OD’s Personal Decision for a Toric ICL Influences Her Conversations

By Christine Smith, OD, of Westlake Village, California

Through my work co-managing refractive surgery patients, I expanded my knowledge about the procedures and options that exist and started seriously considering what path might be best for me. I could never see more than 20/20 with my contact lenses, and I knew that there had to be a better option.

I began to see trends of positive outcomes from my patients who had a toric ICL procedure. With my own diligent research, I personally chose toric ICL and had my procedure done in October 2019 at Dougherty Laser Vision in Westlake Village, California. My vision is now better than what I previously experienced with contact lenses, and I have less irritation from dry eye and no longer experience halos with night vision.

I didn’t know much about toric ICL before, and I’ve discovered it’s an avenue of refractive surgery that many patients and doctors don’t know much about. In fact, many patients don’t even realize there is more than one kind of refractive surgery. I take the time to explain how different options can provide better outcomes depending on each patient’s circumstances. There is a lot more validity to my conversations with patients discussing the option of toric ICL now; it’s become a passion of mine because I know now firsthand the impact it can have.

WHAT MAKES TORIC ICL DIFFERENT?

Toric ICL involves placing a specialty polymer lens right behind the iris and in front of the lens of the eye. It is considered a specialty procedure because it involves penetration to the eye. While it’s not as well known, toric ICL has been around just as long as LASIK, and there have been many updates and improvements over the past two decades. There are several manufacturers of toric ICL; the ones I had implanted are VISIAN ICL, which provides me crisp vision with a lifetime guarantee.

I explain it to my patients as a contact lens that CORRECTS your vision permanently placed inside the eye instead of on the front side. You can’t see it, and it doesn’t move around. The surgeon creates a small hole to allow fluid to flow from one chamber of your eye to the other, which allows your ocular system to work and filter properly, letting fluid flow from one part to the other. This enables patients to have stable eye pressure and healthy eyes as their vision is corrected.

WHO’S A GOOD CANDIDATE?

With my high prescription at -8.00D, I was a borderline candidate for either LASIK or ICL. Because I had dry eye symptoms and commonly saw halos at night, I found that ICL was the better option. In some cases, LASIK makes more sense as it is a simpler procedure without penetration of the eye

Each and every patient should be individually considered for the best procedure, but here are some areas where toric ICL may be a good match.

• Patients with high prescriptions or higher forms of astigmatism of which it can be risky to proceed with LASIK
• Patients who have a career or hobby such as firefighters, military or combat sports
• Patients who do not want to alter the cornea—the great optics and vision from toric ICL doesn’t change the corneal shape (note: you can still redo lasik and still fit contacts even if you do LASIK initially)
• Patients who want an option that is reversible—the lens can be removed, if needed, if patient desires or for a future procedure such as cataract surgery
• Patients who want a lifelong option—the lens material is designed to not be rejected by the body
• Patients with prescriptions between -3.00 to -20.00 are eligible

Because the surgery requires penetration of the eye, there is a slightly higher risk of infection; however, that risk level is dramatically decreased when patients follow the post-procedure protocol involving medicated eye drops.

WHO SHOULD I REFER TO?

I don’t refer patients for toric ICL to just any surgeon because it is a specialty procedure involving penetration of the eye. Patients should be referred to doctors who have specialty training in it; many LASIK surgeons are not comfortable in performing it.

I recommend investigating your local ophthalmology offices websites to see if they mention that they offer this service. If they do, they are likely proud of the offering and have earned the necessary trainings and certifications involved with toric ICL. Read through the doctors’ reviews from patients who have had this procedure, and pay a visit or make a phone call to ask about the services they prefer to be referred to for. When live events resume, consider attending conversations hosted by MDs in your area. This will provide you further education on how to co-manage, what to look for post-surgery and overall updates on the technology and how these patients should be managed differently than those who had other kinds of refractive surgery.

You can even reach out to local community pages and ask for patient feedback in who has provided this service. Be bold! Reaching out in this fashion shows that your engagement and initiative to help co-manage these patients.