Evaluation of pupil diameter after posterior chamber phakic intraocular lens implantation

Long-term observation of V4c implantable collamer lenses implantation for moderate to extreme high myopia correction: five years follow-up

BACKGROUND

This study aims to assess the long term effectiveness, safety, predictability and stability of V4c implantable collamer lenses (ICL) for correction of moderate to extreme high myopia.

METHODS

We reviewed 125 eyes from 64 patients who implanted V4c ICL at the Refractive Surgery Center of West China Hospital in Chengdu, China, between May 2015 and January 2017. The median spherical equivalent was -11.50 D (interquartile range [IQR]: -13.00 to -9.00 D). We followed up with the patients over five years and evaluated several parameters, including uncorrected visual acuity (UDVA), corrected visual acuity (CDVA), axial length, refractive error, endothelial cell density (ECD), intraocular pressure (IOP), white-to-white distance (WTW), and vault. We performed a correlation analysis to explore the potential impacts on vault following implantation.

RESULTS

The median safety index (postoperative CDVA/preoperative CDVA) during the last follow-up was 1.00 (interquartile range [IQR]: 1.00-1.20), and the efficacy indices (postoperative UDVA/preoperative CDVA) were 1.20 (IQR: 1.00-1.25), 1.20 (IQR: 1.00-1.33), and 0.8 (IQR: 0.65-1.00) at postoperative 1 week, 1 month, and 5 years, respectively. At the five-year mark, 16% of the eyes were within ±0.50 D of expected correction, and 73% were within ±2.00 D. No significant difference in ECD was observed between pre-operative and post-operative measurements. Compared to baseline, we observed a significant increase in IOP at the one-week follow-up, which decreased significantly at the one-month visit. Furthermore, we identified ICL size and spherical equivalent (SE) as independent variables in a multiple linear regression model that accurately predicted the five-year vault after surgery.

CONCLUSION

In conclusion, V4c ICL implantation is an effective and safe treatment for moderate to extreme high myopia with good predictability and stability over the long-term.

Long-term Comparison of Vault and Complications of Implantable Collamer Lens with and without a Central Hole for High Myopia Correction: 5 Years

PURPOSE

To investigate the long-term safety, efficacy, stability, vault, and complications of implantable collamer lens with (ICL V4c) and without (ICL V4) a central hole for correcting high myopia.

METHODS

78 eyes (40 patients) underwent ICL V4c implantation and 78 eyes (48 patients) underwent ICL V4 implantation were enrolled. They were followed up for 5 years of the uncorrected and corrected distance visual acuity, spherical equivalent (SE), axial length, intraocular pressure, endothelial cell density and vault.

RESUITS

The safety indices of the ICL V4c and V4 groups at 5 years were 1.25 ± 0.40 and 1.31 ± 0.40, respectively (P = .353). The efficacy indices were 0.90 ± 0.29 and 1.00 ± 0.44, respectively (P = .098). The preoperative, 1 month and 5 year postoperative logMAR UDVAs were respectively 1.54 ± 0.48, 0.11 ± 0.17, and 0.20 ± 0.26 in the V4c group and 1.56 ± 0.44, 0.14 ± 0.19, and 0.22 ± 0.26 in the V4 group (P = .703, 0.329, 0.585). The logMAR CDVAs were resepectively 0.13 ± 0.18, 0.02 ± 0.11, and 0.05 ± 0.16 in the V4c group and 0.18 ± 0.22, 0.05 ± 0.14, and 0.09 ± 0.21 in the V4 group (P = .128, 0.169, 0.229). The SE were resepectively -15.10 ± 4.32 D, -0.71 ± 1.31 D and -1.65 ± 1.30 D in the V4c group and -15.44 ± 3.51 D, -0.61 ± 1.12 D and -1.40 ± 1.30 D in the V4 group (P = .585, 0.637, 0.296). The mean vault reduced by 97.31 ± 136.61 μm in the V4c group and by 99.74 ± 245.83 μm in the V4 group. Three eyes (3.85%) with mid-periphery anterior subcapsular opacification in the V4c group and two (2.56%) with cataract, one (1.28%) with central anterior subcapsular opacification in the V4 group were observed. The CDVA of 20/40 was obtained in the two cataract eyes after phacoemulcification and intraocular lens implantation.

