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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 9 August 2007
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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 !
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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.
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Introduction Posterior Chamber Sulcus Fixated Lens Version 4
Myopia D to > D Hyperopia D to D
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Loading the ICL The ICL is marked to ensure proper orientation in the eye as it unfolds Lower left Leading right Alignment Marks
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Clear Corneal Incision
Temporal, clear corneal incision orients best to iris plane
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Video - ICL Injection
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ICL Positioning Use the paracentisis
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Video: ICL Positioning
Rotate using the edge of the lens or on the haptic “body” OK to use footplates
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73 Eyes Since 6th May 2002 Age : 23 to 47 Mean age : 34.33 ± 6.37 yrs
Male : 12 Female : 36
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Pre-Op MRSE Range : D to D Mean : ± 3.45 D
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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: months
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Predictability of Refraction
Planned Refraction Within ± 0.50 D : 45 (61.6 %) Within ± 1.00 D : 59 (80.8 %)
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Post-Op UCVA Those eyes with 20/20 or better Pre-Op BCVA
20/ (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/ (0 %) Total
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Stability of refraction
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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%)
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Lost 1 line Age: 39 M Pre-op MRSE: -10 D 20/20
Post-op MRSE: 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.
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Lost 1 line Age: 39 F Pre-op MRSE: -13.88 D 20/15
Post-op MRSE: D 20/20 Follow up: months Post-op BCVA varied between follow up visits from 20/15 to 20/20. No other complication was noted.
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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: D 1 (1.4 %) overcorrect by +1.5 D (VD not at 12mm)
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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
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Complications 2 eyes (2.7 %) developed ASC Mean pre-op MSE -9.28 D
MSE at last visit -3.00 D 20/20 /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
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Early result: Toric ICL
25 eyes (since June 2004) Age range: 23 to 44 Mean age: ± 6.8 yrs M : F 4 : 14 Mean follow up: 7.5 ± 4.4 months (range 1.4 to 18.8 months)
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Early result: Toric ICL
Mean ICL power: Sphere ± 3.22 D Cylinder ± 1.20 D Pre-op Post-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
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Early result: Toric ICL
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Early result: Toric ICL
Cumulative post-op BCVA and UCVA
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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
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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.
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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)
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The Verisyse anterior-chamber Lens
Picture from
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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
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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
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What if one develops a cataract extraction leads to immediate presbyopia?
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Multi-Focal IOL *Diagrams from AMO
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Refractive IOL - Array *Diagrams from AMO
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*Diagrams from AMO
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*Diagrams from AMO
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*Diagrams from AMO
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*Diagrams from AMO
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Adjustment by human eye to Multi-Focal IOL *Diagrams from AMO
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Basic Theory Diffractive MIOL - Tecnis MF near focus far focus
*Diagrams from AMO
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*Diagrams from AMO
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TecnisMF Array ReZoom far focus near focus *Diagrams from AMO 43
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Patients No. of patients No. of eyes Mean age Range Array 59 95
35 to 85 ReSTOR 27 43 50 to 84 TecnisMF 130 179 7 to 87
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Refraction Array ReSTOR TecnisMF Preop mean MRSE (D) -10.00 -0.60
-6.18 STD ±7.9 ±3.07 ±5.29 Range +7.75 to +4.00 to -6.75 +5.63 to Postop mean MRSE (D) -0.22 -0.26 0.04 ±1.01 ±0.68 ±0.57 +2.38 to -6.63 +1.00 to -2.00 +2.00 to -2.25
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3 IOLs Comparison Cumulative Postop UCVA
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3 IOLs Comparison Cumulative Postop BCVA
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Safety Preop vs Postop BCVA: Gain / Loss
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3 IOLs Comparison Cumulative Postop Near UCVA
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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
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TecnisMF Questionnaire
% of time spectacles are required 0% <50% >50% Reading 100% (including newspaper, books, documents) Near tasks 100% (including SMS, watch, etc) Distance 100% 1 patient requires spectacles for computer
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Mix and Match- Early result
Spectacles dependence Ave. Time Spent Yes No Distance ---- 0% 100% Reading 2.8 hr Computer 5.2 hr All patients are 100% of time SPECTACLES FREE
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Thank You
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