1 / 47

Optometric Certification Course for the Visian ICL

Optometric Certification Course for the Visian ICL. Offering patients the latest refractive procedure: The Visian Implantable Contact Lens. C. Dan Siapco, MD North Cascade Eye Associates Mount Vernon, WA. Course Objectives . Identify appropriate ICL patients

gerik
Download Presentation

Optometric Certification Course for the Visian ICL

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Optometric Certification Course for the Visian ICL Offering patients the latest refractive procedure: The Visian Implantable Contact Lens C. Dan Siapco, MD North Cascade Eye Associates Mount Vernon, WA

  2. Course Objectives • Identify appropriate ICL patients • Identify who does NOT qualify for the ICL • Appropriately manage postoperative ICL patients • Refer ALL ICL patients to our center* *shameless self-promotion

  3. Optometric Certification Course • First of its kind presented in the US • BDP is committed to education and training of surgeons and optometrists in new technology • Surgeons • MD certification course & live surgery • Comanagement of ICL patients needs to occur as numbers of patients increase

  4. ICL in the Public Arena • Today Show • Much more to come • Need to be ready to answer questions and be familiar with the technology • Patients increasingly asking for ICL vs LASIK

  5. Our Experience • FDA Investigators for clinical trials in 1997 • We are the highest volume ICL surgical practice in the world • Hosted surgeons seeking refinement of techniques • Speaker at US and international conferences • Goal is to provide patients a VIP experience

  6. Refractive Surgery • Review of classical approaches

  7. Evolution of Refractive Surgery ICL • The Visian ICL represents a major step in the evolution of refractive surgery LASIK Cataract/ IOL

  8. Background on the ICL • Phakic intraocular lens (PIOL, ICL, etc) • Posterior chamber lens implant—behind iris, anterior to crystalline lens • Collamer material very biocompatible

  9. Background on the ICL • Excellent visual outcomes • Minimal healing time • Minimal postoperative restrictions • Remarkably low risk of complications

  10. Comparison to Verisyze • Invisible in the eye to the patient and observers Verisyse Visian ICL

  11. Identifying the Ideal ICL Candidate

  12. Identifying the Ideal ICL Candidate • Topography • Pachymetry • Higher Rx • Pupil Size • Visual Demands • Medical Conditions

  13. 1) Topography Questionable or suspicious topography (forme fruste keratoconus, etc)

  14. 1) Topography No question topography—Keratoconus

  15. 2) Marginal Corneal Thickness • Thin pachymetry • LASIK tissue ablation must leave a residual untreated bed of 250µ (275 µ at BDPEC) • Consider future enhancements in higher corrections, especially in younger patients

  16. LASIK Plans • 6.5 mm pupil • -7.50 +0.75 x 178 • 519 micron cornea 7.0 mm treatment zone 120µ IntraLase flap 122µ ablation required 519µ - 120µ = 399µ - 122µ = 277µ bed • Much more concerning when the patient is 22 years old and may likely require future enhancements

  17. What about PRK in these patients? • Compared to PRK, the ICL offers •Much quicker visual recovery—1 day vs 1 month •Absence of pain vs up to 1 week of intense pain •No fluctuating vision vs 1 month of back-and forth •Postoperative regimen is EXQUISITELY simple compared to PRK Steroids Antibiotic

  18. What about PRK in these patients? • PRK is a practice killer • PRK patients don’t refer other PRK patients • PRK patients always wonder if they made the right choice • Managing postop PRK can be very difficult

  19. 3) Higher Correction Patients with -6.00 diopters or more have the ICL recommended as a procedure of choice, due to the greater quality of vision this offers

  20. 4) Large Pupils • If the pupil is larger than 7.0 mm , the ICL is recommended as the procedure of choice --Glare & halos inconsequential compared to LASIK

  21. 5) Higher Visual Demands • Patients with higher visual expectations (engineers, professional drivers, etc.) -need quicker visual recovery -expect improved quality of vision -require less halos at night • ICL candidates, even at less than -6.00 correction

  22. 5) Higher Visual Demands • National Geographic photographer • Military sniper trainer • Radiology personnel • FBI agent --all could have LASIK, but opted for ICL for better visual quality

  23. 6) Medical Contraindications Strongly consider the ICL in these patients • Dry eyes • Collagen vascular disease • Fibromyalgia • Cheloid formers • Aborted LASIK flaps • Engineering background

