1. INTRAOCULAR CONTACT LENS
HKMA Structured CME Program
John Chang, MD
Director of Guy Hugh Chan Refractive Surgery Centre
Hong Kong Sanatorium and Hospital
9 August 2007

2. LASIK is not the best option for every patient
Dioptre removal/optical zone &
quality of vision trade-off
Large pupils
Dry eyes
Steep / flat corneas
« Funny corneas » / Keratoconus
Thin corneas
We all have those patients !

3. Phakic IOLs Advantages Preserves Corneal topography.
No induced aberrations
=> Better quality of vision
High predictability.
Stable refractive outcome.
Safe in eyes with suspicious corneas.
Removable
Minimal capital expenses.

4. Introduction Posterior Chamber Sulcus Fixated Lens Version 4
Myopia D to > D
Hyperopia D to D

5. Loading the ICL
The ICL is marked to ensure proper orientation in the eye as it unfolds
Lower left
Leading right
Alignment Marks

6. Clear Corneal Incision
Temporal, clear corneal incision orients best to iris plane

7. Video - ICL Injection

8. ICL Positioning
Use the paracentisis

9. Video: ICL Positioning
Rotate using the edge of the lens or on the haptic “body”
OK to use footplates

11. 73 Eyes Since 6th May 2002 Age : 23 to 47 Mean age : 34.33 ± 6.37 yrs
Male : 12
Female : 36

12. Pre-Op MRSE
Range : D to D
Mean : ± 3.45 D

13. Follow up 1 day, 1 week, 1 month, 3 month, 6 month,
and 1 year and beyond
Dilated slit lamp & fundus exam (DFE) for all eyes at 6 months
Range: 2 weeks to 43.8 months
Mean: months

14. Predictability of Refraction
Planned Refraction
Within ± 0.50 D : 45 (61.6 %)
Within ± 1.00 D : 59 (80.8 %)

15. Post-Op UCVA Those eyes with 20/20 or better Pre-Op BCVA
20/ (48.7 %)
20/20 or better 31 (79.5 %)
20/25 or better 36 (92.3 %)
20/40 or better 39 (100.0 %)
Worse than 20/ (0 %)
Total

16. Stability of refraction

17. Safety Pre- vs Post- BCVA gained 2 or more lines 14 (19.2 %)
gained 1 line 39 (53.4 %)
no change 18 (24.7 %)
lost 1 line 2 (2.7 %)
Lost > 1 line 0 (0%)

18. Lost 1 line Age: 39 M Pre-op MRSE: -10 D 20/20
Post-op MRSE: D 20/25
Follow up: 1 month
Patient complaint of difficulty with reading and elected to have ICL removed despite near VA J2 after 1 month.

19. Lost 1 line Age: 39 F Pre-op MRSE: -13.88 D 20/15
Post-op MRSE: D 20/20
Follow up: months
Post-op BCVA varied between follow up visits from 20/15 to 20/20. No other complication was noted.

20. Complications Out of 73 eyes: 1 (1.4 %) ICL size too small – observe
1 (1.4 %) brow ache for 2 months
1 (1.4 %) ICL removed after 1 month ( pt didn’t like it) 39 year old male, c/o near vision problem
MRSE at 1 month: D
1 (1.4 %) overcorrect by +1.5 D (VD not at 12mm)

21. Complications
1 eyes (1.4 %) complained of seeing extra light from P.I.
17 eyes (23.3 %) developed transient IOP rise within 2 month post op;
range 23 to 30 mmHg;
all controlled by timolol;
all resolved by 1 month;
only 3 eyes in 2006, all other before 2005

22. Complications 2 eyes (2.7 %) developed ASC Mean pre-op MSE -9.28 D
MSE at last visit
-3.00 D 20/20
/20
UCVA
20/150
20/25
ACD
3.2
3.18
WTW
11.5 11
Lens type
ICM125V4
ICM115V4
Comment
onset at 20 month
onset 13 days, visually significant at 18 months

23. Early result: Toric ICL
25 eyes (since June 2004)
Age range: 23 to 44
Mean age: ± 6.8 yrs
M : F 4 : 14
Mean follow up: 7.5 ± 4.4 months
(range 1.4 to 18.8 months)

