Lens-Based Refractive Surgery

In a recent episode of Innovation Journal Club, William F. Wiley, MD, discussed the evolution of Implantable Collamer Lens (ICL) technology, particularly the impact of the recently available EVO ICL (STAAR Surgical).

Dr. Wiley, an early adopter of ICLs since their FDA approval, reflected on how the procedure has transformed over the past decade-plus. In its early years, ICL implantation was considered a niche option, offered primarily to patients with extreme myopia who were not good candidates for corneal refractive surgery. At the time, surgeons often pushed the limits of LASIK and PRK, treating patients in the range of -10.00 D to -11.00 D, while reserving ICLs only for the most severe refractive errors.

The introduction of the EVO ICL caused Dr. Wiley to rethink this approach. Designed with central flow ports that eliminate the need for preoperative peripheral iridotomies, EVO significantly reduced procedural discomfort and improved safety. Dr. Wiley emphasized how meaningful this change was: not only did it remove one of the most challenging and uncomfortable preoperative steps, but it also made the lens more forgiving by improving aqueous flow dynamics. As a result, surgeons now experience fewer concerns about vaulting, pupillary block, or lens-related complications. Because of these advancements, Dr. Wiley said he has steadily lowered the refractive threshold for offering EVO ICLs.

“Now, we’re really comfortable offering it for any patient that fits within the criteria. So, at -3.00 D and above, we’re offering EVO,” Dr. Wiley said.

EVO ICL offers several advantages compared with corneal refractive surgery. Since the cornea is left untouched, there is no tissue removal, no nerve transection, and no unpredictable healing response. Patients avoid dry eye complications and achieve highly predictable results, often within hours of surgery. Dr. Wiley noted that unlike LASIK, after which eyes may show regression due to corneal remodeling, EVO outcomes remain remarkably stable.

These clinical impressions were recently confirmed in a 3-year study of EVO ICL implantations, which showed excellent long-term predictability and efficacy (Figures 1 and 2).¹ The study also demonstrated the stability of the EVO platform: mean spherical equivalent was -7.62 D preoperatively, -0.10 D at 12 months, -0.11 D at 24 months, and -0.12 D at 36 months.

“The study shows that at 3 years out, patients saw better than they did initially or before surgery. So not only did it stay stable, but there was some slight improvement over time, which is amazing,” Dr. Wiley said.