CONCLUSION

Long-term ICL V4c and ICL V4 implantations are safe, effective, and stable for high myopia correction. ICL V4c can potentially reduce the risk of lens opacification and may be more tolerant to low vault than ICL V4.

Five-year outcomes of EVO implantable collamer lens implantation for the correction of high myopia and super high myopia

Background

To evaluate the long-term safety, efficacy, predictability, and stability of implantable collamer lens with a central hole (EVO ICL) implantation for correcting high myopia (HM) and super high myopia (SHM).

Methods

This prospective study evaluated 83 eyes of 46 patients who were divided into groups based on their spherical equivalent refractive error (SE): HM group (− 12 D ≤ SE < − 6 D) and SHM group (SE < − 12 D). They were followed up for 5 years after ICL implantation; assessments of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refractive error, axial length, intraocular pressure, corneal endothelial cell density, and vault were conducted, and a questionnaire was administered.

ResuIts

At 5 years postoperatively, the safety indices of the HM and SHM groups were 1.03 ± 0.10 and 1.32 ± 0.39, and the efficacy indices were 0.83 ± 0.25 and 0.86 ± 0.32, respectively. In the HM group, 60.47% and 79.07% of the eyes were within ± 0.50 D and ± 1.00 D of the attempted correction, while it was achieved for 22.50% and 47.50% of the eyes in the SHM group, respectively. The SE of the HM group decreased from  − 9.72 ± 1.41 D preoperatively to 0.04 ± 0.39 D 1 month postoperatively and − 0.67 ± 0.57 D 5 years postoperatively, while in the SHM group, it decreased from − 15.78 ± 3.06 D preoperatively to  − 0.69 ± 0.97 D 1 month postoperatively and − 1.74 ± 1.19 D 5 years postoperatively.

Conclusion

EVO ICL implantation is safe, effective, and predictable for correcting HM and SHM. CDVA improved more after surgery for SHM, but the growth of axial length still needs attention.

Dynamic assessment of variations in pupil diameter using swept-source anterior segment optical coherence tomography after phakic collamer lens implantation

Purpose

To dynamically assess variations in pupil diameter induced by changes in brightness in myopic eyes implanted with an implantable collamer lens (ICL, STAAR Surgical) with a central port.

Methods

This prospective, observational single-center case series study comprised 65 eyes from 65 consecutive patients undergoing ICL implant. A modified commercially available swept-source Fourier-domain anterior segment optical coherence tomography (AS-OCT) device was used for imaging and performing dynamic pupillometry under changing light conditions before and after a mean follow-up interval of four months after surgery.

Results

Preoperative mean pupil size under photopic conditions was 3.38 ± 0.64 mm; after surgery, this increased to 3.48 ± 0.61 mm. Mean pupil size under scotopic light conditions was 5.72 ± 0.79 mm before surgery and 5.84 ± 0.77 mm postoperatively. The differences between preoperative and postoperative pupil diameter in miosis and mydriasis were 0.10 ± 0.44 mm (P = 0.078) and 0.12 ± 0.58 mm (P = 0.098), respectively. The scotopic pupil exceeded the optic zone of the implanted lens in 39 eyes (60%). The mean central vault value was 412 ± 177 μm under maximum miosis and 506 ± 190 μm under maximum mydriasis. We found a positive correlation between vault and differences in pupil diameter under all light conditions (P < 0.05).

Conclusion

Dynamic AS-OCT enables a very precise determination of the pupillary diameter in the iris plane. The changes in the pupil diameter under different light conditions after the implantation of an ICL are related to the postoperative vault.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40662-021-00262-2.

Short-term changes in and preoperative factors affecting vaulting after posterior chamber phakic Implantable Collamer Lens implantation

Background

To describe the very early vault changes in the first month after Implantable Collamer Lens (ICL) implantation and to evaluate the effect of preoperative biometric factors on vault.

Methods

Eighty-three eyes from eighty-three subjects with complete data who met follow-up requirements were recruited in this retrospective study between May 2019 and March 2020. We quantitatively assessed the postoperative vault at 2 h, 1 day, 1 week, and 1 month following implantation. Associations between the postoperative vault and age, ICL size, spherical equivalent (SE), axial length (AL), central corneal thickness (CCT), flat keratometry (K), steep K, mean K, anterior chamber depth (ACD), crystalline lens thickness (LT), white-to-white (WTW) diameter obtained by three devices, horizontal and vertical sulcus-to-sulcus (STS) diameter, bright and dark pupil sizes (BPS and DPS) and DPS-BPS were investigated using Spearman’s correlation analysis and stepwise multiple regression analysis.

