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The authors have no financial or proprietary interest in the materials presented herein.
The Visian Implantable Collamer Lens ([ICL] STAAR Surgical, Monrovia, CA) is a ciliary sulcus-placed posterior chamber intraocular lens used in the management of high myopia in phakic patients. 1 Because of the risk of cataract, ICL vaulting greater than 250 µm is recommend to reduce rubbing of the ICL on the crystalline lens. However, excessive vaulting greater than 750 µm increases the risk of angle closure and pupillary block glaucoma. 2 Based on U.S. Food and Drug Administration (FDA) studies, the recommended method for predicting the appropriate lens length and potential vault height is the white-to-white horizontal corneal diameter, which is best measured during biometric measurements. Alternatively, one could also directly measure the ciliary sulcus diameter with ultrasound biomicroscopy (UBM). 3 Although white-to-white is the FDA-approved measurement, evidence suggests that it does not reliably correlate with the ciliary sulcus diameter. Consequently, sulcus-based diameter measurements with UBM sizing are superior in predicting the proper postoperative ICL vaulting. 2,3
Whenever there is a poor correlation between white-to-white and sulcus-to-sulcus measurements, concern should be raised for an underlying mass lesion or measurement error. To illustrate this point, a 42-year-old woman diagnosed as having high myopia, white-to-white measurements of...