EVO ICL™ vs Myopic Laser Vision Correction

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Both EVO ICL and LASIK are surgical options for treating myopia, but depending on patients’ unique eyes and preferences, one approach might be a better option than the other. Both routes can greatly improve patients’ vision so that they no longer need glasses or contacts, and both are 10 to 30-minute-long outpatient bilateral procedures. However, their limits, inclusions/exclusions, and risks differ in important ways.

Comparing EVO ICL and LASIK

  • EVO ICL
    • Received FDA approval in March 2022
    • a soft, flexible lens made from a biocompatible material called Collamer that is inserted front of the eye's natural lens; not dependent on corneal thickness
    • design includes a central port with associated advantages and disadvantages (Packer 2018, Tian et al. 2017)
      • No need for pre-operative laser peripheral iridotomies
      • No concern for pupillary block
      • Possible decreased incidence of anterior subcapsular cataract formation
      • Hole-related dysphotopsias and night vision problems (transient)
  • LASIK
    • improves vision by using a laser to remove tissue from and reshape the patient’s cornea. Therefore, the cornea has to be thick enough to be reshaped safely.
    • Refer to this page for more information: https://eyewiki.aao.org/LASIK_for_Myopia_and_Astigmatism:_Safety_and_Efficacy

Limits of EVO ICL and LASIK

  • EVO ICL
    • Can correct myopia between -3.0 D to -15.0 D, as well as reduce myopia up to -20.0 D
  • LASIK
    • Consistent results in correcting myopia up to -10 D sphere, +5 D cyl, although success has been achieved among very high myopia patients (−10.00 to −13.50 D) thanks to modern laser technology (Wallerstein et al. 2020)

Inclusion/Exclusion Criteria

  • EVO ICL
    • Age: 21-45 yrs old
    • Stable refraction
    • Adequate AC depth (>3.0 mm)
    • Normal endothelial cell density
    • Wide open angle
  • LASIK (AAO 2013)
    • Age: generally >20 yrs old
    • Refractive stability for at least 12 months
    • Adequate central corneal thickness measurement (250µm recommended for LASIK as a safe residual stromal bed thickness)
    • Normal topography (abnormal is most significant risk factor for postop ectasia)
    • No ocular disease

Risks

  • LASIK
    • Induced dry eye and ocular surface disease (Toda 2018)
      • Post-LASIK dry eye is the most common postoperative dry eye after ophthalmic surgeries.
        • Clinical signs include positive vital staining of the ocular surface, decreased tear breakup time and Schirmer test values, reduced corneal sensitivity, and decreased functional visual acuity.
        • Likely due to loss of corneal innervation caused by flap-making
      • Post-LASIK ocular surface pain, possibly induced by abnormal reinnervation or neural sensitization of peripheral nerves and the central nervous system
  • EVO ICL
    • Less dry eye compared to laser vision correction (Gjerdrum et al. 2020)
    • Induced higher order aberration and undesirable visual effects in EVO (Tian et al. 2017)
      • Visian ICL V4c caused more HOA, especially spherical aberration, than Visian ICL V4 when treating high myopia, but there was no difference in compensation factor and subjective visual quality. Therefore, the presence of the central port of Visian ICL V4c has no significant effect on visual quality.
    • Risks of intraocular complications (Packer 2018)
      • Endophthalmitis
      • ASC cataract
        • Older age and higher levels of myopia increase risk
      • Pupillary block/angle closure glaucoma

References

  1. EVO ICL or LASIK? EVO ICL. https://us.discovericl.com/evo-visian-icl-lens. Published December 24, 2022. Accessed December 29, 2022.
  2. Feldman B, Huang D, Reddy V, Saad A, Shafer B. LASIK for myopia and astigmatism: Safety and efficacy. EyeWiki. https://eyewiki.aao.org/LASIK_for_Myopia_and_Astigmatism:_Safety_and_Efficacy. Published October 19, 2021. Accessed December 29, 2022.
  3. Gjerdrum B, Gundersen KG, Lundmark PO, Potvin R, Aakre BM. Prevalence of Signs and Symptoms of Dry Eye Disease 5 to 15 After Refractive Surgery. Clin Ophthalmol. 2020;14:269-279. Published 2020 Jan 28. doi:10.2147/OPTH.S236749
  4. Packer M. The Implantable Collamer Lens with a central port: review of the literature. Clin Ophthalmol. 2018;12:2427-2438. Published 2018 Nov 27. doi:10.2147/OPTH.S188785
  5. Summary recommendations for Keratorefractive Laser Surgery - 2013. American Academy of Ophthalmology. https://www.aao.org/clinical-statement/summary-recommendations-lasik--january-2008. Published November 5, 2013. Accessed December 29, 2022.
  6. Tian Y, Jiang HB, Jiang J, Wen D, Xia XB, Song WT. Comparison of Implantable Collamer Lens Visian ICL V4 and ICL V4c for high myopia: A cohort study. Medicine (Baltimore). 2017;96(25):e7294. doi:10.1097/MD.0000000000007294
  7. Toda I. Dry Eye After LASIK. Invest Ophthalmol Vis Sci. 2018;59(14):DES109-DES115. doi:10.1167/iovs.17-23538
  8. Wallerstein A, Kam JWK, Gauvin M, et al. Refractive, visual, and subjective quality of vision outcomes for very high myopia LASIK from - 10.00 to - 13.50 diopters. BMC Ophthalmol. 2020;20(1):234. Published 2020 Jun 17. doi:10.1186/s12886-020-01481-2
  9. What's the procedure for EVO ICL? EVO ICL. https://us.discovericl.com/procedure. Published December 17, 2022. Accessed December 29, 2022.
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