Sponsored by STAAR Surgical™
January 2024
With more than 3 million lenses distributed worldwide, the EVO ICL™ (STAAR Surgical) is a widely adopted refractive surgery option for patients. In a recent YoungMD Connect workshop, Deepinder Dhaliwal, MD; Arjan Hura, MD; and Neda Shamie, MD, shared an overview of the lens’ features, surgical implantation tips, and patient education strategies.
Deepinder K. Dhaliwal, MD; Arjan Hura, MD; and Neda Shamie, MD
The EVO ICL™ Lens is a posterior-chamber phakic IOL made of STAAR’s unique Collamer® material. The lens inserts behind the iris into the sulcus, and without sutures, so no scarring occurs. Because the implantation does not create an aberrated cornea, EVO ICL™ recipients experience excellent night vision1,2, and no dry eye symptoms.3,4 Also, because the procedure preserves the cornea’s shape, there is no risk of postoperative corneal shape regression.
In its pivotal US FDA study, the EVO ICL™ demonstrated the same predictability and accuracy for low myopes as for extreme myopes. Recipients had a manifest refraction spherical equivalent ranging from -3.00 D to -6.00 D and astigmatism up to 4.00 D; 98.9% achieved within ±1.00 D of their intended correction. The lens’ safety profile was excellent, with no reported occurrences of subcapsular cataract, pupillary block, angle closure, or pigment dispersion.5
The two keys for me are that this lens is removable by a doctor if the patient is unhappy, and patients can still receive their IOL of choice when cataract surgery is required.
Good cataract surgeons will be great EVO ICL™ surgeons. In my opinion, ICL surgery is typically easier to perform than cataract surgery, and the skill set translates almost immediately. I use a similar anesthesia protocol and prepare the eye in the standard fashion as you would for cataract surgery.
Surgical Tips and Pearls:
Thanks to educational efforts by STAAR Surgical™, eyecare specialists and patients are more aware of the ICL as an option for those with myopia with or without astigmatism who want freedom from the hassles of glasses and contact lenses. At Maloney-Shamie Vision Institute, we position the ICL typically as the ideal option for patients who have high myopia (> -8.00 D), and for myopia as low as -3.00 D but with risk factors for dry eye disease or other corneas unsuitable for laser vision correction or insufficient corneal thickness. For those with lower myopia and no other pathology, the EVO ICL™ could still be a wonderful option, in my opinion, for reasons already listed above.
With the increase in awareness of this option, patients who may in fact be considered a good candidate for corneal laser vision correction come to their consultation fully vested in the ICL as their preferred option. Many patients appreciate the additive option of the EVO ICL™, which can be easily removed by a doctor, if needed. This is in contrast with the subtractive nature of LASIK, PRK, or SMILE—techniques that require modifying the corneal tissue and are therefore irreversible. The EVO procedure is safe and effective, placing it alongside corneal procedures as an alternative for refractive surgical patients. In our practice, we present patients with all surgical options for refractive correction, much the same way we present different IOL options to cataract patients. In doing so, we collaborate with patients on customizing a surgical offering that fits their clinical picture and their personal choice.
1. Martínez-Plaza E, López-Miguel A, López-de la Rosa A, et al. Effect of the EVO+ Visian Phakic Implantable Collamer Lens on visual performance and quality of vision and life. Am J Ophthalmol. 2021;226:117-125.
2. Parkhurst GD. A prospective comparison of phakic collamer lenses and wavefront-optimized laser-assisted in situ keratomileusis for correction of myopia. Clin Ophthalmol. 2016;10:1209-1215.
3. Ganesh S, Brar S, Pawar A. Matched population comparison of visual outcomes and patient satisfaction between 3 modalities for the correction of low to moderate myopic astigmatism. Clin Ophthalmol. 2017;11:1253-1263.
4. Naves J.S, Carracedo G, Cacho-Babillo I, Diadenosine nucleotid measurements as dry-eye score in patients after LASIK and ICL surgery. Presented at American Society of Cataract and Refractive Surgery (ASCRS) 2012.
5. Packer M. Evaluation of the EVO/EVO+ Sphere and Toric Visian ICL: Six month results from the United States Food and Drug Administration clinical trial. Clinical Ophthalmology. 2022;16:1541-53.
The EVO Visian ICL is indicated for phakic patients 21-45 years of age to correct/reduce myopia with up to 4.00 D of astigmatism with a spherical equivalent ranging from -3.00 to -20.0 D and with an anterior chamber depth (ACD) 3.0 mm or greater.
The EVO Visian ICL is contraindicated in patients with a true ACD of <3.00mm; with anterior chamber angle less than Grade III; who have moderate to severe glaucoma, who are pregnant or nursing; less than 21 years of age; and who do not meet the minimum endothelial cell density (ECD) listed in the Directions For Use (DFU).
A summary of the relevant warnings, precautions and side effects: Endothelial cell loss, corneal edema, cataract, narrowing of the anterior chamber angle, pupillary block, increased intraocular pressure, glaucoma, secondary surgery to reposition, replace or remove the ICL, loss of BSCVA, increase in refractive astigmatism, glare and/or halos, pigment dispersion, iris transillumination defects, endophthalmitis, hypopyon, corneal endothelial damage, ICL dislocation, cystoid macular edema, iritis, retinal detachment, vitritis, and iris prolapse.
Please review the DFU for complete safety and other information before performing the clinical procedure.
Note: OUS indications and approvals vary by country, please check the country specific DFU.
US-EVO ICL-24-0151