Results

The mean vault values at 2 h, 1 day, 1 week, and 1 month after ICL implantation were 672.05 ± 30.72, 389.15 ± 28.33, 517.23 ± 30.76 and 530.12 ± 30.22 μm, respectively. Significant differences were found in the vault values at 2 h, 1 day and 1 week after the operation. The ICL size (β = 0.942; p < 0.001), followed by horizontal STS (β = -0.517; p < 0.001), crystalline LT (β = -0.376; p < 0.001) and vertical STS (β = -0.257; p = 0.017), significantly influenced the vault at 1 month after the operation. The multiple regression equation was expressed as follows: central vault (µm) = -1369.05 + 657.121 × ICL size- 287.408 × horizontal STS − 432.497 × crystalline LT − 137.33 × vertical STS (adjusted R² = 0.643).

Conclusions

After ICL implantation, the vault decreased and then increased, but it did not return to the vault value 2 h after surgery. The ICL size, horizontal and vertical STS and crystalline LT are key factors for predicting postoperative vaulting.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-021-01963-x.

Evaluation of Disk Halo Size after Implantation of a Collamer Lens with a Central Hole (ICL V4c)

Purpose

To investigate disk halo size changes produced by a glare source after surgical insertion of an implantable collamer lens with a central hole (ICL V4c) for myopia correction.

Methods

In this prospective study, disk halo size and pupillary light response with a vision monitor were measured preoperatively and at 1 week, 1 month, and 3 months postoperatively. Pupillary light response parameters included contraction amplitude, latency, duration, and velocity; dilation latency, duration, and velocity; and initial, maximum, minimum, and average pupil diameters.

Results

Forty-two right eyes of 42 patients were enrolled. Postoperative uncorrected distance visual acuity was better than or equal to 20/20 in all eyes. Compared to preoperative values, disk halo size showed no significant difference at 1 week postoperatively (P > 0.05) and then decreased significantly at 1 and 3 months postoperatively (both P < 0.001). Contraction amplitude and velocity, as well as dilation velocity, decreased significantly at all postoperative time points (all P < 0.001). Disk halo size at 3 months postoperatively was significantly correlated with initial (r = 0.446, P=0.003), maximum (r = 0.483, P=0.001), minimum (r = 0.425, P=0.005), and average pupil diameters (r = 0.474, P=0.002).

Conclusions

After ICL V4c implantation, disk halo size was reduced in the short term. Patients with smaller pupil sizes during pupillary response to light experienced smaller halos after ICL V4c implantation.

Influence of refractive error on pupil diameters in highly myopic eyes with implantable collamer lenses

PURPOSE

To investigate the influence of refractive error on pupil diameters in highly myopic eyes with implantable collamer lenses.

SETTING

Shanghai, China.

DESIGN

A prospective consecutive observational study.

METHODS

Sixty-six eyes of 66 patients that underwent ICL V4c implantation were included. Pupil diameters before and 1 week, 1 month, and 3 months after surgery were measured using an automatic pupillometry system (MonCv3; Metrovision, Pérenchies, France) under four standardized illumination conditions: 0, 1, 10, and 100 cd/m². The correlations between changes in pupil diameter and spherical equivalent values and patient age were investigated.

RESULTS

Based on preoperative spherical equivalent values, included eyes were divided into a high-myopia group (-6.3 to -9.9 D (diopters)) and a super-high-myopia group (-10 to -20 D). Pupil sizes remained unchanged after surgery in the high-myopia group and decreased at 1 and 10 cd/m² in the super-high-myopia group. A between-group comparison showed that pupils were significantly smaller in the super-high-myopia group 1 week postoperatively under all illumination conditions and remained smaller at 1 month and 3 months under 1 and 10 cd/m² lighting conditions. Preoperative spherical equivalent values were significantly correlated with the percent decrease in pupil diameter 1 week postoperatively under 0, 1, and 10 cd/m² illumination conditions; the greater the degree of myopia, the greater the reduction in pupil diameter.

CONCLUSION

Preoperative refractive error significantly affects pupil diameter in highly myopic eyes after implantable collamer lens implantation. Pupils of super highly myopic eyes remained smaller than preoperative levels under mesopic conditions after implantable collamer lens implantation.

