Analysis of Accommodation and Optical Quality After Myopia Surgery With Phakic Intraocular Lens Implantation.

Purpose: To characterize the accommodative function and optical quality in high and moderate myopia after the implantation of a phakic intraocular lens implantable collamer lens (ICL).

Methods: This was a prospective observational study of 20 myopic patients undergoing bilateral ICL implantation with a mean spherical equivalent (SE) of -7.44 diopters (D) (range: -4.37 to -12.00 D). Amplitude of accommodation, subjective accommodative response, optical quality parameters including modulation transfer function cut-off, Objective Scatter Index, and Strehl ratio, and objective accommodative response with a double-pass system (HD Analyzer; Visiometrics SL) were assessed before surgery and 1 month postoperatively.

Results: Mean residual refractive error improved to 0.20 ± 0.19 D (P < .001) at 1 month postoperatively compared to preoperatively. Amplitude of accommodation decreased significantly by 1.65 D (P < .001) from 7.65 ± 1.33 D at baseline to 6.00 ± 0.95 D at 1 month after ICL implantation. However, no significant changes were found in accommodative response or in the optical quality parameters of modulation transfer function cut-off, Objective Scatter Index, Strehl ratio, and objective accommodative response with HD Analyzer between preoperatively and 1-month postoperative follow-up (P > .05).

Conclusions: ICL implantation in healthy patients with moderate to high myopia does not significantly alter accommodative function, as measured by subjective or objective methods, or optical quality parameters, except for a non-clinically relevant decrease in amplitude of accommodation. [J Refract Surg. 2025;41(4):e325-e332.].