Etiology, pathogenesis, and management of acute intraocular lens opacification: a systematic review.

This study aimed to compare ocular wavefront aberrations for pupil diameters of 4 mm and 6 mm, and contrast sensitivity, in eyes with AcrySof IQ and AcrySof Natural intraocular lenses (IOLs). Sixty eyes of 60 patients were enrolled in this prospective randomized study. After phacoemulsification the eyes received either AcrySof IQ SN60WF or AcrySof Natural SN60AT IOLs. One month after surgery, all patients underwent complete ophthalmological examination including corneal topography, wavefront analysis for pupil diameters of 4 mm and 6 mm, and contrast sensitivity measurements with the CSV 1000E instrument under photopic and mesopic conditions with and without glare. There was no statistically significant difference between groups in age, sex or other preoperative ocular characteristics (p > 0.05). Patients with AcrySof IQ IOLs had higher contrast sensitivity at 6 c.p.d. under photopic conditions, at 6 c.p.d. and 18 c.p.d. under mesopic conditions, and at 6 c.p.d., 12 c.p.d. and 18 c.p.d. under mesopic conditions with glare (p < 0.05). Corneal spherical aberration was 0.273 ± 0.074 μm in the AcrySof Natural group and 0.294 ± 0.086 μm in the AcrySof IQ group (p = 0489). Ocular spherical aberration was 0.362 ± 0.141 μm and 0.069 ± 0.043 μm (p < 0.001) for 6-mm diameter pupils and 0.143 ± 0.091 μm and 0.017 ± 0.016 μm (p < 0.001) for 4-mm diameter pupils, with AcrySof Natural and AcrySof IQ IOLs, respectively. There were no significant differences in other higher-order aberrations between the groups (p > 0.05). Aspherical AcrySof IQ IOLs significantly reduced spherical aberration for pupil diameters of both 4 mm and 6 mm and also improved contrast sensitivity more than spherical AcrySof Natural IOLs, especially in mesopic conditions.

Management of uveitic cataract in patients with juvenile idiopathic arthritis (JIA) is challenging, and intraocular lens (IOL) implantation is controversial. This study investigated the outcome after minimally invasive surgery with IOL implantation. Retrospective analysis after phacoemulsification with in-the-bag IOL implantation was performed in 16 patients (17 operations) with ANA-positive JIA-associated chronic uveitis. In these patients, 25 G capsulectomy and anterior vitrectomy was performed and they received an intravitreal triamcinolone (TA) injection. Mean age at uveitis onset was 5 ± 2 years, and surgery was performed at a mean age of 11 ± 2.2 years. Preoperatively, uveitis was inactive in all patients, and visual acuity was logMAR 0.8 ± 0.44; additional uveitis complications were present in all patients, and 15 patients were receiving systemic immunosuppression/biologicals. After surgery (mean follow-up 26.5 ± 11.7 months), presence of cystoid macular oedema, papilloedema, ocular hypertension/glaucoma and hypotony did not increase compared with baseline. There was no significant worsening of AC inflammation (by cell numbers and laser flare values). IOL deposits persisted in four patients, and synechiae developed in eight. The visual acuity was improved (≥2 lines) in all patients (mean logMAR 0.3 ± 0.24). Retrolental membrane formation was not noted. Secondary capsular opacification was observed in seven patients, requiring Nd:YAG capsulotomy in five of them. Phacoemulsification and in-the-bag IOL implantation may improve visual outcome in JIA-associated uveitis with minimally invasive surgical technique and intravitreal TA injection. Well-controlled uveitis with appropriate use of topical steroids and systemic immunosuppression or biologicals appears as a perioperative requirement.

Visual Outcomes and Accommodative Response of the Lumina Accommodative Intraocular Lens

Spherical Aberration and Contrast Sensitivity in Eyes Implanted with Aspheric and Spherical Intraocular Lenses: A Comparative Study

