Article and Commentary Suggest Caution With ICL: Intraocular collamer lens

[JohnHaganMD]

Just published today.  Signficant rates of cataract formation, cataract surgery and new complication of ocular hypertension and glaucoma.


LINKS:   ARTICLE:
http://archopht.jamanetwork.com/article.aspx?articleID=2498860&utm_source=Silverchair_Information_Systems&utm_campaign=Thursday_March_3_2016&utm_content=olf&cmp=1&utm_medium=email  

COMMENTARY:
http://archopht.jamanetwork.com/article.aspx?articleID=2498857&utm_source=Silverchair_Information_Systems&utm_campaign=Thursday_March_3_2016&utm_content=olf&cmp=1&utm_medium=email

[JohnHaganMD]

ERROR: I meant to say "as much glasses INDEPENDENCE AS POSSIBLE"

[JohnHaganMD]

I did see that article in Eye World News.  Not many studies that have looked at that. The thought that occured to me at the time. The refractive patients are self selected to desire the best possible vision and ideally with as much glasses as possible. Thus when they get in their 40's and start to need reading glasses they are usually very unhappy. Many jump at the chance to get insurance coverage to removed even a small cataract and go to a mono-vision or insert a multifocal IOL or accommodating IOL.  Other patients have made peace with their glasses, may not put as much value on seeing perfectly and have not had their eyes operated on. Thus I think a serious problem with this and other studies looking at it is that the patient populations are very dissimilar.  I double that LASIK and Surface PRK are very cataractogenic.

[SoftwareDeveloper]

I would be curious how the risks compare to laser surgery, since an article this month suggests corneal refractive  may   increase the risk of cataracts as well:

http://www.eyeworld.org/article-study-reveals-cataract-surgery-increasing-in-corneal-refractive-surgery-patients
"Patients who have had corneal refractive surgery seem to be getting cataract surgery more than a decade earlier, on average, compared to their non-corneal refractive surgery counterparts, according to research published in the Journal of Cataract & Refractive Surgery.1
... While the average age at the time of cataract surgery for these refractive patients was about 63 years old, non-refractive cases were having the procedure, on average, at 74 years old. "

I haven't looked into this study to evaluate its quality however ,  and the article mentions some of the complications with trying to interpret the results.
Since I've already had my cataract surgery and I've got other distractions at the moment, I hadn't taken time to evaluate the tradeoffs, though I'm curious for the sake of others considering refractive surgery options.

[JohnHaganMD]

Your concerns were addressed by Dr. McClead in his critique.  Other studies have shown increase in cataract formation.  
from article critique
Although refractive results were excellent, with a mean (SD) logMAR uncorrected distance acuity of 0.02 (0.33) at 8 years after surgery and 73% of eyes with uncorrected distance acuity of 20/20 or better, 17% of eyes that lost at least 1 line of best-corrected acuity, and 7% of eyes that lost 2 or more lines, 5% of eyes required cataract extraction during this 8-year period.

This second study shows even higher rate of cataract formation, cataract surgery and for first time glaucoma.   I find this study quite disturbing 20% of these non-cataractous, relatively young people need cataract surgery within 10 years. Moreover many are highly myopic and cataract surgery even if successful moves these patients into a risk of retinal detachment of as high as 1-2%.

[SoftwareDeveloper]

That is unfortunate news. One problem with the study is that it doesn't provide a comparison to a matched set of similarly  myopic eyes of patients with a similar age profile that weren't surgically treated and/or were treated via laser to get an idea of how much it changes the risk.

It highlights the fact that people need to be aware of risks, given that *someone* winds up being the statistic even in low risk procedures, however  their conclusion still is that : "This study confirms that ICL implantation provides good long-term safety and stability of refraction in patients with high myopia. There is a larger than expected rate of lens opacity and phacoemulsification, which continues to increase up to 10 years after surgery. The rates of ocular hypertension are greater than previously reported. These outcomes have important clinical implications, and, as such, this information should be part of the available patient information before ICL implantation."

In addition of course cataracts aren't the end of the world, they are treatable, I don't know how treatable the other issues are in these cases. A better longterm followup would be to compare the final results (including treatment of these complications) with   matched eyes with no treatment or laser treatment (or even contact lenses, given there are also things like risk of infection from contact lenses when worn for several years, they aren't risk free).

[SoftwareDeveloper]

I should note that surgeons reading the paper (unlike a layperson) likely have in mind  some idea of the prevalence of those issues in those without ICLs from other studies so the comparison may be more useful for laypeople, which isn't the target audience for a paper like that. However its still  cleaner if a study would do a directly matched comparison, and its  more convenient for those reading a study even if they are familiar with other data from eyes without ICLs.