Analysis of pre-operative factors affecting range of optimal vaulting after implantation of 12.6-mm V4c implantable collamer lens in myopic eyes

Background

To evaluate clinical factors affecting postoperative vaulting in eyes that had achieved optimal vaulting within the range of 250–750 μm following implantation of 12.6-mm V4c implantable collamer lenses (ICL).

Methods

A total of 236 eyes of 236 patients that had achieved optimal vaulting following implantation of a 12.6-mm V4c ICL were retrospectively analyzed. Associations between postoperative vaulting and age, preoperative anterior chamber depth (ACD), preoperative axial length (AL), preoperative white-to-white diameter, preoperative pupil size, preoperative sulcus-to-sulcus diameter, and preoperative manifest refraction spherical equivalent were investigated using simple regression, stepwise multiple regression, and multinomial logistic regression analyses.

Results

Mean central vaulting at the 6-month follow-up was 519.0 ± 112.8 μm. Variables relevant to postoperative vaulting were, in order of influence, preoperative ACD (β = 0.305, p <  0.001), preoperative pupil size (β = 0.218, p <  0.001), and preoperative AL (β = 0.171, p = 0.006). Low preoperative pupil size was associated with low optimal vaulting (250 to 450 μm), relative to that observed in the mid optimal vaulting group (451 to 550 μm) (odds ratio = 0.532, P = 0.021). Increasing preoperative ACD was associated with high optimal vaulting (551 and 750 μm), relative to that observed the mid optimal vaulting group (odds ratio = 6.340, P = 0.034).

Conclusions

Myopic eyes with greater preoperative ACD, larger pupil size, and longer AL are predisposed to higher postoperative vaulting following 12.6-mm V4c ICL implantation. Therefore, the extremes of these parameters should be considered when choosing V4c ICL size.

Pupil Dynamics Induced by Light Reflex After Posterior Chamber Phakic Intraocular Lens Implantation

PURPOSE

To assess the light reflex of the pupil after Implantable Collamer Lens (ICL) (KS-aquaPORT; STAAR Surgical, Nidau, Switzerland) implantation to determine whether the ICL implantation might affect the pupil dynamics.

METHODS

This study examined 28 eyes of 28 consecutive patients who underwent implantation of the posterior phakic ICL for the correction of myopia and astigmatism. Patient age at the time of surgery was 31.1 ± 6.8 years (range: 25 to 42 years). Preoperative refraction was -7.38 ± 2.26 diopters (D) (range: -3.25 to -11.80 D). Light reflex was evaluated using the infrared pupillometer Iriscorder C7364 (Hamamatsu Photonics, Hamamatsu, Japan). Measured parameters included pupil diameter (D1), constriction ratio, maximum constriction velocity, maximum dilation velocity, and the time required to recover 63% of the pupil diameter (T5). At 6 months postoperatively, the authors also investigated the relationship with the amount of vault using the Pentacam (Oculus Optikgeräte, Wetzlar, Germany). Evaluations with the instrument were performed before and at 1, 3, and 6 months after surgery.

RESULTS

There was no significant association found between any of the parameters (analysis of variance, D1: P = .99, constriction ratio: P = .59, maximum constriction velocity: P = .87, maximum dilation velocity: P = .13, T5: P =.57). The vault of the ICL at 6 months postoperatively was 382.1 ± 176.5 μm. There were no significant associations between the maximum constriction velocity, maximum dilation velocity, and amount of vaulting (Spearman correlation coefficient maximum constriction velocity: r = 0.07, P = .71, maximum dilation velocity: r = 0.26, P = .28).

CONCLUSIONS

The light reflex of the pupillary dynamics continued to be maintained at 6 months after ICL implantation. Current findings also verified that ICL implantation had little influence on the postoperative function of the iris. [J Refract Surg. 2017;33(10):704-707.].

Comparison of early changes in and factors affecting vault following posterior chamber phakic Implantable Collamer Lens implantation without and with a central hole (ICL V4 and ICL V4c)

Background

To objectively compare the early changes in vault over time following implantation of an Implantable Collamer Lens without (ICL V4) and with (ICL V4c) a central hole and the respective factors affecting vault change in moderate to high myopia.

