Accommodation changes after visian implantable collamer lens with central hole for high myopia: A STROBE-compliant article

The changes and causes of asthenopia after ICL implantation

OBJECTIVE

To detect the presence of asthenopia after implantation of Implantable Collamer Lens (ICL).

METHOD

Design: prospective observational case series. Patients with myopia and/or astigmatism who underwent ICL surgeries and completed 3-month follow-up were enrolled. Asthenopia scores, amplitude of accommodation (AA), positive/negative relative accommodation (PRA/NRA), accommodative facility (AF), the ratio of accommodative convergence and accommodation (AC/A), Schirmer test, noninvasive breakup time (NBUT), and HOA were examined before surgeries and at 1 week, 1 month and 3 months postoperatively then statistically analyzed.

RESULTS

Symptoms of asthenopia were significantly decreased at 1 week after ICL surgeries than those before surgeries, but increased gradually as time went by, eventually recovered at 3 months postoperatively. AA, AF, AC/A decreased 1 week postoperatively, returned to the baseline at 1 month and were improved at 3 months after surgeries. NBUT at 1 week, 1 month and 3 months after surgeries were significantly decreased and was the lowest at 1 week postoperatively. PRA, NRA, Schiermer values and HOA had no significant change. Correlation analysis showed that the lower AF and NBUT after ICL surgeries, the more severe the asthenopia symptoms.

CONCLUSION

The symptoms of asthenopia aggravated transiently after ICL implantation surgeries, but improved gradually with time. AF and NBUT were important factors affecting the changes of asthenopia.

Changes in accommodation and convergence function after refractive surgery in myopic patients

In recent years, with the gradual maturation of myopia correction surgery, the changes in binocular visual function after surgery have attracted widespread attention. The accommodation of facility, the amplitude of accommodation, relative accommodation, and accommodation convergence/accommodation assembly are essential parameters for assessing binocular visual function. The changes in these parameters are significant for guiding patients in the design of the preoperative surgical approach and alleviating postoperative visual fatigue. This paper aims to guide the preoperative assessment, design, and postoperative visual training of refractive surgery in myopic patients from the perspective of changes in binocular visual function before and after myopia and surgery, which can improve accommodation and convergence function in patients after refractive surgery.

Changes in Accommodative and Binocular Function following Phakic Intraocular Lens for High and Low-to-Moderate Myopia

The aim was to evaluate accommodative and binocular function of phakic intraocular lens implantable collamer lens (ICL) in high and low-to-moderate myopia. Prospective comparative cohort study with 38 myopic patients who underwent ICL implantation were divided into two groups of 19 patients, each one based on the spherical equivalent (SE): high-power (SE ≤ −6 D) and low-to-moderate (SE > −6 D). The push-up amplitude of accommodation (AA), monocular accommodative facility (MAF), distance and near ocular deviation, near convergence amplitude, near point convergence (NPC), stereopsis, and accommodative convergence/accommodation (AC/A) ratio were assessed before surgery and 1 week and 1 month postoperatively. The mean residual refractive error at 1 month after surgery improved in both groups, 0.18 ± 0.34 D and 0.09 ± 0.26 D, respectively (p < 0.001). There was a significant decrease in AA in both groups between preoperatively and at 1-week (p = 0.001; p = 0.008, respectively) and 1-month follow-up (p = 0.001; p = 0.008). For the rest of the binocular measurements, no statistically significant postoperative changes were found in any group. This finding suggests follow-up studies on amplitude of accommodation in phakic intraocular lens ICL implantation.

Effect of 0.01% Atropine on Accommodation in Myopic Teenagers

Purpose: The purpose of the study is to evaluate the effects of 0.01% atropine eye drops on accommodative system parameters among teenagers with low myopia. Methods: Ninety-five myopic teenagers [39 boys (8.69 ± 2.473) and 56 girls (8.54 ± 2.054) aged 5-17 years] with no history of eye disease were enrolled. Biometric and accommodative system parameters were evaluated before and at 1 week, 1 month, 3 months, and 6 months of 0.01% atropine eye drop instillation. Results: Participants without accommodative demand at 6 months demonstrated insignificant changes after the atropine instillation (all p > 0.05). Nevertheless, there were significant differences in accommodative sensitivity, accommodative amplitude, accommodative responsiveness, and negative relative accommodation (NRA) at 3 months compared with baseline after atropine instillation (all p < 0.05). Except spherical equivalent refraction, cornea thickness, intraocular pressure, and axial length were stable after the 0.01% atropine instillation (all p > 0.05). Conclusion: Morphologically, current measurements suggested that 0.01% atropine had favorable reduction of accommodation for childhood low myopia over a half-year period.