24. Early result: Toric ICL
Mean ICL power: Sphere ± 3.22 D
Cylinder ± 1.20 D
Pre-op
Post-op
Mean sphere
± 3.20 D
-0.20 ± 0.51 D
Mean cylinder
+2.95 ± 1.07 D
+0.64 ± 0.47 D
Mean MSE
± 3.06 D
+0.03 ± 0.34 D

25. Early result: Toric ICL

26. Early result: Toric ICL
Cumulative post-op BCVA and UCVA

27. Advantages ICL vs LASIK No / Minimal night vision problems
Stability /Faster recovery.
Correct much higher ranges of myopia (-3.0 D to D)
Also correct hyperopia (+3.0 D to D)
Reversible
No ectasia

28. Advantages ICL vs LASIK
2 patients had ICL in one eye (-19 D, -17 D) and LASIK in the other eye(-14 D, -13 D)
Higher myopia in the eyes with ICL
Both patients report better quality vision with ICL despite the higher myopia
Stability – no initial overcorrection.

29. Advantages ICL vs ACIOL No endothelial cell loss, no AC reaction
Small self-sealing incision
-No/less induced astigmatism
No need to pre-cut flap in bioptics
Can correct astigmatism at the same time
-(LRI or Toric ICL)

30. The Verisyse anterior-chamber Lens
Picture from

31. Disadvantages Clinically significant ASC 1.3%*
Sizing can be difficult, Orbscan not always reliable
Glaucoma? Pigment dispersion?
Expensive
2 Procedures: Laser P.I. First (uncomfortable), then lens implantation
*5 year follow up US FDA MICL Clinical Trial – in press

32. Conclusion ICL and Toric ICL results very encouraging
Transient IOP rise 2° to Occucoat?
Accuracy as good / better than LASIK for high myopia
Much better immediate and long term stability than Lasik.
Technically not difficult (Avg surgery time 25 mins)
No / Minimal night vision problems
Short learning curve –easier than Phaco

33. What if one develops a cataract extraction leads to immediate presbyopia?

34. Multi-Focal IOL
*Diagrams from AMO

35. Refractive IOL - Array
*Diagrams from AMO

36. *Diagrams from AMO

37. *Diagrams from AMO

38. *Diagrams from AMO

39. *Diagrams from AMO

40. Adjustment by
human eye
to Multi-Focal IOL
*Diagrams from AMO

41. Basic Theory Diffractive MIOL - Tecnis MF near focus far focus
*Diagrams from AMO

42. *Diagrams from AMO

43. TecnisMF
Array
ReZoom
far focus
near focus
*Diagrams from AMO 43

44. Patients No. of patients No. of eyes Mean age Range Array 59 95
35 to 85
ReSTOR 27 43
50 to 84
TecnisMF
130
179
7 to 87

45. Refraction Array ReSTOR TecnisMF Preop mean MRSE (D) -10.00 -0.60
-6.18
STD
±7.9
±3.07
±5.29
Range
+7.75 to
+4.00 to -6.75
+5.63 to
Postop mean MRSE (D)
-0.22
-0.26
0.04
±1.01
±0.68
±0.57
+2.38 to -6.63
+1.00 to -2.00
+2.00 to -2.25

46. 3 IOLs Comparison
Cumulative Postop UCVA

47. 3 IOLs Comparison
Cumulative Postop BCVA

48. Safety
Preop vs Postop BCVA: Gain / Loss

49. 3 IOLs Comparison
Cumulative Postop Near UCVA

50. Questionnaire Night glare* Halo* Satisfaction# Array 1.51 (32%)
1.68 (36%)
3.72 (92%)
ReSTOR
1.03 (21%)
1.47 (30%)
3.77 (87%)
TecnisMF
1.88 (44%)
1.99 (44%)
3.70 (93%)
* the higher the score, the more the severity (from 0-5)
# the higher the score, the higher the satisfaction (from 0-5)
(%) percentage of eyes had score ≥3

51. TecnisMF Questionnaire
% of time spectacles are required
0% <50% >50%
Reading 100%
(including newspaper, books, documents)
Near tasks 100%
(including SMS, watch, etc)
Distance 100%
1 patient requires spectacles for computer

52. Mix and Match- Early result
Spectacles dependence
Ave. Time Spent
Yes No
Distance
---- 0%
100%
Reading
2.8 hr
Computer
5.2 hr
All patients are 100% of time SPECTACLES FREE

53. Thank You