Quality of Life in High Myopia

Endothelial cell loss post-implantable collamer lens V4c: meta-analysis

Endothelial cell density (ECD) loss is a noted effect of implantable collamer lens (ICL) V4c surgery. Current literature provides a wide range of values for ECD loss postsurgery, which may not be helpful in advising patients and clinicians. A meta-analysis exploring ECD loss in ICL V4c for myopia correction was undertaken. 18 studies were included in this meta-analysis with 2 subgroup analyses to account for the variability in follow-up lengths. The average ECD loss 3 months, 12 months, and 21.25 (mean) months postsurgery were 1.32% ± 1.28% ( P < .001, 95% CI, -75.158 to -1.19), 1.75% ± 2.17% ( P < .001, 95% CI, -134.09 to 14.52), and 3.84% ± 1.78% ( P < .001, 95% CI, -156.04 to -54.26), respectively. ECD loss is most pronounced 3 months postsurgery, suggesting that acute surgical trauma was the primary contributor rather than long-term lens implantation. Overall, ICL V4c is for myopia correction exhibits similar ECD loss as seen in other ICL models, thereby affirming its safety.

The comparison of corneal higher-order aberration and surgically induced astigmatism between the clear corneal incision and the limbus tunnel incision of posterior chamber implantable collamer lens implantation

BACKGROUND

This study aimed to compare the corneal high-order aberrations and surgically induced astigmatism between the clear corneal incision and limbus tunnel incision for posterior chamber implantable collamer lens (ICL/TICL) implantation.

METHODS

A total of 127 eyes from 73 myopic patients underwent ICL V4c implantation, with 70 eyes receiving clear corneal incisions and 57 eyes receiving limbus tunnel incisions. The anterior and back corneal surfaces were measured and the Root Mean Square of all activated aberrations (TRMS) was calculated, including higher-order aberration (HOA RMS), spherical aberration Z40, coma coefficients (Coma RMS) Z3-1 Z31, and surgically induced astigmatism (SIA). The measurements were taken preoperatively and postoperatively at 1 day, 1 week, and 1, 3, and 6 months. In this study, the corneal higher-order aberration was estimated as the Zernike coefficient calculated up to 5th order. The measurements were taken at a maximum diameter of 6.5 mm using Pentacam.

RESULTS

One week after the operation, the corneal back Z31 of the clear corneal incision group was 0.06 ± 0.06, while the limbus tunnel incision group showed a measurement of 0.05 ± 0.06 (p = 0.031). The corneal back Z40 of the clear corneal incision group was -0.02 ± 0.25, compared to -0.04 ± 0.21 in the limbus tunnel incision group (p = 0.01). One month after the operation, the corneal back SIA of the clear corneal incision group was 0.11 ± 0.11, compared to 0.08 ± 0.11of the limbus tunnel incision group (p = 0.013), the corneal total SIA of the clear corneal incision group was 0.33 ± 0.30, compared to 0.15 ± 0.16 in the limbus tunnel incision group (p = 0.004); the clear corneal incision group exhibited higher levels of back astigmatism and total SIA than the limbus tunnel incision in the post-operation one month period. During the 6- month post-operative follow-up period, no significant difference in Z31, Z40, and other HOA RMS data was observed between the two groups. The total SIA of the corneal incision group and the limbus tunnel incision group were 0.24 ± 0.14 and 0.33 ± 0.32, respectively (p = 0.393), showing no significant difference between the two groups 6 months after the operation.

CONCLUSION

Our data showed no significant difference in the high-order aberration and SIA between clear corneal incision and limbus tunnel incision up to 6 months after ICL-V4c implantation.

The Effects of Implantable Collamer Lens ICL Implantation in High Myopia Patients' Mental Health

Purpose

To investigate the psychological changes in patients pre and post implantable collamer lens (ICL, EVO) implantation surgery in the posterior chamber.

Patients and methods

Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to assess the mental states of 43 patients who underwent ICL implantation surgery performed by the same surgeon between January 2021 and December 2022.

