EVO ICL rounds out continuum of modern refractive procedures
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The STAAR EVO ICL, which is approved for correction of 3 D to 20 D of myopia and 1 D to 4 D of astigmatism, typically affords double-digit myopes 20/15 vision 1 day postop in my practice.
A lot of information has already been reported about the excellent clinical capabilities associated with the ICL, so this article will focus on the practice management implications of offering the EVO ICL.
Options
By complementing our comprehensive refractive surgery roster, the EVO supports our primary practice imperative, which emphasizes putting the patient first. We constantly evaluate new technologies and embrace those that can successfully address our patients’ needs so that we have an ideal option for every person who qualifies for refractive surgery. While the EVO ICL is essentially new — it gained FDA approval in the United States in 2022 — it has long been available outside the country. More than 1 million EVO procedures have been performed worldwide.
Marketing
Approximately 10% of our refractive surgery patients are EVO recipients, and as consumers become familiar with these lenses, patients are presenting asking for the lens by name. We have a significant marketing budget that is heavily weighted to direct-to-consumer advertising. We use billboards, airport signage, radio, TV, Google ads and social media, among other things. This strategy lets prospective patients know that we offer the best-known corneal refractive surgery, as well as the newest lens-based refractive surgery.
Pricing
In our practice, all corneal refractive surgery procedures are the same price. Taking cost out of the paradigm ensures that patients evaluate their options based on what is best for their eyes and what I recommend for them. For instance, if a patient is a candidate for both EVO and LASIK, we discuss the pertinent ramifications, such as whether they have dry eye or thin corneas, and then we make the decision together.
Office-based surgery
I perform EVO ICL surgery in my office-based surgery (OBS) suite, and doing so enables us to control how the patient perceives the entire experience from check in to check out. These patients are like LASIK/SMILE patients in that they do not want to go to a hospital or an ASC. It is a streamlined procedure that takes less than 10 minutes, and they expect it to be performed in a convenient and streamlined fashion — our OBS suite enables us to accommodate that expectation.
No peripheral iridotomy needed
Some surgeons are on the fence about whether or not to adopt the EVO because they think this lens requires them to perform a preoperative laser peripheral iridotomy (PI). The simple answer: PI is not required. The longer explanation: EVO is the next generation version of the original Visian ICL, and the most important distinction between EVO and its predecessor is that EVO is designed with a 360 µm central port along with four other ones. The ports eliminate the need for a PI by allowing aqueous humor to flow more easily through the lens and out through the trabecular meshwork, essentially eliminating EVO’s risk for pupillary block.
Easy to fold
Another common concern that has surgeons questioning whether EVO is right for their practice is that they do not typically fold their lenses. This lens is pliable, easy to manipulate and easy to fold. I have been in practice for nearly 20 years, and like most surgeons, I relegated IOL folding to a technician, but I found it easy to become accustomed to folding this ICL. I want to emphasize that surgeons have everything they need in their skill set to safely fold and implant the EVO ICL.
Measurements
For this procedure, the two most important measurements are manifest refraction and anterior chamber depth. We use the Pentacam (Oculus) pachymeter to ascertain white-to-white measurement, as well as the anterior chamber depth, and this system has been reliable and accurate. However, I am interested in learning more about the ArcScan Insight biometry system and more recently the Absolute by Lumibird because it is newer and has an excellent reputation for ICL sizing, and we are always on the lookout for technology that can potentially improve accuracy.
Patient management
I perform all preop and postop care, as well as the EVO surgery. I would encourage new EVO ICL surgeons to see their postop patients at 1 day, 1 week and 1 month to get a feel for what the eye should look like at those intervals. Once you are comfortable with that, then you may choose to comanage with another doctor. If you go in that direction, have the comanaging doctor spend a few days with you in the clinic to see what you are evaluating postoperatively, such as placement and vaulting of the lens.
Ultimately, like LASIK and even refractive cataract surgery, the EVO ICL has the capacity to make a lot of patients happy. Recovery is quick, and in my experience, the vast majority of these patients are satisfied with their result 1 day postop.
- Reference:
- Packer M. Clin Ophthalmol. 2018;doi:10.2147/OPTH.S188785.
- For more information:
- Robert F. Melendez, MD, MBA, CEO and founder of the Juliette Eye Institute in Albuquerque, New Mexico, and a clinical professor at the University of New Mexico Health Sciences Center, can be reached at dr.melendez@julietteeye.com.
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