EVO ICL™ vs Myopic Laser Vision Correction

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Both EVO ICL and laser vision correction (ex. LASIK, PRK, SMILE) 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 procedures. However, their limits, inclusions/exclusions, and risks differ in important ways.

Comparing EVO ICL and LASIK

  • LASIK improves vision by using a laser to remove tissue from and reshape the patient’s cornea, which is the clear layer that forms the front of the eye. Therefore, the cornea has to be thick enough (as measured by the doctor) to be reshaped safely. If your cornea is not thick enough for LASIK, that is not a problem for EVO ICL, since EVO ICL works by being inserted in front of the eye’s natural lens.
  • EVO ICL
    • Recent FDA approval
    • Advantage and disadvantages of central port
      • 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)
    • Comparable to LASIK: 1 day bilateral surgery (in most cases), quick visual improvement, minimal discomfort

Limits of EVO ICL and LASIK

Laser Vision Correction

  • Consistent results 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)


EVO ICL

Inclusion/Exclusion Criteria

Laser Vision Correction (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


EVO ICL

  • Age: 21-45 yrs old
  • Stable refraction
  • Adequate AC depth (>3.0 mm)
  • Normal endothelial cell density
  • Wide open angle

Risks

Laser Vision Correction

  • 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
    • SMILE has less impact on corneal nerves and induces less postop dry eye
    • 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 hole 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

General Pathology

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Pathophysiology

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Primary prevention

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