Results

Comparing the results before and one week after the operation, there is a significant difference in both the SAS scale (P<0.05) and the SDS scale (P<0.05). Similarly, when comparing the pre-operation and one-month post-operation results, there is also a significant difference in both the SAS scale (P<0.05) and the SDS scale (P<0.05). However, when comparing the one-week post-operation and one-month post-operation results, there is no significant difference in either the SAS scale (P>0.05) or the SDS scale (P>0.05). Moving on to the comparison between the pre-operation results and the national norm level, there is a significant difference in both the SAS scale (P<0.05) and the SDS scale (P<0.05). When comparing the one-week post-operation results and the national norm level, there is a significant difference in the SAS scale (P<0.05). Similarly, when comparing the one-month post-operation results and the national norm level, there is a significant difference in the SAS scale (P<0.05).

Conclusion

After undergoing ICL implantation surgery, patients typically experience a notable decrease in anxiety (SAS) and depression (SDS) scales. These improvements gradually stabilize and enhance during the postoperative recovery period. However, it may require a significant amount of time for patients to fully restore their psychological well-being to levels comparable to the national norm, particularly in terms of anxiety levels.

A Comprehensive Retrospective Analysis of EVO/EVO+ Implantable Collamer Lens: Evaluating Refractive Outcomes in the Largest Single Center Study of ICL Patients in the United States

Purpose

We evaluate visual outcomes in patients with EVO/EVO+™ (posterior chamber phakic intraocular lens with a central port) within approved United States (US) age and refractive range indications.

Patients and Methods

This single-center retrospective study evaluated one-month, single-center postoperative data for 225 eyes meeting inclusion criteria and undergoing EVO/EVO+ implantation from April to October 2022. Data included lens size (mm), lens power (diopters of spherical and cylindrical power), preoperative best corrected visual acuity, preoperative spherical equivalent from manifest refraction, achieved postoperative uncorrected visual acuity, postoperative refraction, intraocular pressure (mmHg), and adverse events.

Results

A total of 225 eyes underwent EVO/EVO+ Implantable Collamer Lens (ICL) implantation from April to October 2022, with 51.5% receiving toric lenses. The most common ICL size was 12.6mm (56.4%), followed by 13.2mm (27.5%), 12.1mm (15.1%), and 13.7mm (0.9%). Among patients with preoperative BCVA of 20/20 or better (149 eyes), 95.2% achieved postoperative UCVA of 20/20 or better, and 99.3% achieved UCVA of 20/25 or better at postoperative month one. About 75% of eyes were within a spherical equivalent target of ±0.50 D and 94% within ±1.00 D. Toric ICLs were implanted in 116 eyes (51.8%). Of these, anticipated residual cylinder >1 diopter was seen in 21 eyes (18.1%) resulting in three rotations, three explants, and three laser vision correction (LVC) enhancements. The postoperative adjustment rate (including rotations, exchanges, and LVC enhancement) was minimal (4.8%). Incidence of major adverse events was 0%.

Conclusion

Our study, the largest US single-center analysis of EVO/EVO+ ICL implantation, demonstrates strong early results and infrequent adverse events, supporting ICL safety and effectiveness. High predictability and favorable visual outcomes, including 20/20 or better, highlight the reliability of this technology. Despite study limitations, our findings underscore this technology's effectiveness. Future research should refine patient criteria and assess long-term outcomes in this evolving landscape.

Ocular features in myopic eyes with longer horizontal ciliary sulcus diameters for intended implantable collamer lens surgery

PURPOSE

To assess the ocular anterior segment characteristics in myopic eyes intended for ICL surgery with horizontal ciliary sulcus-to-sulcus (STS) diameters being greater than vertical STS diameters.

METHODS

This retrospective, comparative case study included 1230 eyes of patients who underwent ICL implantation for the treatment of myopia or myopic astigmatism at the Zhongshan Ophthalmic Center from September 2020 to November 2021. The myopic eyes were divided into two groups according to the relatively long diameter of the ciliary sulcus. General parameters and anterior chamber parameters were compared between the two groups.

