Assessment of subjective intraocular forward scattering and quality of vision after posterior chamber phakic intraocular lens with a central hole (Hole ICL) implantation

Intraocular Implantable Collamer Lens with a Central Hole Implantation: Safety, Efficacy, and Patient Outcomes

This review summarizes the available literature and provides updates on the efficacy, safety, and patient outcomes of phakic intraocular lens implantation using implantable collamer lens (ICL), with a focus on newer models with a central port (EVO/EVO+ Visian Implantable Collamer Lens, STAAR Surgical Inc.). All studies included in this review were identified from the PubMed database and were reviewed for relevancy of their topic. Data on hole-ICL implantation performed between October 2018 and October 2022 in 3399 eyes showed a weighted average efficacy index of 1.03 and a weighted average safety index of 1.19 within an average follow-up of 24.7 months. The incidence of complications such as elevated intraocular pressure, cataract, and corneal endothelial cell loss was low. Moreover, both quality of vision and quality of life improved after ICL implantation, confirming the benefits of this procedure. In conclusion, ICL implantation is a promising refractive surgery alternative to laser vision correction with excellent efficacy, safety, and patient outcomes.

Determinants of Subjective Quality of Vision After Phakic Intraocular Lens Implantation

PURPOSE

To evaluate postoperative subjective quality of vision in patients who underwent Implantable Collamer Lens (ICL) (STAAR Surgical) implantation for correction of myopia and to identify potential predictive parameters.

METHODS

In this single-center cross-sectional study, a total of 162 eyes of 81 patients (58 women, 23 men) who underwent ICL implantation were analyzed. The Quality of Vision (QOV) questionnaire was used to assess patient-reported outcomes. Baseline characteristics (eg, age), treatment parameters (eg, surgical corrected refraction), and refractive (eg, residual refraction) and visual (eg, uncorrected distance visual acuity) outcomes were analyzed regarding their effect on QOV.

RESULTS

Mean age was 33.3 ± 7.0 years (range: 21 to 51 years) and mean preoperative spherical equivalent was -8.42 ± 2.49 diopters (D) (range: -3.25 to -14.38 D). After a mean postoperative follow-up period of 19 ± 14 months (range: 6 to 54 months), the safety index score was 1.23 ± 0.21 and the efficacy index score was 1.17 ± 0.22. The mean QOV scores were 35.5 ± 11.3, 32.2 ± 11.1, and 23.3 ± 16.1 for frequency, severity, and bothersomeness, respectively. The most frequently experienced symptoms were halos (90.1%) and glare (66.7%). Halos appeared in 66.7% of the patients "occasionally" and 5 of them (6.2%) experienced them "very often." Only 1 patient (1.2%) classified halos as "very bothersome." Patients older than 36 years reported visual symptoms more frequently (P < .05) and showed higher bothersomeness scores (P = .01).

CONCLUSIONS

Halos are the most commonly perceived long-term visual disturbance after myopic ICL implantation with a central hole. Visual symptoms can persist more than 6 months postoperatively, causing only minor disturbances in most cases. Older patients seem more prone to experiencing these symptoms. [J Refract Surg. 2022;38(5):280-287.].

Five-year clinical outcomes of rigid iris-fixated phakic intraocular lens in northern Chinese

PURPOSE

To investigate the 5-year clinic outcomes of rigid iris-fixated pIOL on the visual performance, complications and intraocular light scattering in northern Chinese.

METHODS

Thirty eyes implanted with iris-fixated phakic IOLs (pIOLs group) and 34 eyes with high myopia (myopia group) were involved in this study. At preoperatively, 6 months, 1, 3, and 5 years postoperatively, the uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BSCVA), endothelial cell density (ECD), and intraocular pressure (IOP) were measured in pIOLs group. The objective scatter index (OSI), modulation transfer function cut off (MTF cut off), and Strehl ratio were measured by Optical Quality Analysis System and a pseudophakic dysphotopsia questionnaire (PDQ) was used to evaluate the subjects' satisfaction in pIOLs and myopia groups.

RESULTS

At 5 years postoperatively, an UCVA of 20/20 or better was found in 43.33% of eyes in pIOLs group. At 6 months, 1, 3, and 5 years postoperatively, the mean ECD decrease were 1.29% ± 0.45%, 2.59% ± 1.30%, 6.67% ± 2.26%, and 10.80% ± 3.48%. The value of OSI in pIOLs group was significantly higher than that in myopia group (P < 0.001). The PDQ results showed that the subjects in myopia group complained less with intolerance of bright lights than those in pIOLs group. The values of Strehl ratio and MTF cut off in pIOLs group were significantly lower than that in myopia group (P < 0.001).

