The EVO ICL for Moderate Myopia: Results from the US FDA Clinical Trial

Characteristics of biological parameters and implantable collamer lens (ICL) size selection in moderate, high, and super-high myopia eyes

OBJECTIVE

To analyze the characteristics of anterior segment biometric parameters in moderate, high, and super-high myopia eyes for ICL size selection.

METHODS

A total of 246 eyes of 131 patients were included in this prospective observational cohort study. Preoperative axis length (AL), central keratometry (Kc), central corneal thickness (CCT), white-to-white (WTW), internal anterior chamber depth (ACD), trabecular iris angle (TIA), anterior chamber width (ACW), angle-to-angle distance (ATA), crystalline lens rise (CLR), lens thickness (LT), sulcus-to-sulcus (STS), ICL size, and postoperative vault at 1 month were recorded and compared among the different degrees of myopia groups.

RESULTS

The moderate myopia showed smaller ACD and TIA than high and super-high myopia (P < 0.05). A higher proportion of CLR positive (+) was in the moderate myopia group (65%), while the super-high myopia group had a higher proportion of CLR negative (-) (55.3%). (P = 0.047). There were no statistical differences among the myopia groups in WTW, ATA, ACW, STS, LT, and postoperative vault (P>0.05). In different degrees of myopia groups, vertical ATA, ACW and STS were longer than horizontal ATA, ACW and STS (P < 0.001), and horizontal-STS showed a higher correlation with horizontal-ATA (r = 0.655) and horizontal-ACW (r = 0.660) than with WTW (r = 0.591). The 12.1 mm size ICL was slightly selected in moderate myopia (35.8%) more than high myopia (14.6%) and super-high myopia (26.3%) (P = 0.013).

CONCLUSION

Compared to high and super-high myopia, moderate myopic eyes exhibited smaller ACD, TIA while similar WTW, ATA, ACW and STS, with the lens positioned more anteriorly. It should be concerned to the effect of sagittal axis parameters ACD and CLR on the ICL size in different degrees of myopia.

Assessment of measurement variability across automated biometry devices

PURPOSE

To evaluate measurement variability between different readily available automated biometric devices for the purposes of improving surgeon decision-making for phakic intraocular lens (IOL) sizing.

SETTING

Private practice (Houston, Texas).

DESIGN

Prospective, single-center, bilateral, nonrandomized, open-label, observational study.

METHODS

This study included healthy eyes, with no prior eye surgery, and with a spherical equivalent of at least -1.00 diopter. Orbscan II was compared with Argos, Atlas 9000, caliper, IOLMaster 500, IOLMaster 700, iTrace, Lenstar LS900, Pentacam HR, and Pentacam AXL Wave. Preoperative measurements included white-to-white (WTW), anterior chamber depth (ACD), and central corneal thickness (CCT). Linear mixed-effect models were created to determine adjustment factor between the Orbscan II and other devices for WTW, ACD, and CCT measurements.

RESULTS

204 participants (408 eyes) completed the study. All mean WTW measurements were significantly different compared with the Orbscan II ( P < .01), except for Pentacam AXL Wave. All mean ACD and CCT measurements were significantly different compared with the Orbscan II ( P < .01). Adjustment factors for WTW ranged from -0.65 to 0.24 mm. Adjustment factors for ACD ranged from -0.21 to -0.16 mm. Adjustment factors for CCT ranged from 19.9 to -36.0 μm.

CONCLUSIONS

The biometers tested were not interchangeable with the Orbscan II. Adjustment factors for WTW and ACD may compensate for differences between devices and adapt ICL sizing recommendations.

A Comprehensive Retrospective Analysis of EVO/EVO+ Implantable Collamer Lens: Evaluating Refractive Outcomes in the Largest Single Center Study of ICL Patients in the United States

Purpose

We evaluate visual outcomes in patients with EVO/EVO+™ (posterior chamber phakic intraocular lens with a central port) within approved United States (US) age and refractive range indications.

Patients and Methods

This single-center retrospective study evaluated one-month, single-center postoperative data for 225 eyes meeting inclusion criteria and undergoing EVO/EVO+ implantation from April to October 2022. Data included lens size (mm), lens power (diopters of spherical and cylindrical power), preoperative best corrected visual acuity, preoperative spherical equivalent from manifest refraction, achieved postoperative uncorrected visual acuity, postoperative refraction, intraocular pressure (mmHg), and adverse events.

Results

A total of 225 eyes underwent EVO/EVO+ Implantable Collamer Lens (ICL) implantation from April to October 2022, with 51.5% receiving toric lenses. The most common ICL size was 12.6mm (56.4%), followed by 13.2mm (27.5%), 12.1mm (15.1%), and 13.7mm (0.9%). Among patients with preoperative BCVA of 20/20 or better (149 eyes), 95.2% achieved postoperative UCVA of 20/20 or better, and 99.3% achieved UCVA of 20/25 or better at postoperative month one. About 75% of eyes were within a spherical equivalent target of ±0.50 D and 94% within ±1.00 D. Toric ICLs were implanted in 116 eyes (51.8%). Of these, anticipated residual cylinder >1 diopter was seen in 21 eyes (18.1%) resulting in three rotations, three explants, and three laser vision correction (LVC) enhancements. The postoperative adjustment rate (including rotations, exchanges, and LVC enhancement) was minimal (4.8%). Incidence of major adverse events was 0%.

Conclusion

Our study, the largest US single-center analysis of EVO/EVO+ ICL implantation, demonstrates strong early results and infrequent adverse events, supporting ICL safety and effectiveness. High predictability and favorable visual outcomes, including 20/20 or better, highlight the reliability of this technology. Despite study limitations, our findings underscore this technology's effectiveness. Future research should refine patient criteria and assess long-term outcomes in this evolving landscape.