RESULTS

1230 eyes of 694 patients were included. The proportion of myopic eyes with longer horizontal STS diameters was 4.63%. Horizontal STS distances exceeding vertical meridians in these eyes were mainly attributed to the shortening of vertical STS distances (horizontal STS: P = 0.112; vertical STS: P < 0.001). Eyes with longer horizontal meridians of the ciliary sulcus displayed larger steep keratometry value (P = 0.001), larger corneal volume (P = 0.002), larger corneal astigmatism (P < 0.001), larger ocular residual astigmatism (P = 0.017), worse visual acuity (logMAR UDVA: P = 0.021; logMAR CDVA: P = 0.001), and more iridociliary cysts (P = 0.017) compared to eyes with vertically oval shapes.

CONCLUSION

Myopic eyes with longer horizontal STS diameters are commonly accompanied by a change in corneal morphology and more iridociliary cysts. The anatomical features of the ciliary sulcus should be given sufficient consideration to ICL size and placement selection, contributing to more personalized and precise surgery.

The influence of pupil diameter upon and subjective quality of vision following implantable collamer lens (ICL V4c) implantation: An observational study

This study aimed to assess the change in pupil size and its influence on subjective quality of vision (QoV) in subjects with implanted collamer lenses (ICLs). This retrospective study assessed 53 participants (53 eyes) implanted with ICL (V4c) and categorized them into incremental groups according to pupil diameter. Preoperative and postoperative photopic and mesopic pupil diameter, uncorrected distance visual acuity (UDVA), and QoV questionnaire scores were assessed and compared. Postoperatively, at 3 months, UDVA was -0.10 ± 0.06 logarithm of the minimum angle of resolution (LogMAR), and mean QoV for day and night was 9.34 ± 0.76 and 8.58 ± 1.29, respectively. The mean mesopic and photopic pupil diameters were 6.59 ± 0.79 mm and 4.61 ± 0.74 mm, respectively. Photopic pupil diameter negatively correlated with "QoV day" (Rs = -0.413, P = .001), positively correlated with "haloes" (Rs = 0.568*, P < .001) and "blurred vision" (Rs = 0.243, P = .04) respectively. Mesopic pupil diameter negatively correlated with "QoV night" (Rs = -0.426, P = .001), positively correlated with "haloes" (Rs = 0.624*, P < .001), "starburst" (Rs = 0.233, P = .046) and "difficulty focusing" (Rs = 0.27, P = .025), respectively. Participants had excellent VA at 3-month follow-up. Photopic and mesonic pupil diameter negatively correlated with QoV day and QoV night scores, respectively. Pupil diameter was found to have a more significant effect on visual symptoms at night, and lower QoV due to larger pupil size was more noticeable at night. Further investigation is needed to explore the importance of pupil diameter and its impact on the QoV in ICL implanted patients.

Predicting post-operative vault and optimal implantable collamer lens size using machine learning based on various ophthalmic device combinations

BACKGROUND

Implantable Collamer Lens (ICL) surgery has been proven to be a safe, effective, and predictable method for correcting myopia and myopic astigmatism. However, predicting the vault and ideal ICL size remains technically challenging. Despite the growing use of artificial intelligence (AI) in ophthalmology, no AI studies have provided available choices of different instruments and combinations for further vault and size predictions. This study aimed to fill this gap and predict post-operative vault and appropriate ICL size utilizing the comparison of numerous AI algorithms, stacking ensemble learning, and data from various ophthalmic devices and combinations.

RESULTS

This retrospective and cross-sectional study included 1941 eyes of 1941 patients from Zhongshan Ophthalmic Center. For both vault prediction and ICL size selection, the combination containing Pentacam, Sirius, and UBM demonstrated the best results in test sets [R² = 0.499 (95% CI 0.470-0.528), mean absolute error = 130.655 (95% CI 128.949-132.111), accuracy = 0.895 (95% CI 0.883-0.907), AUC = 0.928 (95% CI 0.916-0.941)]. Sulcus-to-sulcus (STS), a parameter from UBM, ranked among the top five significant contributors to both post-operative vault and optimal ICL size prediction, consistently outperforming white-to-white (WTW). Moreover, dual-device combinations or single-device parameters could also effectively predict vault and ideal ICL size, and excellent ICL selection prediction was achievable using only UBM parameters.