Opacification of Hydroview posterior chamber intraocular lenses had been prescribed, but many aspects of this complication remain unknown, including its aetiology, clinical features, pathogenesis, prognosis and treatment. This paper describes an epidemic of Hydroview intraocular lens (IOL) opacification. Subjects in whom the Hydroview IOL was implanted were recalled for evaluation of its transparency, assessment of contrast sensitivity (CS) [VCTS (Vistech CO, Dayton, Ohio, USA)] and visual acuity (LogMAR), and analysis of medical and surgical data. The results of IOL exchange in 69 eyes of 67 patients are also presented. Of 103 patients recalled, 46 (44.6%) and 3 (2.9%) exhibited opacification of the implanted IOL in one and both eyes, respectively. CS was significantly worse in the presence of an opacified IOL (P<0.050), even when Snellen acuity was unaffected. Where the viscoelastic employed during the primary cataract surgery was reliably documented, VISCOAT was used in 100% of cases (43/43), whereas Healonid had not been used in any (0/57) (P<0.0001). Following IOL exchange, visual acuity improved from a mean (+/-SD) of 0.75 (0.41) to 0.4 (0.34) LogMAR. The prevalence of Hydroview IOL opacification is associated with the use of VISCOAT in the primary cataract surgery, and there is a biochemically plausible rationale to account for this. Visual acuity and contrast sensitivity are adversely affected by opacification of the Hydroview IOL, but CS to a greater extent. Exchange of opaque IOLs is a visually rewarding procedure.

Opacification of the Hydroview H60M intraocular lens: Total patient recall

To evaluate visual acuities and contrast sensitivities (CS) after accommodative, refractive, and diffractive multifocal intraocular lens (IOL) implantations. After cataract extractions, in 20 eyes accommodative IOL (group 1), in 30 eyes refractive IOL (group 2), and in 20 eyes diffractive multifocal IOL (group 3) implantations were performed. CS were measured with the stereo optical functional acuity contrast test. Uncorrected distance (UCDVA) and distance corrected near visual acuities (DCNVA) and refractive values were determined. The mean UCDVA (0.99+/-0.03) and DCNVA (0.98+/-0.04) of group 3 were significantly better than the other IOL groups. The mean DCNVA of group 2 (0.71+/-0.14) was significantly better than group 1 (0.5+/-0.08). One month after the operations CS, values of group 2 were significantly lower than the 2 other IOL groups. Photopic CS values of group 1 at 12 and 18 cycles per degree (cpd) were significantly higher than group 3. Three months after the operations, CS values of group 1 and 3 were significantly higher than that of group 2 at 3, 6, 12, and 18 cpd and in all spatial frequencies respectively. There was no difference between groups 1 and 3 with respect to photopic CS values. Mesopic CS values of group 3 were significantly higher than that of group 1 at 1.5, 3, and 6 cpd. At the 6th and 12th month, CS values of group 3 were similar or better compared to the values of the 3rd month. The diffractive multifocal IOL resulted in more favorable visual acuities and higher CS values than accommodative and refractive multifocal IOL.

Trifocal intraocular lenses versus bifocal intraocular lenses a er cataract extraction among participants with presbyopia.

