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INTRAOCULAR CONTACT LENS HKMA Structured CME Program John Chang, MD Director of Guy Hugh Chan Refractive Surgery Centre Hong Kong Sanatorium and Hospital.

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Presentation on theme: "INTRAOCULAR CONTACT LENS HKMA Structured CME Program John Chang, MD Director of Guy Hugh Chan Refractive Surgery Centre Hong Kong Sanatorium and Hospital."— Presentation transcript:

1 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

2 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 !

3 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.

4 Introduction Posterior Chamber Sulcus Fixated Lens Version 4 Myopia D to > D Hyperopia D to D

5 Lower leftLeading right Loading the ICL The ICL is marked to ensure proper orientation in the eye as it unfolds Alignment Marks

6 Clear Corneal Incision Temporal, clear corneal incision orients best to iris plane

7 Video - ICL Injection

8 ICL Positioning Use the paracentisis

9 Video: ICL Positioning Rotate using the edge of the lens or on the haptic body OK to use footplates

10

11 73 Eyes Since 6th May 2002 Age:23 to 47 Mean age:34.33 ± 6.37 yrs Male:12 Female:36

12 Pre-Op MRSE Range:-7.00 D to D Mean: ± 3.45 D

13 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

14 Predictability of Refraction Planned Refraction Within ± 0.50 D:45(61.6 %) Within ± 1.00 D:59(80.8 %)

15 Post-Op UCVA Those eyes with 20/20 or better Pre-Op BCVA 20/1519(48.7 %) 20/20 or better31(79.5 %) 20/25 or better36(92.3 %) 20/40 or better39(100.0 %) Worse than 20/400(0 %) Total 39

16 Stability of refraction

17 Safety Pre- vs Post- BCVA gained 2 or more lines14(19.2 %) gained 1 line39(53.4 %) no change18(24.7 %) lost 1 line2(2.7 %) Lost > 1 line0(0%)

18 Lost 1 line Age:39 M Pre-op MRSE:-10 D20/20 Post-op MRSE:+0.13 D20/25 Follow up:1 month Patient complaint of difficulty with reading and elected to have ICL removed despite near VA J2 after 1 month.

19 Lost 1 line Age:39 F Pre-op MRSE: D20/15 Post-op MRSE:-0.50 D20/20 Follow up:14.9 months Post-op BCVA varied between follow up visits from 20/15 to 20/20. No other complication was noted.

20 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 didnt like it) 39 year old male, c/o near vision problem MRSE at 1 month: D 1 (1.4 %) overcorrect by +1.5 D (VD not at 12mm)

21 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

22 Complications 2 eyes (2.7 %) developed ASC Mean pre-op MSE-9.28 D D MSE at last visit-3.00 D 20/ /20 UCVA20/15020/25 ACD WTW Lens typeICM125V4ICM115V4 Commentonset at 20 monthonset 13 days, visually significant at 18 months

23 Early result: Toric ICL 25 eyes (since June 2004) Age range:23 to 44 Mean age:32.0 ± 6.8 yrs M : F4 : 14 Mean follow up:7.5 ± 4.4 months (range 1.4 to 18.8 months)

24 Early result: Toric ICL Mean ICL power:Sphere ± 3.22 D Cylinder ± 1.20 D Pre-opPost-op Mean sphere ± 3.20 D-0.20 ± 0.51 D Mean cylinder+2.95 ± 1.07 D+0.64 ± 0.47 D Mean MSE ± 3.06 D+0.03 ± 0.34 D

25 Early result: Toric ICL

26 Cumulative post-op BCVA and UCVA

27 Advantages ICL vs LASIK No / Minimal night vision problems Stability /Faster recovery. Correct much higher ranges of myopia (-3.0 D to D) Also correct hyperopia (+3.0 D to D) Reversible No ectasia

28 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.

29 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)

30 The Verisyse anterior-chamber Lens Picture from

31 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

32 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

33 What if one develops a cataract extraction leads to immediate presbyopia?

34 Multi-Focal IOL *Diagrams from AMO

35 Refractive IOL - Array *Diagrams from AMO

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

41 Basic Theory Diffractive MIOL - Tecnis MF far focusnear focus *Diagrams from AMO

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43 TecnisMF Array far focus near focus ReZoom *Diagrams from AMO

44 Patients No. of patients No. of eyesMean ageRange Array to 85 ReSTOR to 84 TecnisMF to 87

45 Refraction ArrayReSTORTecnisMF Preop mean MRSE (D) STD±7.9±3.07±5.29 Range+7.75 to to to Postop mean MRSE (D) STD±1.01±0.68±0.57 Range+2.38 to to to -2.25

46 3 IOLs Comparison Cumulative Postop UCVA

47 3 IOLs Comparison Cumulative Postop BCVA

48 Safety Preop vs Postop BCVA: Gain / Loss

49 3 IOLs Comparison Cumulative Postop Near UCVA

50 Questionnaire Night glare*Halo*Satisfaction # Array1.51 (32%)1.68 (36%)3.72 (92%) ReSTOR1.03 (21%)1.47 (30%)3.77 (87%) TecnisMF1.88 (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

51 TecnisMF Questionnaire % of time spectacles are required 0% 50% Reading100% 0 0 (including newspaper, books, documents) Near tasks100% 0 0 (including SMS, watch, etc) Distance100% patient requires spectacles for computer

52 Mix and Match- Early result Ave. Time SpentYesNo Distance----0%100% Reading2.8 hr0%100% Computer5.2 hr0%100% Spectacles dependence All patients are 100% of time SPECTACLES FREE

53 Thank You


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