CONCLUSIONS

Strategies based on multiple machine learning algorithms for different ophthalmic devices and combinations are applicable for vault predicting and ICL sizing, potentially improving the safety of the ICL implantation. Moreover, our findings emphasize the crucial role of UBM in the perioperative period of ICL surgery, as it provides key STS measurements that outperformed WTW measurements in predicting post-operative vault and optimal ICL size, highlighting its potential to enhance ICL implantation safety and accuracy.

Effect of central hole location in phakic intraocular lenses on visual function under progressive headlight glare sources

PURPOSE

To analyze the effect of the central hole location in the V4c implantable collamer lens (ICL) on the quality of vision, including progressive headlight glare simulation and quality of life.

SETTING

IOBA-Eye Institute, Valladolid, Spain.

DESIGN

Case series.

METHODS

The central hole location was determined by slitlamp and dual Scheimpflug imaging for 6 months or more postoperatively. The visual acuity, mesopic contrast sensitivity, halogen glare contrast sensitivity, xenon glare contrast sensitivity, photostress recovery time after glare, de Boer scale, and Quality of Life Impact of Refractive Correction (QIRC) questionnaire results were evaluated. Multiple regression models were used to analyze the effect of the central hole location on parameters using the pupil center and visual axis as references based on Cartesian and polar coordinates.

RESULTS

The safety index was 1.13 and the efficacy index, 1.12. Under all testing circumstances, central hole decentration did not affect the visual acuity or contrast sensitivity. With the visual axis as a reference, worse QIRC values were associated with greater upward central hole displacement (P = .03) and a lower polar angle value (P = .008); also, halogen glare discomfort was greater with a higher radius (P = .04). Using the pupil center as a reference, greater nasal central hole decentration was associated with longer xenon glare photostress recovery time (P = .002).

CONCLUSIONS

Implantation of the ICL with a central hole yielded excellent visual outcomes, even under increasing glare sources, regardless of the hole's location. However, hole decentration might affect patient-perceived quality of life, bothersome halogen glare, and longer xenon glare photostress recovery time. Such complaints after the early postoperative period might be managed with discrete ICL centration if the central hole is decentered upward or nasally.

Prospective Randomized Multicenter Comparison of the Clinical Outcomes of V4c and V5 Implantable Collamer Lenses: A Contralateral Eye Study

Purpose

To compare the visual and refractive outcomes and night vision performance questionnaire results between V4c and V5 implantable Collamer lenses in a prospective, randomized, multicenter study.

Settings

Four refractive surgery centers.

Design

Prospective randomized multicenter single-masked comparative study.

Methods

Twenty-three patients were enrolled in this study. A conventional V4c model (EVO Visian ICL) was implanted in one eye, and a V5 model (EVO+ Visian ICL), which has a larger optic diameter than the V4c model, was implanted in the contralateral eye. The uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were evaluated before and 6 months after surgery. At 6 months after surgery, a questionnaire on night vision disturbances was administered. The efficacy, safety, and predictability of the two implanted ICL models were compared.

Results

There were no significant differences in the postoperative UDVA and CDVA between the two ICL models. The mean efficacy indexes for the V4c and V5 lenses were 1.16 ± 0.22 and 1.03 ± 0.23, respectively. The mean safety indexes of the V4c and V5 lenses were 1.21 ± 0.20 and 1.19 ± 0.20, respectively. The night vision performance questionnaire revealed that 7 patients (37%) noticed a difference in visual performance between the eyes, and all of them reported that they could see better at night with the V5-implanted eye compared with the V4c-implanted eye.

Conclusion

The V4c and V5 ICL models achieved similar visual and refractive outcomes, whereas the V5 model showed a possible advantage in reducing night vision disturbances.

Patient-reported Outcomes for Assessment of Quality of Life in Refractive Error: A Systematic Review

SIGNIFICANCE

This review has identified the best existing patient-reported outcome (PRO) instruments in refractive error. The article highlights the limitations of the existing instruments and discusses the way forward.

PURPOSE

A systematic review was conducted to identify the types of PROs used in refractive error, to determine the quality of the existing PRO instruments in terms of their psychometric properties, and to determine the limitations in the content of the existing PRO instruments.

METHODS

Articles describing a PRO instrument measuring 1 or more domains of quality of life in people with refractive error were identified by electronic searches on the MEDLINE, PubMed, Scopus, Web of Science, and Cochrane databases. The information on content development, psychometric properties, validity, reliability, and responsiveness of those PRO instruments was extracted from the selected articles. The analysis was done based on a comprehensive set of assessment criteria.