Methods

This prospective study comprised of 38 eyes of 38 patients implanted with ICL V4 and 39 eyes of 39 patients implanted with ICL V4c intraocular lenses. We quantitatively assessed the postoperative values of vault and pupil size at 1 day, 1 week, and 1 month following implantation using a rotating Scheimpflug camera (Pentacam). We compared these postoperative values within and between the two groups and identified the factors affecting vault change.

Results

The mean vaults at 1 day, 1 week, and 1 month following ICL V4 implantation were 303.68 ± 185.11, 517.89 ± 160.07 and 521.32 ± 155.72 μm respectively, and those following ICL V4c were 316.67 ± 186.89, 495.13 ± 180.84 and 510.77 ± 175.51 μm, respectively. There was a significant difference in vault between 1 day and 1 week postoperatively. There was a significant association between the vault change and the pupil size change in both groups from 1 day to 1 month postoperatively (Pearman correlation coefficient; ICL V4: r = 0.585, P = 0.001; ICL V4c: r = 0.588, P <0.001). The vault value 1 month after implantation of ICL V4 and ICL V4c was associated with the preoperative anterior chamber depth, horizontal corneal diameter, horizontal and vertical sulcus-to-sulcus.

Conclusions

Pupil movement is a critical factor in vault change, with increasing vault observed postoperatively from 1 day to 1 week associated with the declining effects of pharmacological miosis and increasing pupil size. The anterior chamber depth, horizontal corneal diameter, horizontal and vertical sulcus-to-sulcus show some correlation with vault.

Electronic supplementary material

The online version of this article (doi:10.1186/s12886-016-0336-8) contains supplementary material, which is available to authorized users.

Pupil Diameter Changes in High Myopes after Collamer Lens Implantation

PURPOSE

To observe the changes in pupil size under photopic and scotopic conditions after Implantable Collamer Lens (ICL) implantations in eyes with high myopia.

METHODS

The ICL was implanted in 90 eyes belonging to 45 patients with high myopia. Photopic pupil diameters, scotopic pupil diameters, anterior chamber depths, and ICL vaults were examined at the preoperative, postoperative 1-month, and postoperative 3-month stages. The preoperative and postoperative photopic pupil diameters and scotopic pupil diameters were also compared with each other to note the differences between them. The correlations between preoperative and postoperative pupil diameter changes under different light conditions and presurgical refractive error were analyzed alongside patient's age and ICL vault.

RESULTS

Pupil diameters at both postoperative 1-month and postoperative 3-month stages were smaller than those before operation in distinct light environments, as well as pupil constriction amplitude. Correlation analysis showed that there was a statistically significant correlation between pupil diameter changes under different light conditions and presurgical refractive error at 1 month and 3 months after ICL implantation; pupil diameter decreased more when presurgical refractive error powers were less myopic. Statistically significant correlations were not found, however, with patient's age and ICL vault. Postoperative 1-month and mean postoperative 3-month anterior chamber depths were decreased when compared with preoperative anterior chamber depths. Statistically significant correlations were found in change in preoperative and postoperative anterior chamber depth and ICL vault. No statistically significant difference was found between ICL vault at the postoperative 1-month and postoperative 3-month stages.

CONCLUSIONS

Pupil diameter may decrease at the 1- and 3-month stages after ICL implantation under both photopic and scotopic conditions. This indicates that reduction of pupil diameter may be caused by mechanical contact between the ICL and the posterior iris surface.

Risk factors associated with night vision disturbances after phakic intraocular lens implantation

PURPOSE

To investigate the incidence and severity of night vision disturbances after implantable collamer lens surgery and to analyze the risk factors.

DESIGN

Retrospective, noncomparative study.

METHODS

Medical charts from 50 eyes of 25 patients who underwent implantable collamer lens implantation were retrospectively reviewed. The incidence and severity of night vision disturbances were evaluated using questionnaires administered 6 months after surgery. Univariate simple and multiple logistic regression analyses were used to detect risk factors associated with postoperative night vision disturbances. Potential risk factors included in the analysis were keratometric value, anterior chamber depth, postoperative residual refractive error, higher-order aberrations, preoperative and postoperative mesopic pupil size, the difference between preoperative and postoperative mesopic pupil size, the difference between mesopic pupil size and implantable collamer lens optic zone diameter, white-to-white diameter, sulcus-to-sulcus diameter, and postoperative implantable collamer lens vaulting. The power, size, optic zone diameter, and toricity of the implantable collamer lens were also included as variables.