  24. Refractive Considerations • The myopic ICL is approved for -3 to -20 refractive errors, with up to 1.50 diopters of cylinder • ICL patients typically tolerate residual refractive error much betterthan LASIK patients. • Patients with postoperative refractive error may consider LASIK enhancement over the ICL

  25. Patient Outcomes

  26. After ICL After LASIK Quality of Vision • Simulation of quality of vision having equal treatment with the ICL and LASIK based on higher order aberrometry (-7.0D treatment)

  27. High Definition Vision from Edwin J. Sarver, PhD; Donald R. Sanders, MD, PhD; John A. Vukich, MD Comparison of Image Quality for High Myopes Corrected with Laser in situ Keratomileusis and Phakic Intraocular Lens

  28. LASIK vs ICL 1 Day Postop • LASIK Patient “e…v…o…t…z…2, but when is it going to clear up?” • ICL Patient “Oh my gosh, I’ve never seen like this in my life!” Significant “WOW!” factor

  29. Risks of ICL Surgery

  30. Risks—General • Cataract • 1.3% in FDA Study over 8 years • 0.3% in patients younger than 45, less than -13 Rx • Pupillary block glaucoma • Relieves with pupillary dilation • Iridectomy performed as part of ICL procedure

  31. Risks—General • Endothelial cell loss • No cases of clinical significance • Endophthalmitis • Only 1 confirmed case in over 80,000 ICLs • Patient suffered no visual loss

  32. Risks—Sizing of Lens • Four ICL sizes • Based on white-to-white measurement or sulcus-to-sulcus from B-scan • 12.2mm, 12.6mm, 13.2mm, 13.7mm

  33. Risks of ICL Surgery—Sizing of Lens • Sizing too large (excessive vault) • Narrowing of angle, crowding of iris and chamber • IOP elevation • Consider exchanging for shorter ICL

  34. Risks of ICL Surgery—Sizing of Lens • Sizing too short (shallow or absent vault) • Lens rests on anterior capsule • Theoretical risk of cataract formation • Patients with zero vault many years post ICL show no cataract • Consider exchanging for longer ICL

  35. Preoperative Evaluation

  36. Preoperative Screening • Myopia -3.00 to -20.00 • +/- astigmatism • Topography • Anterior chamber depth (ACD) • 3.0mm FDA approval • On A-scan subtract pachymetry from ACD for true ACD

  37. Contraindications • No previous refractive surgery • Progressive refractive error • Corneal/Endothelial pathology • Glaucoma • Narrow AC angle • Cataract or capsular opacification • AC Depth < 3.0mm

  38. Contraindications • History of: • Iritis • Synechiae • Pigment dispersion • Pseudoexfoliation • Low/abnormal endothelial cell count per age range • Keratoconus – Some data to support this may be an excellent alternative • Patients under age 21 (off-label)

  39. Postoperative Evaluation

  40. Postoperative Evaluation • Vision • IOP • Slit Lamp Examination

  41. Slit Lamp Examination • Slit Lamp Examination • Patency of PI • No inflammation, chamber formed • Round Pupil • Vault

  42. Assessing the Vault • Dark or clear space between ICL and crystalline lens • Aqueous space • Measured in percentage of corneal thickness • “Perfect” vault is 100% • Good vault is approximately 50-150%, but can be less or more

  43. Assessing the Vault • ICL is extremely compatible with ocular tissues, even at extremes of vault • Rarely has to be exchanged

  44. Postoperative Instructions • Exquisitely simple! • Pred qid for 1-2 weeks • Vigamox qid for 1-2 weeks • Shield or goggles at bedtime for 3 days

  45. Conclusion • The Visian ICL represents the latest evolution of refractive surgery • Pushes refractive surgery into the realm of phakic intraocular procedures • Bridges the gap for patients who previously were not candidates for any refractive procedures • Raises the bar for improved visual acuity even in patients who are LASIK candidates

  46. A Life-Changing Experience • My highest myope treated with ICL is -18.00 • She was functionally debilitated by myopia • Unable to wear contact lenses due to dry eyes • Is now 20/15 uncorrected • Declares emphatically that the ICL has “changed my life!” • Is busy handing out business cards to anybody who wears glasses, regardless of their Rx

  47. Educating Your Patients • Successful communication of what is best for the patient • High Definition Vision • Use the visianinfo.com website • Use previous ICL patients—best ambassadors for your practice • STAAR marketing & consultation support

More Related