Visian ICL: a viable alternative to corneal refractive surgery?

In the treatment of myopia, STAAR Surgical's Visian ICL (Implantable Collamer Lens) is a preferable alternative to corneal refractive surgery, according to a panel of experts speaking at the STAAR Surgical symposium.

The meeting was convened to discuss various scenarios that refractive surgeons might encounter with the lens, and how best to address issues if they arise.

For patients with slight ectasia, Paul Dougherty, MD recommended using ICL rather than LASIK or PRK, as he believes it generates a better quality of vision and faster recovery. The use of Intacs implants was also discussed as a solution in ectasia patients. "Intacs buy you time, but they do not solve the problem," said Dr Dogherty. "It's a difficult situation; the first-line of defence is always a contact lens, but if the disorder becomes bad enough you have to replace the diseased tissue, which is why we want to avoid it."

When it comes to analysing the cornea prior to refractive treatment, most refractive surgeries use 2D topographies to ensure stability, with only 30% employing 3D systems. Although 2D technology provides good information, the panel agreed that it has certain limitations particularly with determining the thickness and volume of the cornea. "As a result, your level of suspicion is higher," said John Vukich, MD. "There will be a point at which you will find that additional 3D information is very useful. In most cases, those who move onto 3D topographies never go back to 2D."

The panel went on to demonstrate the importance of lens loading when inserting the ICL into the chamber. For example, when placing the ICL into the chamber, a fairly common error is the insertion of the lens upside down. According to meeting moderator, Amar Agarwal, MD, "surgical hands are to blame for this, not the loading system." In this case, Dr Dougherty advised that it is best that surgeons do not attempt to turn the lens back around while inside the chamber, as this may lead to significant cell loss and an uncertainty of success. Instead, he recommended that it is re-inserted.

It is also possible, according to Dr Agarwal, for the lens to become stuck inside the syringe. He explained that this can now be avoided because of the design of the nozzle, which has been incorporated into the loading system to enable the user to pull out the lens easily.

Ideal candidates for ICL treatment are those with 15 D of myopia and younger than 45 years of age. Hyperopic patients are also more likely to benefit from ICL rather than LASIK. Used within these guidelines, it was agreed that ICL is an extremely safe product. This is demonstrated in the lens' popularity; the company has experienced a 30% annual growth in ICL sales for five consecutive years. "Bad ideas lose momentum and go away quietly; good ideas continue to roll in their popularity," explained Dr Dougherty.

The panel concluded that if a surgeon is suspicious of administering corneal treatment, they should avoid using corneal refractive surgery such as LASIK and PRK. "The bottom line is, prevention is always better than cure," said Dr Agarwal. "Yes, there is a solution to poor vision, but treatment is a big headache. The solution should be to divert the problem, and ideally you should find another alternative to corneal refractive surgery."