CONCLUSIONS

Iris-fixated pIOL induce more intraocular light scattering. A significant decrease in ECD was observed at 5 years postoperatively. An annual evaluation of ECD is necessary for patients undergoing pIOL implantation.

Posterior-chamber phakic implantable collamer lenses with a central port: a review

We aimed to summarize the outcomes reported following the implantation of the V4c implantable collamer lens with a central port (ICL, STAAR Surgical Inc) for myopia correction. A literature search in PubMed, Web of Science and Scopus was carried out to identify publications reporting clinical outcomes of patients who were implanted with the V4c ICL model and had a follow‐up period of at least 6 months. A total of 35 clinical studies published between 2012 and 2020 were included in the present review. A comprehensive analysis of the available data was performed, focusing on visual and refractive outcomes at different time‐points post‐surgery. In addition, adverse events and other parameters such as endothelial cell density, intraocular pressure and vault measurements—which were evaluated in some of the studies—were also compared. This review encompassed a total of 2904 eyes. The outcomes reported in this review lead us to conclude that ICL V4c implantation for myopia correction is a safe and efficient procedure, with stable visual and refractive outcomes and low adverse event rates. The patient’s anterior segment should be thoroughly characterized, and the ICL parameters should be carefully selected so as to achieve good outcomes and avoid complications.

Comparison of visual quality after implantation of A1-UV and SN60WF aspheric intraocular lens

AIM

To compare the visual performance of pseudophakic eyes implanted with A1-UV and SN60WF aspheric intraocular lens (IOL), and to investigate the correlations between visual quality parameters and pupil size.

METHODS

This prospective comparative study included 105 eyes of 90 patients with age-related cataract who underwent uneventful phacoemulsification. The subjects were divided into two groups according to the implanted IOL type. Three months postoperatively, visual acuity and contrast sensitivity were measured, wave-front aberrations were assessed using a KR-1W aberrometer (Topcon), and objective optical quality parameters were performed using an optical quality analysis system-OQAS II (Visiometrics). Independent sample t-test and Spearman correlation analysis were used for data analysis.

RESULTS

There were no significant differences found in visual acuity, contrast sensitivity and visual quality parameters between the two groups (P>0.05). The measured intraocular spherical aberration (SA) in A1-UV IOL eyes of -0.19±0.05 µm was close to the designed SA value of -0.20 µm. The modulation transfer function cutoff, Strehl ratio and OQAS values were negatively correlated with pupil size in both groups (P<0.01).

CONCLUSION

The subjective and objective visual quality in pseudophakic eyes with A1-UV and SN60WF IOLs are comparable. For aspheric IOL eyes, visual quality decreases with increasing pupil size.

Implantable collamer lens with a central hole for residual refractive error correction after corneal refractive surgery

The present study aimed to assess the visual and refractive outcomes of an implantable collamer lens with a central hole (ICL V4c) for residual refractive error correction after corneal refractive surgery in individuals with myopia. A total of 16 eyes of eight consecutive patients with myopia undergoing ICL V4c implantation after corneal refractive surgery were investigated. The uncorrected visual acuity (VA) and best-corrected VA were examined prior to surgery and at 1, 3 and 6 months after surgery. The post-operative values of the modulation transfer function (MTF) cutoff frequency, Strehl ratio (SR), objective scattering index (OSI) and Optical Quality Analysis System (OQAS) values (OVs) were quantitatively assessed using an OQAS. At 6 months after surgery, the mean uncorrected LogMAR VA was 0.06±0.10 and the values had improved in 100% of the eyes. The mean MTF cutoff frequency, SR, OSI, OV 100%, OV 20% and OV 9%, were 31.294±4.321 cycles/degree, 0.187±0.039, 1.399±0.274, 1.066±0.261, 0.748±0.287 and 0.509±0.229, respectively. In conclusion, ICL V4c implantation for the correction of residual refractive error after corneal refractive surgery appeared feasible and safe and also had an excellent optical performance. However, long-term changes in visual quality require further investigation.

Evaluation of retinal light scattering, visual acuity, refraction and subjective satisfaction in patients after Acrysof IQ PanOptix intraocular lens implantation

AIM

To evaluate the retinal light scattering, visual acuity, refraction and subjective satisfaction in patients after implantation of Acrysof IQ PanOptix intraocular lens.

METHODS

Our group included 32 eyes of 21 patients who underwent cataract surgery or refractive lensectomy with Acrysof IQ PanOptix multifocal intraocular lens implantation at the Ophthalmology Clinic of Faculty Hospital Hradec Králové during the time from September 2015 to December 2017. The observed parameters were visual acuity, subjective refraction, retinal light scattering and patient subjective satisfaction. Preoperative refractive values and visual acuity values were compared with results obtained on day 1, 1 month and at an average of 27 months postoperatively. Subjective satisfaction and degree of light scattering on the retina were evaluated at the end of the follow-up period.

