Patient: Given I have dry eyes, do you recommend ICL over LASIK for me?

Dr. Sharpe: I definitely recommend the EVO ICL over LASIK for contact lens intolerance and dry eyes. The ICL is implanted inside your eye and does not touch the surface of your eyes, so is incapable of causing dryness on the surface. Moreover, many of our patients have much better ocular comfort because they no longer have anything sitting on the surface of their eyes. It’s really quite remarkable and a wonderful feature of the EVO ICL.

Patient: How long have you been performing ICLs and how often do you perform them?

Dr. Sharpe: I have been doing the ICL procedure for over 10 years. I initially went to a large practice in Salt Lake City where they had a lot of experience doing them. We did hundreds in the first few years, but it has really taken off after the FDA approval of the EVO ICL in March 2022. Since then, I have done nearly 3000 implants and perform the surgery two or three days per week.

Patient: What are the most common complications of ICL?

Dr. Sharpe: There are indeed very few complications. The sizing is very important and occasionally results in needing to exchange the lens for a smaller or larger size. In my hands this occurs about one in every 400 implants, which is better than the national average, and is fairly easy to do- of course we try very hard to avoid the need.

Patient: What is my exact prescription and eye measurements?

Dr. Sharpe: This is, of course, different for every person, but with the EVO ICL we can treat -2.50 (which takes about a -3.00 lens (the EVO ICL numbers are slightly higher than your glasses numbers, which are slightly higher than your contact lens numbers) up to -15.00. I have treated a bit higher than that even and sometimes do LASIK on top of the EVO ICL for the rare patient that has an even higher prescription.

Patient: Do I have enough anterior chamber depth for safe implantation?

Dr. Sharpe: The anterior chamber depth (ACD) is adequate in 95% of patients. In the US, the studies were done only with people who had an ACD higher than 3.0 mm, whereas outside the US the studies were performed on 2.8 mm or higher. Occasionally we will go a bit lower than that depending on the patient’s options. This has never been a problem, but occasionally the ACD is out of the range for safe implantation.

Patient: Which ICL model do you use? (EVO/EVO+)

Dr. Sharpe: This is a very common question and understandably confusing. The EVO and EVO+ were initially two separate models, with the EVO+ having a slightly larger optical zone and therefore theoretically improving night vision to some degree. In the United States, they only sell the model with the larger optical zone, so they dropped the “+” designation and just call it the EVO. Therefore all EVO lenses in the US are the EVO+ with the larger optical zone. My understanding is that there is still a smaller optical zone ICL sold in China. We only use the absolute newest model lens at SHARPEVISION.

Patient: Will I need a peripheral iridotomy beforehand? If not, how does this lens allow fluid to flow safely? How do you ensure there’s no blockage after surgery?

Dr. Sharpe: Fortunately you DON’T! We no longer need iridotomy after the EVO ICL model was approved in the US in March 2022. The EVO ICL has tiny holes that allow fluid pressure to equalize on either side of the lens, therefore there is never any fluid flow issue after the EVO ICL.

Patient: Is the EVO ICL toric (for astigmatism)

Dr. Sharpe: This is also different for different patients. I take a look at the direction and magnitude of the astigmatism and implant a toric lens for people with greater than 0.75 units (diopters) of astigmatism. Less than that it’s a negligible amount and won’t be noticed. The powers of astigmatism correction go from -1.00 up to -4.00, although I have treated higher amounts, and we potentially can adjust the result with LASIK if someone has a prescription that is outside the range of the EVO. It’s really wonderful to have multiple tools to help our patients get a truly custom result.

Patient: What diagnostic machines do you use? Do you measure vault (the space between the lens and natural lens) and pupil size in low light? Do you customize lens sizing per eye?

Dr. Sharpe: Yes to all of the above. We have multiple ways of measuring your eyes including the Galilei G4, Pentacam, iTrace, Argos biometer, IOL Master biometer, and Optos. All of the above are measured, as well as your prescription. All of these measurements are taken in multiple ways to give us a complete picture of you eye and ensures accuracy. The best way to see this is to come in and have your own comprehensive evaluation that you can schedule online at sharpe–vision.com.

Patient: What is my current eye pressure (IOP)?  Is it considered normal for my age? Do I have any risk factors for glaucoma?

Dr. Sharpe: Everyone’s eye pressure fluctuates similar to our blood pressure although the two are not related. “Normal“ eye pressure is considered 10 to 21 mmHg. This pressure measurement is also affected by your corneal thickness and other variables. It’s important to measure this throughout your lifetime with regular visits to you optometrist because even “normal” pressure can result in glaucoma as we get older. This also should be thoroughly discussed with us at your consultation, but it is extremely unusual in young people.

Patient: Does ICL increase my lifetime risk of glaucoma?

Dr. Sharpe: No, there is no reason to believe that the EVO ICL will increase anyone’s risk for glaucoma. Structurally, it doesn’t affect either the production, flow, or egress of the fluid out of your eyes. However, it’s very important to have routine follow up with your optometrist to catch any number of other potential issues with your eyes. Don’t quit going just because you can see perfectly.

Patient: What method do you use to measure eye pressure? Do you take multiple readings for accuracy?

Dr. Sharpe: We almost exclusively use the iCare tonometer to measure your eye pressure, and yes, it takes multiple readings for accuracy. Old school measurements still involve the “air puff“ which can startle you but is benign. The previous standard of care was the “tonopen,” but it was less comfortable. With this advancement in technology, we don’t even have to numb your eye and you will barely feel it, if you feel it at all.

Patient: What is my personal risk of pressure spikes after an Implantable Collamer Lens procedure? What causes pressure to rise after ICL in my case? How often does this happen with your patients?

Dr. Sharpe: Excellent questions! I believe everyone’s risk is very low, and I have not found any significant variables that can predict it. It has become very rare with increasing experience implanting the lens. During the surgery, we put a gel inside your eye that acts to lubricate, protect, and maintain the space where the lens will go. Once the lens is in position, we remove the gel with gentle rinsing with sterile saline. In my hands, the pressure is normal throughout the process in 99.8% of people. Occasionally, the pressure will go up briefly in the first 6 to 10 hours causing an achy discomfort behind the eye. I give everyone my cell number just to make sure they have access any time for any problems or concerns.

Patient: How do you determine the correct lens size? How do you measure and predict vault (space between lenses)? What happens if the vault is too high or too low?

Dr. Sharpe: This is also a very germane question. The EVO ICL is very forgiving, and there are only four sizes. I called them small, medium, large, and extra large. The percentage of these sizes is roughly: 20%/43%/33%/4%. The measuring techniques are varied, but I use our Galilei device which I find to be very consistent. We also measure at the slit lamp using a very accurate beam of light to make the final determination. In the unlikely event that the fit is not correct for your eye, we can exchange it. In my hands this is about one in 400 lenses, which is about as good or better than anyone has reported using any device, system, or nomogram.