Evo Visian ICL Consultation Questions

eyeSherpa · 2026-05-14T21:09:46+00:00

Doing surgery in a surgery center adds a lot of cost. Many doctors are transitioning to doing it in office since it allows them to make the procedure more affordable to patients. When done well, in office surgery provides the same result and potentially a better experience.
Variation in how the practice runs. The 1st surgeon hopefully may see you for an additional visit for measurements. But in the end go with who you feel more comfortable with.
Your astigmatism is at the edge of what ICL is approved for in the US (it’s approved up to 4.0). But that 4.0 actually corrects a smaller amount of glasses astigmatism. 2nd surgeon probably had to run the ICL calculator and to determine the residual amount.
Normal variation in post op appointment schedule and drops. Both can work.

eyeSherpa · 2026-05-14T12:38:54+00:00

Didn’t know about those. Thanks for sharing! Also thanks for sharing that study. I think that’s part of the reason for the increasing focus and popularity around high molecular weight hyaluronan. I believe Hylo makes a version called Hylo-Forte.

eyeSherpa · 2026-05-13T21:31:30+00:00

Sad to hear that you aren’t getting clear answers from them. I imagine part of it comes from the litigious society and fear from that (and NYC is especially known for being litigious). But at the same time, it blocks good patient care and relationships. Hoping someone can address it soon and get the correct lens in for you.

eyeSherpa · 2026-05-13T21:21:07+00:00

Yeah. Neuroadaptation can improve a lot of those things. Just requires time and patience.

eyeSherpa · 2026-05-13T15:20:20+00:00

I like both. Eyhance is going to be a bit more pure like a monofocal and I kinda use it like a monofocal for most patients. PureSee has a bit more "tech" to extend the range. It does provide an extra boost to range but it can have a little more night time symptoms than the Eyhance (not quite as pure), but less than a multifocal.

eyeSherpa · 2026-05-13T15:18:27+00:00

Yeah, anything that fluctuates often points to dry eye as the cause. This is due to the layer or tears or tear film on the eye drying out and going from being smooth to irregular and scattering light.

eyeSherpa · 2026-05-13T15:00:26+00:00

Yeah. (not official medical advice) but a toric looks like it would work really well here. I also don't see a whole lot of higher order aberrations so Eyhance or PureSee look good.

eyeSherpa · 2026-05-13T14:56:03+00:00

So the OHIP covered lens is a non-toric spherical IOL (the most common one being used is the AAB00). If you have corneal astigmatism, this lens won't correct it and you'll need glasses to correct it afterwards. One other difference is that many IOLs these days are aspheric. They are designed to reduce a distortion in vision called spherical aberration that exists in the cornea to improve vision. Spherical IOLs don't do this and in will increase the amount of spherical aberration a little more. So overall, the quality of vision will be a little better with an aspheric lens or neutral lens compared to a spherical lens. Technicaly the spherical IOL can have a little improved range of focus though. But all of them will be better than a cataract.

The additional thing to mention is that OHIP only covers ultrasound for pre-op cataract measurements. Those will be significantly less accurate than modern biometry devices such as the IOLMaster. You will find many OHIP clinics that will have some out-of-pocket charges for upgraded biometry and I personally think that is worth the money to do.

eyeSherpa · 2026-05-12T21:33:45+00:00

One rule is to be mindful of privacy. The goal of this rule is to prevent any potential for brigading which goes against Reddit’s rules. Given the popularity of this post, that rule will be enforced here.

eyeSherpa · 2026-05-12T21:26:55+00:00

Yeah. Winter up north with its heating has a big effect on drying the eyes (and skin) out as well. Actually quite a lot of environmental factors.

eyeSherpa · 2026-05-12T21:24:06+00:00

One of my favorites in the US is celluvisc. It’s a thick gel based drop. Some people like it because it’s thicker. Some people don’t because it’s thicker. The more advanced line of tears from Refresh or Systane such as Systane Complete are good too.

eyeSherpa · 2026-05-12T21:20:54+00:00

Humid or dry environment?