Presbyopia occurs when the lens of the eyes loses its elasticity leading to loss of accommodation. The lens may also progress to develop cataract, affecting visual acuity and contrast sensitivity. One option of care for individuals with presbyopia and cataract is the use of multifocal or extended depth of focus intraocular lens (IOL) after cataract surgery. Although trifocal and bifocal IOLs are designed to restore three and two focal points respectively, trifocal lens may be preferable because it restores near, intermediate, and far vision, and may also provide a greater range of useful vision and allow for greater spectacle independence in individuals with presbyopia. To assess the effectiveness and safety of implantation with trifocal versus bifocal IOLs during cataract surgery among participants with presbyopia. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 9); Ovid MEDLINE; Embase.com; PubMed; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 26 September 2019. We searched the reference lists of the retrieved articles and the abstracts from the Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) for the years 2005 to 2015. We included randomized controlled trials that compared trifocal and bifocal IOLs among participants 30 years or older with presbyopia undergoing cataract surgery. We used standard Cochrane methodology. We identified five studies conducted in Europe with a total of 175 participants. All five studies assessed uncorrected distance visual acuity (primary outcome of the review), while some also examined our secondary outcomes including uncorrected near, intermediate, and best-corrected distance visual acuity, as well as contrast sensitivity. Study characteristics All participants had bilateral cataracts with no pre-existing ocular pathologies or ocular surgery. Participants' mean age ranged from 58 to 64 years. Only one study reported on gender of participants, and they were mostly women. We assessed all the included studies as being at unclear risk of bias for most domains. Two studies received financial support from manufacturers of lenses evaluated in this review, and at least one author of another study reported receiving payments for delivering lectures with lens manufacturers. Findings All studies compared trifocal versus bifocal IOL implantation on visual acuity outcomes measured on a LogMAR scale. At one year, trifocal IOL showed no evidence of effect on uncorrected distance visual acuity (mean difference (MD) 0.00, 95% confidence interval (CI) -0.04 to 0.04; I2 = 0%; 2 studies, 107 participants; low-certainty evidence) and uncorrected near visual acuity (MD 0.01, 95% CI -0.04 to 0.06; I2 = 0%; 2 studies, 107 participants; low-certainty evidence). Trifocal IOL implantation may improve uncorrected intermediate visual acuity at one year (MD -0.16, 95% CI -0.22 to -0.10; I2= 0%; 2 studies, 107 participants; low-certainty evidence), but showed no evidence of effect on best-corrected distance visual acuity at one year (MD 0.00, 95% CI -0.03 to 0.04; I2= 0%; 2 studies, 107 participants; low-certainty evidence). No study reported on contrast sensitivity or quality of life at one-year follow-up. Data from one study at three months suggest that contrast sensitivity did not differ between groups under photopic conditions, but may be worse in the trifocal group in one of the four frequencies under mesopic conditions (MD -0.19, 95% CI -0.33 to -0.05; 1 study; I2 = 0%, 25 participants; low-certainty evidence). In two studies, the investigators observed that participants' satisfaction or spectacle independence may be higher in the trifocal group at six months, although another study found no evidence of a difference in participant satisfaction or spectacle independence between groups. Adverse events Adverse events reporting varied among studies. Two studies reported information on adverse events at one year. One study reported that participants showed no intraoperative or postoperative complications, while the other study reported that four eyes (11.4%) in the bifocal and three eyes (7.5%) in the trifocal group developed significant posterior capsular opacification requiring YAG capsulotomy. The certainty of the evidence was low. There is low-certainty of evidence that compared to bifocal IOL, implantation of trifocal IOL may improve uncorrected intermediate visual acuity at one year. However, there is no evidence of a difference between trifocal and bifocal IOL for uncorrected distance visual acuity, uncorrected near visual acuity, and best-corrected visual acuity at one year. Future research should include the comparison of both trifocal IOL and specific bifocal IOLs that correct intermediate visual acuity to evaluate important outcomes such as contrast sensitivity and quality of life.

Aims/Purpose: Cataract, i.e., an opacification of the natural intraocular lens, is one of the leading causes of visual impairments worldwide. Cataract surgery, which involves the removal of the opaque lens and implantation of an artificial intraocular lens, is one of the most cost‐efficient interventions in all of health care to improve visual impairments. However, it remains unclear how exactly visual performance changes after surgery, which we aim to investigate in our study.Methods: We tested 30 older adults undergoing cataract surgery longitudinally with a battery of visual tests. Participants were tested a total of four times: before surgery, after surgery on one eye, after surgery on the second eye, and a few weeks after surgery when vision was fully stabilized. The battery tested various visual abilities and included the following tests: visual acuity, contrast sensitivity, coherent motion, orientation discrimination, reaction time, and visual search. All tests were performed binocularly, and a subset of tests was repeated monocularly.Results: Results suggest that visual acuity and orientation discrimination performance increase after each surgery. Performance in contrast sensitivity and coherent motion significantly increases after the surgery on the first eye but not between the second and third tests. Thus, monocular surgery is sufficient to improve performance in these tests. On the other side, visual search and reaction time performance do not seem to benefit from cataract surgery. For all tests, the level of performance after surgery is maintained in the last testing.Conclusions: Our study shows that cataract surgery leads to improved perceptual functions in most, but not all, tests. Future analysis will determine whether the level of performance change depends on baseline performance, and whether predictions about surgery success can be made based on performance in the tests.

