J. Morgan Micheletti, MD, of Berkeley Eye Center in Houston, Texas, talks about the biometer data that hopefully allows more surgeons to confidently implant EVO ICL.
J. Morgan Micheletti, MD:
I recently completed a study in early 2024, which we presented at the 2024 ASCRS and won best paper, where we looked at biometers of all different makes and models compared to the original Orbscan II, which was initially utilized to generate the sizing equation used for ICL.
Now, we know that we want ICL surgery to be similar to LASIK in that a patient comes in, they take a couple measurements, they get set up for surgery. It’s less contact, less time. By contact I mean an immersion scan or something that requires actually physically touching the patient’s eye, just to improve comfort.
We have all these tools in our clinic today, but we have a hard time necessarily correlating them to what the vault and the postoperative vault might be.
The purpose of this study was to create fudge factors, if you will, from our modern biometry devices compared to the Orbscan II, so that we can more accurately calculate the size.
Because it’s not that we have a sizing problem with ICLs. I think I hear that from other surgeons a lot, they say, “Oh, ICLs are a difficult thing to get into, because how do you determine which size to use?” It’s actually not that hard, you just have to know which biometer to use. Or if you’re using X biometer to use Y adjustment factor.
Now we have that data and we have that information, I think it’s going to unlock some new potential and hopefully allow more surgeons to confidently implant ICL.
But there’s also lots of other ways, right? If you don’t have one of these biometers and you want to go with ultrasound or intersegment OCT, those are also extremely accurate ways, and you may not need these conversion factors.
The point is there’s lots of tools, it’s not a one size fits all model. But the idea is to try to get it out there, so as many different surgeons have access to it as possible with their current technology that they have in their clinics.
One of the best parts about EVO ICL is that we’re not messing with the cornea. We’re learning more and more about altering the cornea in different ways and how it may set a patient up later in terms of which IOLs they may or may not be a candidate for.
I think that by bypassing the alteration of the cornea with something like Excimer laser technology, and instead doing an additive supplemental procedure like EVO ICL, we can maintain that ability for the patient to unlock for themselves future technologies, while providing that excellent clarity that we know and have come to expect from EVO ICL.
Recently, we looked at nine different biometers and compared it to the original Orbscan II. The only reason is because we don’t really have Orbscan IIs anymore, they’re more antiquated. But we have newer modern biometry tools, such as the IOLMaster 700, Pentacam AXL Wave, ARGOS, Lenstar, etc. These are more likely to be found in our offices right now.
What we wanted to do was to look at a bunch of different eyes; we looked at 408 different eyes over the course of a couple months. We ran all of these patients through all of the different biometers to calculate the fudge factor or the adjustment factor, if you will. What was the mean difference between these different biometers and how they measured white to white AC depth corneal thickness? Because we can make that adjustment and plug that into the calculator for ICL sizing.
Why we need to do that is important. All of the original measurements were done on the Orbscan II, hence the whole purpose of comparing it to the Orbscan II. Our devices do measure differently. Some measure bigger, some measure smaller, some measure very similarly. That doesn’t mean one device is better than the other, they just measure differently. That’s all it is.
It’s no different than going to Lowe’s or Home Depot; they may have a slightly different yardstick that’s a couple millimeters different. Even though you’re still measuring the same thing, the measuring stick just may be a little different. That’s what we’re trying to show here in this study, is what is that difference?
We do that. It’s a great new data, it’s great new information to have and to get out to surgeons. We’re hoping that it’ll be out there soon. It’s been submitted for publication, and so we’re hoping that we’ll be able to get that data out there shortly.
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