Enhancing efficiency with the EVO Visian Implantable Collamer Lens

For a new generation of implantable lenses for myopia from STAAR Surgical, the adage “less is more” clearly applies.

In March 2022, the FDA approved the company’s EVO/EVO+ Visian Implantable Collamer Lens (ICL) for the correction of myopia and myopia with astigmatism. The lens provides sharp vision, does not induce the dry eye that can come with contact lens wear and, perhaps most notable, obviates the preoperative peripheral iridotomy required for the previous version of the Visian lens.

CENTRAL PORT

The EVO/EVO+ features a central port, one of five ports in the lens. That central port eliminates the need to perform a laser peripheral iridotomy, says George O. Waring IV, MD, FACS, medical director, Waring Vision Institute, Mount Pleasant, S.C. “Historically, the laser peripheral iridotomy was the least comfortable part of the procedure. Now, these are a thing of the past with the EVO technology,” says Dr. Waring.

What’s more, this central port eliminates two potential complications: pupil block angle closure and early anterior subcapsular cataract formation, according to Gregory D. Parkhurst, MD, FACS, founder and physician CEO, Parkhurst NuVision, San Antonio. With these five ports, aqueous can travel from the posterior chamber to the anterior chamber. “That fluid dynamic is creating an environment where the EVO ICL is effectively floating in front of the crystalline lens,” he says.

Dr. Waring agrees that the EVO ICL can reduce the incidence of both of those complications. “We feel that this generation of lens is more anatomically forgiving.”

The EVO Visian ICL is indicated for use in phakic eye treatment in patients 21 to 45 years of age for the correction/reduction of myopia in patients with spherical equivalent ranging from -3.0 D to -20.0 D at the spectacle plane. Also approved was EVO+, which offers a larger optical zone as well as toric versions of the lens.

FEWER LIMITS

The EVO/EVO+ lenses represent a solution for patients who want to see without external aids such as eyeglasses and contact lenses, even if they are not optimal candidates for a laser procedure. “There’s a group of patients who may be told that they’re not ideal candidates for laser treatments,” notes Dr. Parkhurst. “ICL eye surgery can actually help some of these patients because it has fewer limitations in terms of aspects like corneal thickness and magnitude of myopia. We can treat some of those super high myopes who are seeking to live without glasses and contacts, even if they can’t have laser eye surgery.”

Beyond super high myopes, additional patients could also benefit. “What I’ve found over my career is that the quality of vision and patient satisfaction with the platform is so high that we often go lower and lower in terms of the myopia we’re treating,” says Dr. Parkhurst. Patients who are not suitable candidates include those with shallow anterior chamber depth and/or disorders of the endothelium such as Fuchs’ dystrophy, notes Dr. Parkhurst.

LASIK-LIKE PROCEDURE

Historically, agrees Dr. Waring, the ICL technology was reserved for patients who might not be candidates for laser vision correction. Now, he notes, the ICL technology can serve as a first-line option for patients with myopia and myopia with astigmatism. Dr. Waring says he now positions the ICL technology as a treatment offering instead of surface ablation or PRK.

In his practice, if a patient is a borderline candidate for LASIK and/or a candidate for PRK but not LASIK, he recommends the ICL. If the patient is a candidate for LASIK but still with moderate to high degrees of myopia, he will often discuss the ICL because the implant is removable, which will help in the treatment of cataracts for patients who have had LASIK.

Dr. Waring calls the EVO “the next generation in implantable collamer lens technology.” It streamlines the flow both clinically and surgically, he notes. “More importantly, it streamlines and enhances the patient experience,” says Dr. Waring. “This is a much more LASIK-like procedure than ever before.”

AVOIDING CONTACT LENS COMPLICATIONS

Another advantage of the EVO ICL involves the elimination of dry eye that might occur with contact lenses.

“Sometimes people will refer to the ICL as the implantable contact lens,” Dr. Parkhurst says. “Since it’s not sitting on the surface of the cornea, it does not cause dry eye like regular contact lenses do. Patients can have a resolution of their contact lens intolerance by moving to the ICL.”

ENHANCED EFFICIENCY

This new generation of EVO lens makes it even more comfortable for the surgeon to perform the procedure, says Dr. Parkhurst. The ports aid efficient removal of viscoelastic. “The viscoelastic will be removed by just traveling through those ports, and so it’s much more efficient. The addition of the ports in this EVO lens has not only improved the safety in the long term for patients, but it has improved the efficiency in the operating room.”

Dr. Parkhurst estimates about a 25% faster total case time, from roughly 7 minutes per eye to roughly 5 minutes per eye.

ADDED AWARENESS

Dr. Waring expects that this new generation of the ICL platform will help set the stage for future versions of the lens, for instance for correction of presbyopia.

Dr. Parkhurst stresses the need for awareness of the ICL Visian option by both patients and eye-care professionals. “It can be life-changing for people to just be able to wake up and see and not have to reach for their glasses in case of an emergency or worrying about their eyes getting dried out from contacts,” he says. “This platform produces a really excellent sharpness of contrast and quality vision. If more people became aware of the lens, we’d be able to help more patients.” OM