Presentation on theme: "INTRAOCULAR CONTACT LENS"— Presentation transcript:
1INTRAOCULAR CONTACT LENS HKMA Structured CME ProgramJohn Chang, MDDirector of Guy Hugh Chan Refractive Surgery CentreHong Kong Sanatorium and Hospital9 August 2007
2LASIK is not the best option for every patient Dioptre removal/optical zone &quality of vision trade-offLarge pupilsDry eyesSteep / flat corneas« Funny corneas » / KeratoconusThin corneasWe all have those patients !
3Phakic IOLs Advantages Preserves Corneal topography. No induced aberrations=> Better quality of visionHigh predictability.Stable refractive outcome.Safe in eyes with suspicious corneas.RemovableMinimal capital expenses.
4Introduction Posterior Chamber Sulcus Fixated Lens Version 4 Myopia D to > DHyperopia D to D
5Loading the ICLThe ICL is marked to ensure proper orientation in the eye as it unfoldsLower leftLeading rightAlignment Marks
6Clear Corneal Incision Temporal, clear corneal incision orients best to iris plane
17Safety 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%)
18Lost 1 line Age: 39 M Pre-op MRSE: -10 D 20/20 Post-op MRSE: D 20/25Follow up: 1 monthPatient complaint of difficulty with reading and elected to have ICL removed despite near VA J2 after 1 month.
19Lost 1 line Age: 39 F Pre-op MRSE: -13.88 D 20/15 Post-op MRSE: D 20/20Follow up: monthsPost-op BCVA varied between follow up visits from 20/15 to 20/20. No other complication was noted.
20Complications Out of 73 eyes: 1 (1.4 %) ICL size too small – observe 1 (1.4 %) brow ache for 2 months1 (1.4 %) ICL removed after 1 month ( pt didn’t like it) 39 year old male, c/o near vision problemMRSE at 1 month: D1 (1.4 %) overcorrect by +1.5 D (VD not at 12mm)
21Complications1 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
22Complications 2 eyes (2.7 %) developed ASC Mean pre-op MSE -9.28 D MSE at last visit-3.00 D 20/20/20UCVA20/15020/25ACD3.23.18WTW11.511Lens typeICM125V4ICM115V4Commentonset at 20 monthonset 13 days, visually significant at 18 months
23Early result: Toric ICL 25 eyes (since June 2004)Age range: 23 to 44Mean age: ± 6.8 yrsM : F 4 : 14Mean follow up: 7.5 ± 4.4 months(range 1.4 to 18.8 months)
26Early result: Toric ICL Cumulative post-op BCVA and UCVA
27Advantages 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)ReversibleNo ectasia
28Advantages 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 ICLBoth patients report better quality vision with ICL despite the higher myopiaStability – no initial overcorrection.
29Advantages ICL vs ACIOL No endothelial cell loss, no AC reaction Small self-sealing incision-No/less induced astigmatismNo need to pre-cut flap in biopticsCan correct astigmatism at the same time-(LRI or Toric ICL)
31Disadvantages Clinically significant ASC 1.3%* Sizing can be difficult, Orbscan not always reliableGlaucoma? Pigment dispersion?Expensive2 Procedures: Laser P.I. First (uncomfortable), then lens implantation*5 year follow up US FDA MICL Clinical Trial – in press
32Conclusion ICL and Toric ICL results very encouraging Transient IOP rise 2° to Occucoat?Accuracy as good / better than LASIK for high myopiaMuch better immediate and long term stability than Lasik.Technically not difficult (Avg surgery time 25 mins)No / Minimal night vision problemsShort learning curve –easier than Phaco
33What if one develops a cataract extraction leads to immediate presbyopia?
43TecnisMFArrayReZoomfar focusnear focus*Diagrams from AMO43
44Patients No. of patients No. of eyes Mean age Range Array 59 95 35 to 85ReSTOR274350 to 84TecnisMF1301797 to 87
45Refraction Array ReSTOR TecnisMF Preop mean MRSE (D) -10.00 -0.60 -6.18STD±7.9±3.07±5.29Range+7.75 to+4.00 to -6.75+5.63 toPostop mean MRSE (D)-0.22-0.260.04±1.01±0.68±0.57+2.38 to -6.63+1.00 to -2.00+2.00 to -2.25
50Questionnaire Night glare* Halo* Satisfaction# Array 1.51 (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
51TecnisMF Questionnaire % of time spectacles are required0% <50% >50%Reading 100%(including newspaper, books, documents)Near tasks 100%(including SMS, watch, etc)Distance 100%1 patient requires spectacles for computer
52Mix and Match- Early result Spectacles dependenceAve. Time SpentYesNoDistance----0%100%Reading2.8 hrComputer5.2 hrAll patients are 100% of time SPECTACLES FREE