RESULTS

One hundred forty-eight articles describing 47 PRO instruments in refractive error were included in the review. Most of the articles (99 [66.9%]) used refractive error-specific PRO instruments. The PRO instruments comprised 19 refractive, 12 vision but nonrefractive, and 16 generic PRO instruments. Only 17 PRO instruments were validated in refractive error populations; six of them were developed using Rasch analysis. None of the PRO instruments has items across all domains of quality of life. The Quality of Life Impact of Refractive Correction, the Quality of Vision, and the Contact Lens Impact on Quality of Life have comparatively better quality with some limitations, compared with the other PRO instruments.

CONCLUSIONS

This review describes the PRO instruments and informs the choice of an appropriate measure in refractive error. We identified need of a comprehensive and scientifically robust refractive error-specific PRO instrument. Item banking and computer-adaptive testing system can be the way to provide such an instrument.

Optical and visual quality of the visian implantable collamer lens using an adaptive-optics visual simulator

PURPOSE

To evaluate visual and optical quality of the implantable collamer lens for different powers and sizes of incision surgery.

DESIGN

Prospective study in humans.

METHODS

An adaptive optics visual simulator was used to measure 3 powers of implantable collamer lenses and simulate the implantable collamer lens wavefront aberration's pattern for small- and large-incision surgery. Visual acuity (VA) and contrast sensitivity were measured in 11 observers for 3- and 5-mm pupils. Modulation transfer function, point spread function, and Strehl ratio were calculated.

RESULTS

At 3 mm pupil, no statistically significant differences were found between both incision sizes for any implantable collamer lens power, except for -15 diopter (D) implantable collamer lens at 25 cycles/degree (cpd) (P < .05). At 5 mm pupil, statistically significant differences in Strehl ratio, VA, and contrast sensitivity were found between both incision sizes for all implantable collamer lens powers (P < .05). The outcomes were better with small incision. Implantable collamer lens power also affected the optical and visual quality. At 3 mm pupil, no statistically significant differences were found in VA and contrast sensitivity between implantable collamer lens powers, except between -3 and -15 D at low-contrast VA and at 20 and 25 cpd (P < .05). At 5 mm pupil, no statistically significant differences were found in Strehl ratio, VA, and contrast sensitivity between -3 and -6 D implantable collamer lens, but they did become apparent for -15 D implantable collamer lens for both incision sizes, all contrasts and spatial frequencies (P < .05).

CONCLUSIONS

The implantable collamer lens provides good optical and visual quality, although these outcomes decreased with large-incision surgery because of the increase of aberrations.

Optical quality of the Visian Implantable Collamer Lens for different refractive powers

PURPOSE

To evaluate the optical quality of the Visian Implantable Collamer Lens (ICL) for different powers and pupil diameters.

METHODS

Wavefront aberrations of the -3, -6, -9, -12 and -15 diopters (D) V4b ICLs were measured at 3- and 4.5-mm pupils. The root mean square (RMS) of total higher order aberrations (HOAs), trefoil, coma, tetrafoil, secondary astigmatism, and spherical aberration were evaluated. In addition, modulation transfer function (MTF) of the five ICL powers was measured for a 3-mm pupil. The point spread functions (PSFs) of each ICL evaluated was calculated from the wavefront aberrations at 4.5-mm pupil.

RESULTS

The ICLs evaluated had negative spherical aberration and negligible amounts of other aberrations. The negative spherical aberration increases when the ICL power increases being related with its innate optical properties. At 3-mm pupil, no statistically significant differences between ICLs were found for all the Zernike coefficient RMS values analyzed (p > 0.05). At 4.5-mm pupil, significant RMS values for the spherical aberration and total HOAs were found between medium-low and high powers (p < 0.05). Similar MTFs were obtained for all ICLs, although they slightly worsened when increased the ICL power.

CONCLUSIONS

ICLs evaluated provide good optical quality in terms of wavefront aberrations, MTF, and PSF. Although spherical aberration increases with ICL power, these values are clinically negligible to affect the visual quality after its implantation.