Comparison of accommodation and accommodative micro-fluctuation after implantable collamer lens and LASIK surgery for myopia

BACKGROUND

To longitudinally analyze and compare the accommodative micro-fluctuation (MFs) and accommodative function between myopic patients after implantable collamer lens (ICL) implantation and laser in situ keratomileusis (LASIK).

METHODS

Patients with good corrected visual acuity (20/20 or better) and underwent ICL (V4c) and LASIK for myopic-correction (ranging from - 3.50 to - 8.50 D) were recruited. Refraction, amplitude of accommodation (AMP), accommodative lag, higher-order aberration (HOA), and MFs were recorded before surgery and 1 and 3 months after surgery. The ACOMEREF automatic refractor was used to measure the high-frequency component (HFC) of the MFs, which suggested tension of the ciliary muscle.

RESULTS

The study comprised 120 eyes. At 3 months after surgery, the manifest refractive spherical equivalent of the ICL and LASIK groups were - 0.11 and - 0.09 D, respectively (p = 0.46). HFC values were significantly higher at 1 month (p = 0.03) and 3 months postoperatively (p = 0.03) in the ICL group compared to that in the LASIK group. The ocular HOA of the ICL group was 1.08 ± 0.43 μm, which was lower than the LASIK group 1.45 ± 0.54 μm (p = 0.01). No significant differences in AMP and accommodative lag between groups were noted at 3 months postoperatively. There was a positive correlation between HFC and vault of the ICL lens (r² = 0.14, p = 0.005). There were no correlations between HFC and ocular HOA and postoperative MRSE in the two groups (all p>0.05).

CONCLUSIONS

The HFC increased significantly after an early period of ICL implantation compared to laser in situ keratomileusis for myopic correction, which indicated increased tension of the ciliary muscle, and had a positive correlation on the vault of the ICL lens; However, studies with longer follow-up time and more structural evaluation are needed.

Comparative Study of Implantable Collamer Lens Implantation in Treating Four Degrees of Myopia: Six-Month Observation of Visual Results, Higher-Order Aberrations, and Amplitude of Accommodation

PURPOSE

To compare the visual and refractive outcomes, higher-order aberrations (HOAs), and amplitude of accommodation (AA) after implantable collamer lens (ICL) model V4c implantation in four degrees of myopia.

METHODS

One hundred and thirty-seven myopic eyes (137 patients) undergoing ICL implantation were included and divided into four groups: Group 1 with spherical equivalent (SE) ≤-6.0D, Group 2 with SE from -6.13D to -9.0D, Group 3 with SE from -9.13D to -12.0D, and Group 4 with SE from -12.13D to -18.0D. The postoperative visits were scheduled at 1 day, 1 week, 1 month, 3 months, and 6 months. Visual and refractive outcomes, HOAs and AA were observed and compared.

RESULTS

At 6 months postoperatively, the uncorrected distance visual acuity (UDVA) in Group 4 was worse than the values in the other groups (all p < .05). Meanwhile, Group 4 had more eyes with corrected distance visual acuity (CDVA) improvement than the other groups. Furthermore, 96%, 100%, 100%, and 81% of eyes had an SE within ±0.5D in Group 1, Group 2, Group 3, and Group 4 (p < .05 between Group 4 and the other groups), respectively. The postoperative UDVA and SE remained stable in all groups. No significant change in total HOAs was found between preoperative and postoperative values for each group. However, quatrefoil increased in each group, whereas trefoil was induced in all groups except for Group 1. Negative spherical aberration was induced in Group 3 and Group 4. AA significantly decreased 1 week postoperatively and gradually improved in each group. Although AA improved to the preoperative level in Group 1 at 3 months postoperatively, it was still lower than the preoperative level in the other groups.

CONCLUSIONS

In treating different degrees of myopia with ICL implantation, differences were observed in terms of CDVA improvement, SE predictability, HOAs induction, and accommodation recovery.