Aims/Purpose: Cataract, i.e., an opacification of the natural intraocular lens, is one of the leading causes of visual impairments worldwide. Cataract surgery, which involves the removal of the opaque lens and implantation of an artificial intraocular lens, is one of the most cost‐efficient interventions in all of health care to improve visual impairments. However, it remains unclear how exactly visual performance changes after surgery, which we aim to investigate in our study.Methods: We tested 30 older adults undergoing cataract surgery longitudinally with a battery of visual tests. Participants were tested a total of four times: before surgery, after surgery on one eye, after surgery on the second eye, and a few weeks after surgery when vision was fully stabilized. The battery tested various visual abilities and included the following tests: visual acuity, contrast sensitivity, coherent motion, orientation discrimination, reaction time, and visual search. All tests were performed binocularly, and a subset of tests was repeated monocularly.Results: Results suggest that visual acuity and orientation discrimination performance increase after each surgery. Performance in contrast sensitivity and coherent motion significantly increases after the surgery on the first eye but not between the second and third tests. Thus, monocular surgery is sufficient to improve performance in these tests. On the other side, visual search and reaction time performance do not seem to benefit from cataract surgery. For all tests, the level of performance after surgery is maintained in the last testing.Conclusions: Our study shows that cataract surgery leads to improved perceptual functions in most, but not all, tests. Future analysis will determine whether the level of performance change depends on baseline performance, and whether predictions about surgery success can be made based on performance in the tests.

Purpose: To compare postoperative visual acuity, spherical equivalent and contrast sensitivity of eyes implanted with either spherical C-flex(570C) or aspheric C-flex(970C) intraocular lenses (IOL). Methods: Forty eyes implanted with posterior chamber intraocular lenses were divided into two groups: C-flex(570C) (20 eyes) and C-flex(970C) (20 eyes). In these two groups, postoperative best corrected visual acuity (logMAR), spherical equivalent and contrast sensitivity was performed at one month and three months, postoperatively. Results: In the spherical group, the preoperative naked visual acuity was 1.250.46 (logMAR). The best corrected visual acuity at postoperative three months was 0.490.28. In the aspheric group, the preoperative naked visual acuity was 1.290.67. The bestcorrected visual acuity at postoperative three months was 0.390.30. There were statistically significant differences in best-corrected visual acuity between the preoperative and the postoperative three months results in the spherical IOL group and in the aspherical IOL group. There were no statistically significant differences in spherical equivalent between preoperative and postoperative onemonth results and between preoperative and postoperative three-month results in the spherical IOL group and the aspherical IOL group. In the aspherical IOL group, contrast sensitivity at postoperative one and three months were better in the all spatial frequency than in the preoperative scotopic condition. Conclusions: When we compared eyes implanted with the spherical C-flex(970C) with eyes implanted with the spherical C-flex (570C), there were no statistically significant differences in spherical equivalent or best corrected visual acuity. The aspherical IOL group showed better contrast sensitivity than did the spherical IOL group postoperatively at both one month and three months.