Efficacy and Safety of Implantable Collamer Lens V4c Implantation in 1,834 Myopic Eyes for 1 Year of Follow-up

PURPOSE

To evaluate visual outcomes of patients with myopia after EVO Implantable Collamer Lens (ICL) (STAAR Surgical) implantation and predict risk factors of postoperative vault abnormalities.

METHODS

In this single-center, retrospective analysis, 1,834 eyes of 926 patients with myopia who underwent EVO ICL implantation were recruited between 2020 and 2021. Patients were followed up for 1 year, during which surgery outcomes were evaluated. In addition, 31 eyes with vault abnormalities who underwent secondary surgery were enrolled to form a generalized linear model, which aimed to predict risk factors contributing to vault abnormalities.

RESULTS

At the final follow-up visit, safety and efficacy indexes were 1.12 ± 0.17 and 1.10 ± 0.19, respectively, and there was no statistical significance between the low and high myopia groups. Furthermore, 79.18% of eyes achieved a residual spherical equivalent within ±0.50 diopters. Except for the temporary elevation of intraocular pressure at 1 week postoperatively, IOP and endothelial cell density remained stable during follow-up visits. The rate of postoperative adverse events was 21.97% and most adverse events were transient. Vault abnormalities accounted for the majority of complications (9.54%). Results of generalized linear model showed that age was a risk factor for postoperative vault abnormalities, and the anterior chamber depth served as a protective factor (P < .05).

CONCLUSIONS

Visual outcomes of EVO ICL implantation were satisfactory in safety and efficacy indexes in both the low and high myopia groups for 1 year of follow-up, with acceptable stability in postoperative spherical equivalent, intraocular pressure, and endothelial cell density. This study emphasized cautious ICL size selection for older patients and those with shallow anterior chamber depth. [J Refract Surg. 2023;39(10):694-704.].

The Implementation of Glasses-free 3D Display in ICL Surgery: A Pilot Study

PURPOSE

To compare the efficacy and safety of the glasses-free three-dimensional (3D) display and conventional optical microscope in Implantable Collamer Lens (ICL; STAAR Surgical) surgery.

METHODS

This randomized controlled trial enrolled 51 eyes of 26 patients who received ICL surgery. After random allocation, patients received surgery under either a glasses-free 3D display (16 eyes) or a conventional optical microscope (35 eyes). The surgical duration, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), intraocular pressure, vault, postoperative manifest refraction spherical equivalent (MRSE), and complications were evaluated.

RESULTS

Mean surgical time was 5.04 ± 2.74 minutes for the glasses-free 3D group and 4.65 ± 2.63 minutes for the conventional microscope group (P = .639). Postoperative UDVA was -0.02 ± 0.04 and -0.04 ± 0.05 logMAR (P = .169), CDVA was -0.03 ± 0.04 and -0.02 ± 0.05 logMAR (P = .434), and IOP was 17.01 ± 3.15 and 14.82 ± 2.20 mm Hg (P = .055) at 1 month of follow-up, respectively. Vault was 562.86 ± 192.89 and 520.18 ± 215.19 µm, and MRSE was +0.25 ± 0.21 and +0.10 ± 0.51 diopters, respectively, at 1 month postoperatively; all were comparable between the glasses-free 3D group and conventional microscope group (all P > .05). No complication occurred in both groups.

CONCLUSIONS

The glasses-free 3D group achieved similar efficacy and safety compared to the conventional microscope group, and glasses-free 3D surgery is expected to show a significant advantage in clinical and medical education. [J Refract Surg. 2023;39(9):612-619.].

Rotational Stability After Implantation of Two Different Phakic Toric Intraocular Lenses

PURPOSE

To compare clinical outcomes and rotational stability of the toric implantable Collamer lens (TICL) and toric implantable phakic contact lens (TIPCL).

METHODS

Charts were reviewed from January 2011 to January 2023 to identify all TICLs and TIPCLs implanted by a single surgeon. Implant size was generally chosen according to the manufacturer's recommendation, but 15 TIPCLs 0.25 mm larger than recommended to increase vaulting were included.

RESULTS

Eighty-four TICLs and 98 TIPCLs were identified and yielded excellent refractive and visual results in eyes with high myopic astigmatism at the last follow-up visit. No case of acute glaucoma or cataract induction was observed. In total, 15 (8.2%) rotated lenses were recorded; 2 (2.4%) TICLs and 13 (13.3%) TIPCLs (P = .013). Eyes in both groups were similar in preoperative spherical equivalent, cylinder, white-to-white distance, anterior chamber depth (ACD), anterior chamber angle, and mean follow-up times (P = .925, .673, .822, .794, .358, and .873, respectively). Average TICL size was larger than TIPCL size (P < .001). Rotation of the lenses was positively correlated with cylinder and negatively correlated with ACD but not with vaulting (P = .001, r = 0.253; P = .011, r = -0.193; P = .488, r = -0.057; respectively). Vaulting was positively correlated with preoperative ACD (P ≤ .001, r = .329). In eyes with a rotated TIPCL, preoperative cylinder was higher and ACD was shallower than in eyes with a stable TIPCL (P = .001 and .007, respectively). Increasing the implant size had no significant effect on rotation rate (P = .685).

CONCLUSIONS

Although both implants were safe and effective in highly myopic eyes, TICL rotated less frequently than TIPCL and required fewer secondary interventions. Rotation was correlated with preoperative cylinder and ACD but not lens vaulting. [J Refract Surg. 2023;39(7):463-472.].