How one OD and MD work together to provide the EVO ICL

In the collaborative care model practiced at Parkhurst NuVision, in San Antonio, Texas, Anthony Vanrachack, OD, and Gregory D. Parkhurst, MD, FACS, founder and physician CEO, work together to ensure an optimal outcome for myopia patients. One way they achieve this is through the symbiotic roles they play in the implantation of STAAR Surgical’s EVO/EVO+ Implantable Collamer Lens (EVO ICL).

Here, Drs. Vanrachack and Parkhurst discuss these roles.

OD ROLE

Dr. Vanrachack, who also serves as adjunct clinical professor at the University of the Incarnate Word, Rosenberg School of Optometry, says he handles the patient selection, patient education, pre- and postoperative workup.

During an advanced ocular analysis, he says he can identify patients who are ideal candidates for ICL. Specifically, these are myopia patients ages 21 to 45 with a spherical equivalent ranging from -3.00 D to -20.00 D at the spectacle plane; or patients in the same age range with a cylinder of 1.00 D to 4.00 D at the spectacle plane. Additionally, he says, for on-label treatments, such patients must have an anterior chamber depth of 3.00 mm or greater from the corneal endothelium to the natural lens’ anterior surface (in many parts of the world, it is standard of care to include patient’s below 3.00 mm, he notes), and a stable refractive history (within 0.5 D for one year prior to implantation).

“In discussing the EVO ICLs, I educate patients that the ICL is implanted directly behind the colored part of their eye and in front of their natural lens. I further explain that no corneal tissue is removed, and that implantation of the ICL is reversible,” he explains. “My next course of action is to perform additional testing (e.g., dry and wet refraction, anterior segment ultrasound biomicroscopy, calipers for measurement, slit lamp and dilated fundus examination, etc.) that enables me to select the lens power and size.

“In most cases, patients are able to have all their preoperative measurements obtained in one day, which means less office visits and more time living life,” says Dr. Vanrachack.

MD ROLE

Dr. Parkhurst says he enters the picture during a weekly meeting among ODs and MDs at the practice about patient cases, including those patients who will undergo EVO ICL implantation. Additionally, he says he double checks ICL selection, points out Dr. Vanrachack.

Prior to the day of surgery, Dr. Parkhurst, or one of the other surgeons in the practice, meets with the patient to answer questions about the surgery, which he says builds rapport and, therefore, patient trust. This puts patients at ease.

“In our co-management model, that conversation is usually quite brief because the optometrists do such an excellent job in answering patient questions after they have educated the patient about the EVO ICL and what they can expect,” he explains.

COMING TOGETHER

After the procedure, Drs. Parkhurst and Vanrachack, among other MDs and ODs who co-manage EVO ICL implantation at the practice, work together to ensure the patient is doing well.

Dr. Vanrachack observes that many of his patients are seeing just as good, if not better, without glasses and contact lenses postoperatively compared to best correctable vision preoperatively. He says anterior segment OCT is used to objectively measure vault (distance between the posterior portion of ICL to the anterior portion of the crystalline lens). A slit lamp exam is performed to ensure angles are open and to confirm ICLs are well positioned.

If any complications, such as elevated IOP or residual refraction, are identified, surgeons are notified, and a plan of action is mutually determined by the co-managing care team.

Many high myopes have had ICL as a tool to reduce their prescription, the doctors say. With healthy corneas, stable post-operative refraction and corneal topography, Dr. Vanrachack has recommended laser vision correction options to treat residual refractive measurements to obtain spectacle independence. That said, the need for laser vision correction enhancement is rare following EVO implantation, according to the company.

Dr. Parkhurst notes that ICLs are a long-term solution for treating myopia and myopia with astigmatism. At the time of presbyopia, other options, both surgical and non-surgical can be contemplated for the patient. OM

Dr. Vanrachack has no disclosures. Dr. Parkhurst is a consultant for STAAR Surgical.