There is an expression “all that glitters is not gold.” Disturbing glittering sensations of light following cataract surgery may actually originate from the intraocular lens (IOL). Visual complaints of “glittering” following cataract surgery have been the subject of numerous reports linking the cause to optic edge design, material and shape of the IOL. Glittering (or shimmering) sensations and disturbing secondary images of light, producing rings, arcs, and central flashes, are commonly referred to as positive dysphotopsia as incoming light is internally reflected by the squared edges of the implant and projected onto the retinal surface. Off axis light striking the temporal cornea projects onto the nasal edge of the IOL and can create secondary images and disabling glare under scotopic conditions (1,2). Distinguishing the etiology of abnormal visual sensations derived from complex optical aberrations induced by the edge of the IOL from those visual symptoms produced by neurological pathology creates an interesting intersection of commonality between the anterior segment ophthalmic surgeon and the neuro-ophthalmologist. CASE 1 A 57-year-old man had cataract surgery on the left eye. Immediately postoperatively, he complained of seeing a double broken circle with dots around it and a secondary image. Light projected from the temporal field produced a secondary image nasally (Fig. 1A). Symptoms were worse at night when viewing a light source (Fig. 1B). The patient refused surgery in the fellow eye until the problem glare and secondary images was resolved in the left eye. A dilated examination was performed and appeared unremarkable. The patient was offered a second opinion with neuro-ophthalmology. Multiple tests were performed, including automated visual fields, macular optical coherence tomography, and multifocal electroretinography. All testing was normal. The patient was referred to another anterior segment specialist and an IOL exchange was performed with the insertion of an IOL with a round edge optic. Immediately following the IOL exchange, the quality of the symptoms improved slightly but his complaints have not totally resolved.FIG. 1: Positive dysphotopsia. A. Patient drawing depicts a ring and secondary image (image of light) generated by a light source located at approximately 35° in the temporal visual field at a distance of 33 cm. The ring is probably produced from the edges of the intraocular lens. B. A glare source viewed by a pseudophakic eye will produce refracted and reflected images if light rays are able to reflect internally from the edge of the lens. The reflected glare imaged will appear as a thin crescent or partial ring on the side of the retina opposite the glare source [modified from Ref. (1)].Visual dysfunction following implantation of an IOL after cataract surgery may also be manifested as a negative dysphotopsia. First described over 10 years ago (3), negative dysphotopsia appears as a temporal, dark, crescent-shaped shadow following in-the-bag posterior chamber IOL implantation (Fig. 2). Negative dysphotopsias have been linked to the square edge design of the IOL optic, shape of the IOL, high index of refraction, and the anterior capsule extending over the edge of the optic (1,2,4–7). Square truncated edges on many IOLs, originally designed to reduce posterior capsule opacification, may be the source of both positive and negative dysphotopsias. Negative pseudophakic dysphotopsias are caused by the absence of light in the extreme temporal field from the edge of the IOL causing a crescent shadow on the nasal retina where light would normally be transmitted by the crystalline lens of a phakic eye. Although articles demonstrating the crescent-shaped shadow with ray tracing studies are available and the clinical appearance of these symptoms has corresponded to the introduction of square edges, the topic is still debated (4,7). The circular IOL optic accounts for the crescent shape seen in positive and negative dysphotopsias.FIG. 2: Patient drawings of a variety of negative dysphotopsias and the model of intraocular lens implanted in each patient [modified from Ref. (1)].Pseudophakic dysphotopsias are generally considered to be an annoyance of little functional significance. However, many patients become functionally or psychologically disabled from their symptoms. These symptoms have a clear impact on daily visual function and generate the “unhappy 20/20 patient.” It is not uncommon that many of these patients seek second opinions from other ophthalmologists and, in fact, may be referred to a neuro-ophthalmologist for extensive evaluation to rule out neurologic causes of their complaints. The differential diagnosis of pseudophakic dysphotopsias includes a host of neurological conditions with symptoms such as visual field loss, halos, flashes, and entoptic phenomenon such as visual auras, scintillations, and visual hallucinations. Krista et al (8) reported in a study of pseudophakic patients without confounding ophthalmic diseases and with excellent visual acuity, that a visual function questionnaire correlated strongly with patient dissatisfaction from pseudophakic dysphotopsia. This study revealed that subjective visual function may indeed be compromised because of pseudophakic dysphotopsias in otherwise normal 20/20 pseudophakic eyes. Not only is vision of 20/20 considered normal but also the entire ophthalmic examination of the eye is unremarkable. This places an increased burden on the ophthalmologist when examining symptomatic patients to correctly diagnose the symptoms because there are no objective tests to measure the severity of pseudophakic dysphotopsias. Despite bitter complaints about their vision, it is not uncommon for patients who easily read the 20/20 line on a Snellen acuity chart following cataract surgery to be told there is nothing wrong with their eye or their vision. Ophthalmologists may advise patients that their symptoms will disappear over time, suggesting neural adaption may suppress the severity of their awareness of their symptoms. Osher (9) reported negative dysphotopsias in 15.2% on the first postoperative day, 3.2% at 1 year, and 2.4% at 2–3 years. In contrast, after being told there is nothing wrong with their eyes, some patients may go years living with their symptoms without complaining. An IOL exchange from a truncated edge design to a rounded edge design may relieve symptoms of patients with positive dysphotopsias. Several reports have demonstrated relief of symptoms from negative dysphotopsias following YAG laser of the anterior capsule (10,11), IOL exchange with a sulcus fixated IOL (12,13) or prolapsing the optic through the capsulorhexis into the anterior capsule (reverse optic capture), and piggyback IOL implantation into the ciliary sulcus (14). CASE 2 A 71-year-old woman underwent uneventful phacoemulsification with IOLs in both eyes. Since surgery, she described a temporal “dark ring around both eyes” producing a sensation that she could not see and that she was going to step into a hole when she walked. She described “blinders and a dark spot” on the side of her vision as if she was looking through binoculars all of the time. Her symptoms were dismissed by 2 ophthalmologists and she was re-evaluated 8 months later. Visual acuity was 20/20 and J1 in each eye. On examination, there was extensive fibrosis of the anterior (not posterior) capsule extending over the anterior optic of the IOL by several millimeters. Bilateral YAG laser was performed to the anterior capsule allowing light to pass through the periphery of the lens optic, relieving the patient of her symptoms (Fig. 3).FIG. 3: Patient with negative dysphotopsia. A. There is fibrosis and opacification of the anterior capsule around the intraocular lens in the left eye. B. Following YAG laser anterior capsulotomy, the patient's symptoms resolved.In addition to the positive and negative dysphotopsias discussed above, there is another visual dysfunction commonly seen after cataract surgery following implantation of a multifocal IOL. Multifocal IOL intolerance not uncommonly results in patient dissatisfaction with the quality of vision despite having 20/20 eye in each eye. Referred to as “waxy” or “vaseline” vision, these patients may bitterly complain that they are unable to see clearly despite being able to read 20/20 high-contrast Snellen acuity. Concentric diffractive rings in multifocal IOLs create 2 simultaneous focal points and increase light scatter, resulting in reduced retinal image contrast. If the cornea has significant aberrations (>0.5 μm over a 6-mm zone) and is combined with the reduced retinal image contrast from the multifocal IOL, the result is poor quality of vision. Excessive corneal higher order aberrations of the Zernikie third-order and fourth-order (Z3 + Z4) terms have been statistically and clinically linked to multifocal lens intolerance and visual dysfunction (15). Light sources may also produce the presence of a halo (the simultaneously defocused image). Treatment options include refractive surgery to eliminate corneal higher order aberrations with limited success or an IOL exchange with a monofocal IOL. The critical issue in arriving at the correct diagnosis of visual dysphotopsia is the temporal relationship of symptomatic onset after cataract surgery. Many patients complaining of undesired visual disturbances following cataract surgery may seek secondary and tertiary referrals for relief of their symptoms. 20/20 vision and a normal eye examination may pose a conundrum to the clinician to resolve these visual symptoms. All that glittering may not be gold, but it may be pseudophakic dysphotopsias.

