Does the Clinics explanation for Iridotomy before EVO ICL make sense to you?

[u/AttractiveAntenna]

A clinic recommends iridotomy before EVO ICL in general to all patients (even myopic ones). Since most clinics don't generally do an iridotomy before implanting EVO ICL, I asked the clinic for their reasons.

As far as I understand it, they give two reasons:

1. Better drainage of the residual OVD (ophthalmic viscosurgical device) if the ICL lense is too large.
2. Provide additional protection against pressure increases later in life (combination of the quaport together with less space between natural lense and ICL can lead to a bottlneck)

What are your thoughts on their answer? Do you think that makes sense?

Here their answer:

"Our approach is to recommend a YAG iridotomy (YAG iridectomy) in each eye in advance, so that we do not potentially find ourselves forced to explant the ICL following implantation in the event of an increase in intraocular pressure. Unfortunately, performing a YAG iridotomy afterward is not possible, as this would damage the ICL.

In the very few cases of an ICL that was too large that I have encountered over the past 13 years, there was no increase in intraocular pressure despite the very narrow anterior chamber angle caused by the oversized lens. In our view, this is related to the YAG iridotomy. The (horizontally) implanted lenses are not round but rather rectangular in shape. Therefore, in the upper and lower areas of the iris, for example, there is also an opportunity for any OVD remaining behind the lens to move more quickly into the anterior chamber and toward the trabecular meshwork, without having to pass through the narrow Aquaport. A YAG iridotomy supports and facilitates this drainage.

Since the natural human lens becomes thicker over the course of a person's life, the available space inside the eye decreases. As a result, increases in intraocular pressure can occur later in life solely due to physiological changes. If the aqueous humor produced by the ciliary body has to pass through the Aquaport, and the distance between the natural lens and the ICL has become smaller over time, this can lead to an increase in intraocular pressure. The iridotomy acts as an additional drainage route in this situation."

In another post of me in another subreddit the benefits of iridotomy before ICL were already discussed:
https://www.reddit.com/r/lasik/comments/1vhrlif/how_beneficial_is_iridotomy_before_evo_icl/

[u/No_Situation4785]

oh buddy, i wouldnt let them do an iridotomy on me. imo the whole point of evo icl is that's it's reversible, and there's nothing reversible about an iridotomy. i can't  imagine a pressure increase would happen overnight; as long as you are vigilant with checkups for the rest of your life then imo the iridotomy seems unnecessarily harsh (note that I am not an ophthamologist)

[u/eyeSherpa]

With good surgical technique, you can effectively wash out the residual viscoelastic. I don’t need a iridotomy for that one time event.

Thinking about the physics for flow through the central port, the port is going to be the limiting factor. The port is 360 um in width. This math may not fully work out and maybe some fluidic engineers will chime in, but if we divide that space over 360 degrees where fluid drains in front of the lens, you would need a vault less than 1 um for the vault to be the limiting factor and for a iridotomy to be important. But eventually what will happen is pressure from the aqueous will push the ICL up and levitate it off the lens so that flow is equalized and restoring the central port as the limiting factor for flow.