RESULTS

Preoperative, uncorrected distant visual acuity improved from an average of 0,51 ± 0,29 (expressed in decimal values) to 0,94 ± 0,10 at the end of the follow-up period. Preoperative best-corrected distance visual acuity improved from an average of 0,95 ± 0,19 to 1,00 ± 0,09 at the end of the follow-up period. The mean value of preoperative uncorrected near visual acuity was 8,29 ± 4,93 of Jaeger charts, the mean value of uncorrected near visual acuity at the end of the follow-up period was 1,00 ± 0 of Jaeger charts. Subjective satisfaction was assessed using a standardized VF-14 questionnaire at least 1 year after surgery (mean follow-up of 27 months). Retinal light scattering was examined using an Oculus C-Quant instrument. The retinal light scattering value in our sample was 1,12 ± 0,19. In only 6 eyes of 4 patients, the resulting value was outside the physiological range used for eyes with lens crystallina Conclusion: The value of light scattering on the retina is a factor affecting the degree of sensitivity to glare after implantation of multifocal intraocular lenses. In our group, we observed a deviation from the physiological range of retinal light scattering in only 6 eyes of 4 patients, but this did not lead to a deterioration in subjective postoperative satisfaction.

Optical quality after posterior chamber Phakic implantation of an intraocular Lens with a central hole (V4c implantable Collamer Lens) under different lighting conditions

Background

The current study compared optical quality before and after implantation of a posterior chamber phakic intraocular lens with a central hole [V4c implantable collamer lens (ICL)] under bright and dark lighting conditions by means of the Optical Quality Analysis System™ (OQAS; Visiometrics, Terrassa, Spain).

Methods

This prospective study involved 91 eyes of 46 consecutive high myopia patients (15 males and 31 females, average spherical equivalent − 10.50 ± 0.33D) undergoing implantation of a V4c ICL. The modulation transfer function (MTF) cutoff frequency, Strehl ratio, objective scattering index (OSI), and predicted visual acuities (PVAs; 100, 20, and 9%), under different lighting conditions, were measured before and 1 week, 1 month, and 3 months after surgery.

Results

All optical parameters showed significant improvements, at all time points, under dark condition after surgery. We observed no significant changes in PVA 9% at 1 week (mean value 0.539, P = 0.12) or 1 month after surgery (mean value 0.573, P = 0.08) under bright condition; but all other postoperative parameters improved significantly. Comparing the two lighting conditions, the OSI decreased more under dark conditions at 1 week (P = 0.02), 1 month (P = 0.004), and 3 months (P = 0.002), but there was no significant difference in any other parameter. In addition, patients were divided into super high myopia (group S, spherical equivalent greater than − 10 D) and high myopia (group H, spherical equivalent from − 6 D to − 10 D), the group S improved significantly more than group H in all parameters, under both bright and dark conditions.

Conclusions

V4c ICL implantation improved optical quality under both bright and dark lighting conditions, and had a better ability to reduce the extent of scattering in the dark. Furthermore, group S achieved greater improvement in visual quality, which should be considered by physicians before surgery.

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.

Posterior capsular opacification comparison between morphology and objective visual function

BACKGROUND

To compare the influence of posterior capsule opacification (PCO) morphology and severity on intraocular stray light and visual function with different levels of contrast.

METHODS

Forty-five patients diagnosed with PCO were included in this prospective consecutive case series. The Optical Quality Analysis System II (OQAS II) was adopted to assess the objective visual function including objective scatter index (OSI) and optical quality analysis system values (OVs) with 100, 20, and 9% contrast. RTVue-100 OCT was used to evaluate the PCO morphology and severity. Comparisons among visual function, morphology, and severity between pear type and fibrosis PCO were performed. The correlations among the PCO morphology, severity, OSI, and OVs were also determined.

RESULTS

There was a significant correlation between increased OSI and decreased visual acuity in PCO patients before laser capsulotomy. The changes of OSI were also correlated with the PCO area for the 3 mm IOL optic region (r = 0.43, p = 0.02). The OSI was significantly higher in pear type PCO when compared with fibrosis PCO (Z = - 4.06, p ≤ 0.001). In addition, the increased OSI in pear type PCO was significantly correlated with the 100% OVs and the 20% OVs but not with the 9% OVs. In fibrosis PCO, OSI was only correlated with the 100% OVs and the 20% OVs pre-YAG.