RESULTS

The incidence of night vision disturbances was 34.0% for halos and 26.0% for glare. Halos were found to be significantly related to the difference between mesopic pupil size and implantable collamer lens optic zone diameter (P = .013), white-to-white diameter of the cornea (P = .028), and implantable collamer lens optic zone diameter (P = .030). For glare, toricity of the implantable collamer lens was revealed as a significant risk factor (P = .047).

CONCLUSIONS

Although not severe, the incidence of night vision disturbances after implantable collamer lens implantation was not negligible. Possible risk factors for night vision disturbances include implantable collamer lens optic zone diameter, the difference between mesopic pupil size and implantable collamer lens optic zone diameter, and white-to-white diameter of the cornea for causing halos, and the toricity of the implantable collamer lens for causing glare.

Intraindividual comparison of visual performance after posterior chamber phakic intraocular lens with and without a central hole implantation for moderate to high myopia

PURPOSE

To compare postoperative visual performance after implantable Collamer lenses with and without a central hole (Hole ICL and conventional ICL) are implanted to correct moderate to high myopia.

DESIGN

Prospective intraindividual comparative study.

PATIENTS AND METHODS

This study evaluated 58 eyes of 29 patients with spherical equivalents of -7.55 ± 2.09 diopters (D) [mean ± standard deviation] who underwent Hole ICL implantation in one eye and conventional ICL implantation in the other eye by randomization assignment. Ocular higher-order aberrations (HOAs) and contrast sensitivity (CS) function were measured by Hartmann-Shack aberrometry and a contrast sensitivity unit before and 3 months after surgery, respectively. From the contrast sensitivity, the area under the log CS function was calculated.

RESULTS

For 4-mm and 6-mm pupils, the changes after Hole ICL implantation in coma-like aberrations, spherical-like aberrations, and total HOAs are similar to those after conventional ICL implantation (P > .05, Wilcoxon signed rank test). The postoperative area under the log CS function was significantly increased after Hole ICL implantation (P < .05), and was equivalent to that after conventional ICL implantation under photopic, mesopic, or mesopic with glare conditions. Subjective symptoms such as glare or halo were also essentially equivalent after Hole ICL and conventional ICL implantation.

CONCLUSIONS

A newly developed Hole ICL implantation appears to be equivalent in the induction of HOAs and CS function to conventional ICL implantation for the correction of moderate to high myopia, suggesting its viability as a surgical option for the treatment of such eyes, because it does not require additional peripheral iridotomies and may also reduce the risk of cataract formation.

Visual performance after posterior chamber phakic intraocular lens implantation and wavefront-guided laser in situ keratomileusis for low to moderate myopia

PURPOSE

To compare postoperative visual function after implantable collamer lens (ICL) implantation and after wavefront-guided laser in situ keratomileusis (LASIK) in eyes with low to moderate myopia.

DESIGN

Retrospective observational case study.

PATIENTS AND METHODS

We investigated 30 eyes of 20 patients undergoing ICL implantation and 64 eyes of 38 patients undergoing wavefront-guided LASIK for the correction of low to moderate myopia (manifest spherical equivalent: -3.00 to -5.88 diopters [D]). Ocular higher-order aberrations (HOAs) and contrast sensitivity (CS) function were measured by Hartmann-Shack aberrometry and a contrast sensitivity unit before and 3 months after surgery, respectively. From the contrast sensitivity, the area under the log contrast sensitivity function was calculated.

RESULTS

For 4-mm and 6-mm pupils, the changes in ocular third-order aberrations, fourth-order aberrations, and total HOAs after ICL implantation were significantly less than those after wavefront-guided LASIK (P < .05, Mann-Whitney U test). The postoperative area under the log contrast sensitivity function was significantly increased after ICL implantation (P < .001), whereas, after wavefront-guided LASIK, it was not significantly changed (P = .11).

CONCLUSIONS

ICL implantation induces significantly fewer ocular HOAs than wavefront-guided LASIK. Moreover, CS was significantly improved after ICL implantation but unchanged after wavefront-guided LASIK in eyes with low to moderate myopia. Thus, even in the correction of low to moderate myopia, ICL implantation appears to be superior in visual performance to wavefront-guided LASIK, suggesting that it may be a viable surgical option for the treatment of such eyes.