Implantable Collamer Lens Procedure Planning: A Review of Global Approaches

Abstract

More than 2 million implantable collamer lenses (ICLs) have been implanted worldwide. With a central port to improve aqueous flow through the ICL, the latest iteration of this phakic intraocular lens (pIOL) has been shown to have stable outcomes with very low rates of adverse events. However, correct planning and ICL size selection continue to be important to achieve an optimal vault. Shallow or excessive vaults are not complications in and of themselves but may increase the risk of complications. Historically, surgeons have relied on measurements of anterior chamber depth (ACD) and manual, caliper-measured white-to-white (WTW) distance to select the ICL size. New diagnostic and imaging technologies such as optical coherence tomography (OCT) and ultrasound biomicroscopy (UBM) provide additional opportunities for visualization and measurement of the intraocular dimensions involved in phakic intraocular lens implantation, including sulcus-to-sulcus (STS) and angle-to-angle (ATA) diameters. This paper reviews various approaches to ICL planning and sizing that have been published in the peer-reviewed literature, all of which produce acceptable results for predicting vault and size selection. Surgeons may also want to identify a methodology for patient evaluation and ICL size selection that best aligns with their personal preferences, diagnostic technology, and familiarity with analytical optimization tools.

Plain Language Summary

Phakic intraocular lenses (pIOLs) are one method for correcting nearsightedness, with or without astigmatism. This category of refractive surgery has been growing rapidly in the US and around the world. Implantation of the implantable collamer lens (ICL), one type of pIOL, is safe and effective, with stable outcomes and low adverse event rates. When complications do occur, they are typically associated with an inappropriate vault, or distance between the implant and the natural lens. Preoperative planning and accurate ICL sizing are required to achieve an optimal vault and varies, depending on the diagnostic technology available to the surgeon. This paper reviews the current approaches to ICL planning and sizing in order to provide guidance to surgeons implanting this pIOL.

Keywords:

• phakic IOL
• vault
• sizing
• white-to-white
• sulcus-to-sulcus
• angle-to-angle

Acknowledgments

Jan Beiting (Wordsmith Consulting, Cary, NC) provided assistance in preparing this manuscript.

Disclosure

A. Cummings and X. Wang have no conflicts of interest to disclose for this work. V. Thompson reports personal fees from Acufocus, AdOM, Alcon, Allergan, Allotex, Amring, Avisi Technologies, Balance Ophthalmics, Bausch and Lomb, BRIM Biotechnology, BVI, Carl Zeiss Meditec, Centricity, Conjtac, Crystilex, CSO, D&D Biopharmaceuticals, DelSiTech, Euclid Vision Group, Avellino, Expert Opinion, eyeBrain Medical Inc, Eyedetec, Eyesafe, Forsight Robotics, Glaukos, iVeena, Johnson and Johnson, LayerBio, Lightfield Medical, Medevise, Melt Pharmaceuticals, NanoDrops, Ocular Innovations, Oculotix, Oyster Point Pharma, Rayner, Reopia, RxSight, Singular Strategies, Stuart Therapeutics, Tarsus Rx, TearClear, TearOptix, TherOptix, Treehouse Health, Trukera, Visus, 2EyesVision, Staar, Stepwise Medical, and Visant Medical, outside the submitted work.