CONCLUSIONS

OSI and OVs could objectively indicate the visual function impairment in PCO patients. Effects of PCO on light scattering and on objective visual function might be explained by the variations of morphology and severity.

The Implantable Collamer Lens with a central port: review of the literature

The purpose of this review is to summarize preclinical and clinical data from publications appearing in the peer-reviewed scientific literature relevant to the safety and effectiveness of the EVO Implantable Collamer Lens (ICL) posterior chamber phakic refractive lens with a central port (V4c Visian ICL with KS Aquaport, STAAR Surgical, Inc.). A literature search was conducted using PubMed.gov to identify all articles relating to the EVO ICL. Articles were examined for their relevance, and the references cited in each article were also searched for additional relevant publications. On the basis of a total of 67 preclinical studies and clinical reports, including effectiveness data on 1,905 eyes with average weighted follow-up of 12.5 months and safety data on 4,196 eyes with weighted average follow up of 14.0 months, the EVO ICL is safe and effective for the correction of a broad range of refractive errors. High levels of postoperative uncorrected visual acuity, refractive predictability, and stability demonstrate the effectiveness of the EVO ICL. Safety data suggest reduced rates of anterior subcapsular cataract and pupillary block compared with earlier models. Improved safety and proven effectiveness make EVO an attractive option for surgeons and patients.

Short-term Observation of Intraocular Scattering and Bowman's Layer Microdistortions After SMILE-CCL

PURPOSE

To investigate changes in intraocular scattering and Bowman's layer microdistortions after femtosecond laser small incision lenticule extraction using the continuous curvilinear lenticulerhexis technique (SMILE-CCL).

METHODS

In this prospective study, 93 eyes of 93 patients (44 women, 49 men) were treated with SMILE-CCL. Mean age was 26.09 ± 4.39 years and mean spherical equivalent was -6.31 ± 2.16 diopters. The Objective Scatter Index (OSI) was examined with an objective optical quality analysis system. Bowman's layer microdistortions in the central 4-mm optical zone were measured using Fourier-domain optical coherence tomography.

RESULTS

The mean OSI value increased from 0.67 preoperatively to 1.09 at 20 days, and then decreased to 0.84 at 3 months (P < .05). Microdistortions were observed in 62.37% of the eyes at 20 days and 48.39% at 3 months postoperatively (P < .05). The width of the microdistortions per meridian was 283.18 ± 197.19 μm at 20 days; this decreased to 156.00 ± 159.86 μm at 3 months (P < 0.05). Regression analysis models revealed that older age (b = 0.02, P = .03) and higher preoperative spherical equivalent (b = -0.09, P < .05) resulted in higher postoperative OSI values; no significant association was found between postoperative OSI values and microdistortion-related parameters (P > .05). Higher preoperative spherical equivalent (b = -0.28, P = .01) and thinner preoperative corneal thickness (b = -0.02, P = .01) were associated with more microdistortions.

CONCLUSIONS

SMILE induced a temporary increase in OSI values and Bowman's layer microdistortions. The microdistortions did not influence intraocular scattering. [J Refract Surg. 2018;34(6):387-392.].

Evaluation of Optical Quality: Ocular Scattering and Aberrations in Eyes Implanted with Diffractive Multifocal or Monofocal Intraocular Lenses

PURPOSE

To compare objective optical quality, ocular scattering and aberrations of eyes implanted with an aspheric monofocal intraocular lens (IOL) or an aspheric apodized diffractive multifocal IOL three months after surgery.

METHODS

Prospective consecutive nonrandomized comparative cohort study. A total of 80 eyes from 57 cataract patients were bilaterally or unilaterally implanted with monofocal (AcrySof IQ SN60WF) or multifocal (AcrySof IQ ReSTOR SN6AD1) IOLs. Respectively, 40 eyes of 27 patients were implanted with monofocal IOLs, and 40 eyes of 30 patients were implanted with multifocal IOLs. Ocular high-order aberration (HOA) values were obtained using Hartmann-Shack aberrometer; objective scatter index (OSI), modulation transfer function (MTF) cutoff, Strehl ratio (SR), and contrast visual acuity OV at 100%, 20%, and 9% were measured using Objective Quality Analysis System II (OQAS II).

RESULTS

Ocular aberrations performed similar in both groups (p > 0.05). However, significantly higher values of OSI and lower values of MTF cutoff, SR and OV were found in the SN6AD1 group (p < 0.05).

CONCLUSIONS

Both ocular scattering and wave-front aberrations play essential role in retinal image quality, which may be overestimated when only aberrations were taken into account. Combining the effect of ocular scattering with HOA will result in a more accurate assessment of the visual and optical quality.