Eyeworld Daily News

APRIL 23, 2022 | EYEWORLD DAILY NEWS | 3 ASCRS ANNUAL MEETING DAILY NEWS in the middle, and into the angle. Out of 7,214 of this design implanted with between 1 month and 10 years of follow-up, there has been no cataract, no pupillary block, and no pigmentary dispersion, he said. He called the Aquaport "a great step forward." In terms of patient acceptance, Dr. Zaldivar said 90% of patients would rate their experience as 10 out of 10. Compared to LASIK, those with an ICL were more likely to say they were "extremely satisfied" (100% compared to 84.6%). Dr. Zaldivar said there are new tools to further enhance the procedure and outcomes: software to predict vault, high-resolution ultrasound to show the real position of the lens, and intraoperative OCT to avoid overcorrection. "In my opinion, the appearance of this new lens model in the USA is going to be the most disruptive technique in refractive surgery in the coming years," Dr. Zaldivar said. Editors' note: Dr. Zaldivar has no finan- cial interests related to his comments. Vance Thompson, MD, who in- troduced Dr. Zaldivar and the lecture, described Dr. Zaldivar as an innovator and great teacher who has been highly sought after. Dr. Zaldivar performed the first ICL surgery in the world in 1993 and spent the decades since refining the surgery and the implant. He said that, like Dr. Steinert, Dr. Zaldivar is an extraordinary individual. His family has a legacy in ophthalmology, with his father being an ophthalmologist and his son, Roger Zaldivar, MD, as well. Dr. Zaldivar, leading into his lec- ture, said it was "a real honor to be a recipient of this distinguished recog- nition." He said that Dr. Steinert and he worked in the same building when he was a fellow in Boston, and that Dr. Steinert was his inspiration. "To take this recognition in his name is really a privilege," Dr. Zaldivar said. To date, he has performed more than 200,000 refractive procedures and 23,000 phakic IOL procedures. In 1991, refractive surgeries included RK, keratomileusis, lensectomy, and a few others. When he was invited to Russia at the time, he saw a phakic lens proce- dure and said he was convinced it was the path forward. In September 1993, he put in the first ICL in Mendoza, Argentina. Soon afterward with infrared photos, they started to observe decentration and rotational issues with the ICL. So Dr. Zaldivar said he met with the team at STAAR Surgical and helped design the current "footplates" that help avoid rotation and decentration. After this, another problem presented itself. Lenses were getting broken with the injector, which at that time had a metal tip and was designed for silicone IOLs. This problem was solved with the development of an injector with a foam tip. Another prob- lem was pupillary block. Dr. Zaldivar said they began doing two iridotomies to combat this and later developed the implant to have a central hole (avoid- ing the need for iridotomies) in 1994. Dr. Zaldivar showed a picture with a patient 20 years after the first pro- cedure with the version that had the central hole. The 73-year-old patient didn't have a cataract and had excel- lent vision, which Dr. Zaldivar said amazed the team. A couple of years after designing the central hole, they started to suspect that it could be pro- ducing a dysphotopic effect, but they didn't know for sure. In 1996, Dr. Zaldivar coined the term Biotics to describe a combined laser and ICL procedure. Then, he described the end of the 1990s as the "darkest hours." Complications that hadn't occurred before began to ap- pear, such as anterior capsular opacity. Around this time, in 1999, Dr. Zaldivar saw a patient for a 3-year ICL follow-up. The patient had a cataract in one eye but nothing in the other. The difference was one eye had vault under the ICL, the other didn't. "We needed vault to avoid cataracts," Dr. Zaldivar said, describing how the posterior cur- vature of the lens was then improved. But even this wasn't perfect because some anatomical differences between eyes didn't allow for consistent vault. In 2011 came the "aquaflow revo- lution," Dr. Zaldivar said, with a design that forced aqueous humor over the crystalline lens, through the pinhole continued from page 1 Dr. Zaldivar shares a history of his involvement with and the evolution of the ICL.

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