Panel: Phakic IOL surgery similar to cataract, but distinct

ORLANDO, Fla. — Phakic IOL implantation shares many characteristics with cataract surgery, but the two procedures are distinct, according to a panel of surgeons here. The refractive procedure has its own set of special skills and its own learning curve, and adopting it should not be taken lightly, the surgeons said unanimously.

The panel, part of Refractive Surgery Subspecialty Day here at the joint meeting of the American Academy of Ophthalmology and Pan-American Association of Ophthalmology, consisted of Elizabeth A. Davis, MD, Dimitrii D. Dementiev, MD, Stephen S. Lane, MD, Jason E. Stahl, MD, and John A. Vukich, MD. The session moderator was Daniel S. Durrie, MD.

Together, the panelists have experience with most of the phakic IOLs in use today, including the STAAR ICL, the Medennium PRL and the Ophtec Artisan. The American surgeons have all been investigators in Food and Drug Administration clinical trials of one or more of the lenses. None of the lenses have yet received FDA approval.

“This is not typical IOL surgery that you’re used to if you’re a cataract surgeon. There are distinct differences that you need to apply, and can’t just simply make that transition. It’s not a huge learning curve, but there is definitely a learning curve in utilizing these lenses,” Dr. Lane said. Other speakers on the panel echoed this opinion with similar comments.

Dr. Durrie asked the panel to define the limits of phakic IOL surgery. As he put it, “How low will you go?” He asked the panelists to imagine how they will approach the procedure a year after regulatory approval of the devices.

Dr. Vukich said he would initially recommend phakic IOLs for myopes outside the range of LASIK correction, perhaps those above -8 D, and possibly lower that limit “as we learn more about the risk/benefit ratio.” He said he did not see phakic IOLs as an answer for high hyperopes because in these patients’ smaller eyes the anterior chamber may be too shallow and the IOL too thick.

Dr. Davis said she would consider using phakic IOLs in myopia as low as -5 D if the patient had thin corneas that ruled out use of LASIK. She said about +3 D was the lowest error for which she would consider using them for hyperopia.

With wide experience using the Medennium PRL in his practice in Italy, Dr. Dementiev had the lowest limits among the panelists. He said he would use the lens for myopia as low as -3 D and hyperopia as low as +2.5 D.

Dr. Lane said that if the safety profile of phakic IOLs proves to be “in the same ballpark as LASIK,” he would use the procedure in anyone for whom he would today perform LASIK. For hyperopia, he would use phakic IOLs for errors higher than +3 D or +4 D, he said.

The most conservative of the group, Dr. Stahl said his “comfort zone” for phakic IOLs would be “in the higher ranges.” He said for the time being he expects to stick with corneal refractive surgery.