Postoperative visual quality assessment and influencing factors following implantable collamer lens implantation in phakic eyes

Abstract

Myopia is a common refractive error characterized by difficulty in focusing on distant objects; its global prevalence is surging significantly (it is projected to affect 4.76 billion people by 2050), and it poses a major public health challenge. The mainstream treatments for myopia include corneal refractive surgery and intraocular refractive surgery. Among the intraocular refractive procedures, implantable collamer lens (ICL) implantation has been widely applied in phakic eyes and is especially suitable for correcting high myopia and complex refractive errors. ICLs, implanted in the posterior chamber via a small corneal incision, feature biocompatible collamer material and a central aperture design (V4c model), offering unique advantages such as a lack of corneal tissue ablation, reversibility, high safety (safety index ≥ 1.10), and effectiveness (effectiveness index ≥ 1.00), with over 97% of patients achieving a postoperative refractive error within ±1.00 D. Thus, an increasing number of myopic patients, particularly those with high myopia or thin corneas unsuitable for corneal refractive surgery, are opting for ICL implantation, and the procedure has evolved from simple refractive correction to a focus on optimizing postoperative visual quality. With accelerating population aging, patients over 40 years increasingly demand full-range vision (distance/intermediate/near). In this context, ICL demonstrates unique advantages for combined myopia-presbyopia management due to its reversibility and accommodative preservation. This review describes assessment methods for postoperative visual quality following ICL implantation, its influencing factors (preoperative, intraoperative, and postoperative), clinical optimization strategies, and research prospects.