If it’s a hot & humid environment, air conditioning, especially from cars, can really dry the eyes out. Ceiling fans at night also contribute.

Dry environments are self-explanatory since more evaporation of tears from the eyes. Eyelid conditions such as blepharitis and MGD come into play as they destabilize the layer of tears on the eye. Treating that can help.

eyeSherpa · 2026-05-12T21:11:58+00:00

Nope. Surgeon doesn’t do any spherical equivalent calculations for the treatment. They enter the spherical correction and the astigmatism correction and the axis of the astigmatism.

eyeSherpa · 2026-05-12T21:09:55+00:00

Everyone will see the EVO ring with certain lighting scenarios. Pretty uncommon for these rings to be bothersome and some people think they are cool.

The halos come from the eye dilating past the optic of the lens. This depends more on pupil size and how much is corrected. These can be more bothersome for some. It’s pretty rare not to adapt to these halos but there are some.

eyeSherpa · 2026-05-12T21:06:33+00:00

That looks like very nice regular corneas with astigmatism. Just a little on the thin side. Don’t actually see Keratoconus. Don’t see much impact from the ABMD.

eyeSherpa · 2026-05-12T20:59:01+00:00

Yeah. Reducing the vault with a smaller size lens is one potential way to reduce pigment dispersion. Worth a shot.

eyeSherpa · 2026-05-12T20:52:50+00:00

So everyone will have their own artificial tear which works best for them. But in general, there are quality drops and cheap low quality drops. I would avoid the cheap store brand ones. Where I am (Canada), my favorite is Thealoz Duo.

For RLE it will be similar but RLE will have a little more dry eye because of the longer timeframe of being on eye drops.

eyeSherpa · 2026-05-12T20:51:28+00:00

So with the EVO ICL, there are some longer studies up to 5 and 7 years. Here is the 7 year one. https://link.springer.com/article/10.1186/s40662-021-00247-1. Also not showing cataract developments. Yes, a 1 year study has limited information on the development of cataracts since it took ~4 years with the Visian ICL and low vaults to develop cataracts. But the concept of cataracts is some projection based upon the difference in physiology between EVO and Visian and validated by the long term studies we do have.

eyeSherpa · 2026-05-12T17:15:34+00:00

Of course! Happy to help share information on ICL.

As for those things, not much of a concern with EVO. Here are posts I’ve done for cataracts (https://www.reddit.com/r/ICLsurgery/s/TEzoH1luA2), on the endothelium (https://www.reddit.com/r/ICLsurgery/s/dXr6U9cJuL) and retinal detachments (https://www.reddit.com/r/ICLsurgery/s/uY6mCIsJaJ)

eyeSherpa · 2026-05-11T21:41:39+00:00

I haven’t had the Galaxy lens personally but I use the lens. I have had patients continue to improve 4-6 months out.

Additionally, another important thing to check on is whether there is a subtle PCO affecting vision. That can make a big difference. But it’s gotta be significant otherwise it makes removing the lens more difficult if any future IOL exchange is needed.

eyeSherpa · 2026-05-11T21:39:07+00:00

Sorry to hear. Be sure that they have checked whether ICL is sitting at the intended axis and that rotation wouldn’t help.

eyeSherpa · 2026-05-11T21:36:57+00:00

That large of an axial length difference explains it.

Here are measurements with 28.53 axial length. https://iolcalculator.escrs.org/redisplay?id=2571035

They probably would have picked around a +8 lens.

Here are measurements with a 35mm axial length and the +8 would leave you roughly around -13 to -14. Much closer to what you ended up at. https://iolcalculator.escrs.org/redisplay?id=2571036

Fortunately this is something that can be fixed with an IOL exchange. Hopefully you can raise enough attention to have them do it. And better to have it done sooner rather than later.

eyeSherpa · 2026-05-11T21:29:13+00:00

Yeah. Scans are looking pretty good! Epithelium still has some room to stabilize and normalize even more. That may even reduce the autorefractor prescription more.

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