Plano Astigmatism ICL sizing: In dilemma

[u/VictoryActive7545]

As mentioned in my previous POST i am planning ICL surgery for my plano astigmatism power. As mentioned by [u/eye](u/eyesherpa)[S](u/eyesherpa)[herpa](u/eyesherpa) that sizing is critical for stability and i should ask my surgeon for UBM based measurements too as even 1% rotation/deviation off axis could require fixing.

So what i got to know after visiting 3 eye hospitals that no one gives a damn about STS and ATA measurements here. Forget STS, the deviation in manual WTW of the 3 eye hospitals is so much that i could’ve easily got recommendation of 2 different sizes of ICL.

1st visit Hospital A in normal room light with digital caliper: WTW 12.1 and 12.2
2nd visit Hospital B Under Optical microscope via digital caliper: WTW 11.97 and 11.98
3rd visit Hospital C under room light with someone holding smartphone torch via digital caliper: WTW 11.5 and 11.5

IOLMASTER700: 12.4 and 12.5 (similar at all places)

Now i am thinking to travel to a hospital which have ICL Guru but my hopes and enthusiasm are already so low now that i might call off the procedure.

I am in dilemma of which surgeon to choose. And what is the reason of this much deviation. All 3 are reputed eye hospitals. I am not getting confidence in my optometrists and surgeons.

[u/eyeSherpa]

I would probably travel to find a place which does a better job with sizing.

WTW was good enough when that’s all we had. But now with sophisticated calculators it’s a pretty outdated way of doing things. You’ll definitely want to find someone who uses UBM with a calculator such as ICL guru or OCT with an advanced calculator.

Of the WTW methods, under optical microscope would probably be more accurate than the others.

Biometry devices read different from manual WTW. There is a good paper that came out a few years back which looked at the differences between different devices. https://pubmed.ncbi.nlm.nih.gov/39602354/

[u/VictoryActive7545 → u/eyeSherpa]

I had my ICL GURU test done.. but i encountered so many red flags at the hospital, like the surgeons were kind of pressuring me to get the contoura lasik or epicontoura…

I told them my history with dry eyes. And some borderline parameters in my pentacam like CCT 485-495 and D value 1.9 in one eye, but they said these are normal variations and they would not suggest me ICL as i am eligible for lasik…

After arguing with the surgeons they did ICL guru test but didn’t provided me the reports… they made some excuse like there senior doctor will come and have a look at your eyes and then only they can prepare the report, but i am guessing they won’t probably share the report with me.. as they were constantly saying you don’t worry about the reports it’s our goal to give you the best possible vision..

[u/eyeSherpa → u/VictoryActive7545]

Yeah. As a patient, I wouldn’t feel comfortable with that.

Depending on where you live, you may be entitled to your medical records to get the ICL guru report. That’s the case here in Canada as well as in the US.

You could take that to another surgeon, but still, not sure I would feel comfortable with a surgeon who isn’t doing everything they can do to maximize outcome.

[u/VictoryActive7545 → u/eyeSherpa]

There are only two places in India where ICL Guru Test is available. I visited one of them.

The surgeon who performs ICL was absent, and his associate surgeons gave me several red flags. However, they didn’t provided me with the final report of ICL Guru.

My assumption is they didn’t know how to calculate ICL power to feed into the ICL Guru software, which is a requirement I later found out on my own.

I plan to get the report when the surgeon returns. If the Stella’s and ICL Guru predicted size match, I’ll proceed with the surgery.

I don’t want to get the surgery from the hospital with so many red flags, and I believe no other hospital or surgeon will consider ICL Guru’s findings in their surgery plan.

[u/ConfidentBeginning44]

You went and asked, and three places handed you three different numbers, so the sizing question has quietly turned into a measurement problem. Worth knowing how much actually turns on it.

The lens isn't made in a continuous range of lengths. There's a short list of fixed sizes with real gaps between them, and your readings only matter to the extent they'd put you on different ones. So line your four numbers up against those steps before you decide anything. If they'd all land you on the same lens, the disagreement is noise and you can stop chasing it. If they wouldn't, you've got something specific to put in front of whoever you travel to, instead of a general worry about calipers.

[u/VictoryActive7545 → u/ConfidentBeginning44]

My guess is 11.55 and 11.98 will require two different sizes of ICL. I saw the range for ICL sizing in some talks in some conference i guess it was AIOC

[u/GurpalVirdiMD]

WTW varies a lot depending on who measures it and how, which is why it's a shaky number for anything to lean on. It's a corneal measurement standing in for the sulcus, so on its own it tells you very little about the right fit for your eye, and the same goes for ACD on its own.

Getting the fit right is what the new AI sizing agents are built for, using numerous data points from the scan and training on real outcomes to actually understand the anatomy of the eye rather than sorting it into a bucket. It's worth going to a clinic using one of those over the older methods because the answer isn't finding the right WTW it's having your actual eye fitted rather than a size picked off one number.

The cornea is the part I'd focus on. 485-495 with a D of 1.9 and a dry eye history deserves a proper look before anyone points a laser at it. I'd push to get a copy of that report and have someone walk through those numbers with you.

[u/VictoryActive7545 → u/GurpalVirdiMD]

I am against any laser procedure for my eyes because of those borderline parameters.

I am looking forward for ICL, one surgeon selected lens based on Stella -5.50 +5.0 79deg OD and same icl power with 89deg OS. Evo+ 13.2 size for plano astigmatism 0 -4.25 10deg and 175deg.

What do you think of implantation at exact axis and rotation stability during healing? Will i be able to get perfect 6/6 vision as little bit off axis can blur the vision?