The Impact on Vision of Aspheric to Spherical Monofocal Intraocular Lenses in Cataract Surgery: A Systematic Review with Meta-analysis

Purpose: To compare visual acuity and contrast sensitivity between Posterior Chamber Phakic Intraocular Lens (ICL) and Iris-Claw Anterior Chamber Phakic Intraocular Lens (Artiflex) implantation for moderate to high myopia. Setting: Dr. Lutfi Kirdar Kartal Training and Research Hospital, Eye Clinic, Istanbul, Turkey. Participants: Sixty eyes of 30 myopic patients were included in the study. Thirty eyes of 15 patients underwent implantation of ICL (24)/ toric ICL (6) and 30 eyes of 15 patients underwent implantation of Artiflex. Methods: Preoperative and postoperative 1, 6 and 12 months, logarithm of the minimum angle of resolution (log MAR) uncorrected visual acuity (UCVA), log MAR best spectacle-corrected visual acuity (BSCVA), manifest refraction, intraocular pressure (IOP), endothelial cell density (ECD) and complications were evaluated. Contrast sensitivity (CS) was also evaluated at 1.5, 2.52, 4.23, 7.10 and 11.91 cycles per degree spatial frequencies by CC-100 Topcon LCD preoperative and postoperative 1-year. Main outcome measures: Improvement in visual acuity (VA) and CS, percentage change in ECD and IOP. Results: Preoperatively, there was no significant difference in the mean UCVA, BSCVA and CS between the ICL and Artiflex groups (p=0.798; 0.672; 0.510) and the mean spherical equivalent (SE) was significantly better in the ICL group than the Artiflex group (p=0.003). One year postoperatively, the mean UCVA and BSCVA were significantly better in the ICL group than the Artiflex group (p=0.002; 0.0001). We found no significant difference in the mean SE between the ICL and Artiflex groups (p=0.809). The mean photopic CS increased considerably at all spatial frequencies compared with preoperative levels in the ICL and Artiflex groups (p=0.0001) Conclusion: After 1-year follow-up, the phakic IOLs performed well in correcting moderate to high myopia. Preoperatively and 1-year postoperatively, there was no significant difference in the mean photopic CS between the ICL and Artiflex group at all spatial frequencies. No vision-threatening complications occurred during the observation period.