Abstract
PurposeTo investigate the long-term safety and efficacy of monovision surgery using implantable collamer lens V4c (ICL V4c) implantation in myopic patients with early presbyopia.SettingEye and ENT Hospital of Fudan University, Shanghai, China.DesignProspective case series study.MethodsThis study included 64 eyes of 32 patients with early presbyopia, who underwent bilateral ICL V4c implantation for myopia correction. Parameters, including mean spherical equivalent (SE), uncorrected distance visual acuity, corrected distance visual acuity, intraocular pressure, endothelial cell density, presbyopic add power, visual acuity (logMAR) of dominant eyes (D-eye), nondominant (nD-eye) eyes, and both eyes (Bi) at 0.4 m, 0.8 m, and 5 m were recorded at the last follow-up.ResultsAll surgeries were uneventful. At the last follow-up, the safety indices were 1.23 ± 0.18 (D-eyes) and 1.21 ± 0.18 (nD-eyes) (p > 0.05); the efficacy indices were 0.95 ± 0.27 (D-eyes) and 0.92 ± 0.28 (nD-eyes) (p < 0.05), the SE was -0.62 ± 0.47 D (D-eyes); and − 1.21 ± 0.78D (nD-eyes) (p < 0.05), presbyopic add power was 1.31 ± 0.58 D. The visual acuity (logMAR) of D-eyes, nD-eyes, and binocular (Bi) at 5.0 m were: 0.06 ± 0.15 (D-eye), 0.21 ± 0.18 (nD-eye), (p < 0.01), and 0.04 ± 0.13 (Bi); 0.8 m: 0.03 ± 0.18 (D-eye), 0.08 ± 0.16 (nD-eye), (p > 0.05), and − 0.02 ± 0.11 (Bi); 0.4 m: 0.08 ± 0.09 (D-eye), − 0.02 ± 0.08 (nD-eye), (p < 0.001), and − 0.03 ± 0.09 (Bi). Subjects were very satisfied or felt excellent with their visual acuity at near (81.25%) and far distances (87.50%), respectively (versus preoperative, p < 0.001).ConclusionMonovision surgery using ICL V4c implantation is safe and practicable for correction of myopes with presbyopia, with long-term efficacy at near and far distances and patient satisfaction.
Highlights
As the population ages, an increasing number of people, which was estimated to be 2.1 billion worldwide by 2020 [1], is affected by presbyopia, the age-related loss of accommodation
There was no significant correlation between myopic shift (SE at the last follow-up minus that at 3 months postoperatively) and the decrease of vault
Presbyopes may lose their ability to accommodate at the age of 50 years when the crystalline lens loses elasticity [10]
Summary
An increasing number of people, which was estimated to be 2.1 billion worldwide by 2020 [1], is affected by presbyopia, the age-related loss of accommodation. Presbyopes may be managed using monovision [2], in which the dominant eye (D-eye) may be fully corrected for distance vision, and the nondominant eye (nD-eye) may be undercorrected for near vision, producing monocular blur. Earlier, methods such as excimer laser or SMILE were used to correct myopic presbyopia [3]. Refractive lens replacement can cause loss of accommodation and increase the risk of retinal detachment
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