



          Array



           ReZoom



                     near    far
                     focus   focus
*Diagrams from AMO
                      Patients
            No. of
                      No. of eyes   Mean age     Range
           patients

Array        59           95        54 + 11.9   35 to 85

ReSTOR       27           43        65 + 9.7    50 to 84

TecnisMF    130          179        59 + 13.3   7 to 87
                           Refraction
                   Array           ReSTOR           TecnisMF
Preop mean
                  -10.00            -0.60             -6.18
MRSE (D)

STD                ±7.9             ±3.07            ±5.29

Range         +7.75 to -31.25   +4.00 to -6.75   +5.63 to -18.00

Postop mean
                  -0.22             -0.26             0.04
MRSE (D)

STD               ±1.01             ±0.68            ±0.57

Range         +2.38 to -6.63    +1.00 to -2.00   +2.00 to -2.25
                              3 IOLs Comparison
                     Cumulative Postop UCVA
               100
                90
                80
                70
Percentage %




                60
                50                                                   Array
                40                                                   ReSTOR
                30                                                   TecnisMF
                20
                10
                 0
                      20/15   20/20 20/25 20/30 20/40 20/50 <20/60
                                        VA (Snellen)
                          3 IOLs Comparison
                            Cumulative Postop BCVA
               100
                90
                80
                70
Percentage %




                60
                50                                                Array
                40                                                ReSTOR
                30
                                                                  TecnisMF
                20
                10
                 0
                     20/15 20/20 20/25 20/30 20/40 20/50 <20/60
                                     VA (Snellen)
                                                           Safety
                            Preop vs Postop BCVA: Gain / Loss
               45
               40
               35
               30
Percentage %




               25
                                                                                                         Array
               20
                                                                                                         ReSTOR
               15
                                                                                                         TecnisMF
               10
                5
                0
                    gain > 2 lines gain 2 lines   gain 1 line   no change   loss 1 line   loss >1 line
                                             Change in BCVA (Snellen)
                           3 IOLs Comparison
                     Cumulative Postop Near UCVA
               100
               90
               80
               70
Percentage %




               60
               50                                        Array
               40                                        ReSTOR
               30                                        TecnisMF
               20
                10
                0
                      J1     J2   J3     J5   J7   >J7
                                   Near VA
                      Questionnaire
                 Night glare*      Halo*             Satisfaction#

Array            1.51 (32%)        1.68 (36%)        3.72 (92%)

ReSTOR           1.03 (21%)        1.47 (30%)        3.77 (87%)

TecnisMF         1.88 (44%)        1.99 (44%)        3.70 (93%)

    * the higher the score, the more the severity (from 0-5)
    # the higher the score, the higher the satisfaction (from 0-5)

    (%) percentage of eyes had score ≥3
         TecnisMF Questionnaire
% of time spectacles are required
                   0%          <50%      >50%
Reading            100%          0         0
(including newspaper, books, documents)
Near tasks         100%          0         0
(including SMS, watch, etc)
Distance           100%          0         0
1 patient requires spectacles for computer
           Mix and Match- Early result
Spectacles dependence

            Ave. Time Spent   Yes          No
Distance          ----        0%       100%
Reading         2.8 hr        0%       100%
Computer        5.2 hr        0%       100%


           All patients are 100% of time
                  SPECTACLES FREE
Thank You

				
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