Presentation is loading. Please wait.

Presentation is loading. Please wait.

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

Similar presentations

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


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





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


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

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

Similar presentations

Ads by Google