A New Phakic Surgical Approach For Early-Moderate Presbyopia Correction: The Evo Viva (Tm) Icl.

The co-existence of moderate-high myopia and presbyopia represents a challenge in patients younger than 50-55 years old. The age (< 55 years) and long axial length increase the risk for retinal detachment whether a refractive lens exchange with presbyopia-correcting intraocular lens implantation is carried out. A new Implantable Collamer Lens (ICL, EVO Viva^TM) represents a novel approach to surgically correcting myopia and presbyopia in phakic patients. This study aims to evaluate the benefits and potential drawbacks of EVO Viva^TM ICL for myopia and presbyopia correction in phakic patients. To this extent, we analyzed the clinical outcomes and induced aberrations after EVO Viva^TM ICL implantation in myopic patients with presbyopia. 

Instituto Universitario Fernández-Vega (Oviedo), España.

The study included 80 eyes of 40 patients who had bilateral EVO Viva^TM ICL implantation. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, presbyopic add power, binocular through-focus visual acuity, total ocular spherical aberration (SA), coma aberration and Root Mean Square (RMS) HOAs of higher ocular aberrations (HOAs) (i-Trace Aberrometer, Tracey Technologies, USA) for a 4.5 mm pupil size were evaluated.

The mean binocular postoperative UDVA and CDVA (logMAR) were 0.09±0.19 and 0.02±0.03. 67.5% of the eyes remained or improved the CDVA and 32.5% lost lines of CDVA after EVO Viva ICL implantation. The postoperative spherical equivalent was -0.61±0.54D. The presbyopic add power reduced from +1.31±0.74D preoperatively to +0.44±0.58D postoperatively (p<0.0001). The mean visual acuity was 0.1 logMAR or better across the vergence range from +0.50 to -1.50D, better than 0.2 logMAR up to the vergence of -2.00D, and better than 0.3 logMAR up to -2.50D. The total ocular aberrations induced by EVO Viva ICL were -0.34±0.09 μm of SA, 0.24±0.18 μm of coma and 0.26±0.12 μm of RMS HOAs. The eyes that lost lines of CDVA had a higher induced coma aberration.

Our findings showed that in myopic patients aged between 45 and 55 years old, this new EVO Viva^TM ICL ICL provided a good distance visual acuity and allowed obtaining an optimal or functional visual acuity up to a distance between 40-50 cm. The aberrometric outcomes confirmed that this ICL seeks to improve intermediate and near vision by deliberately increasing SA. However, the induced coma may be an unwanted effect of lens misalignment. Therefore, in this increased SA ICL, lens displacement (mainly the maximum levels) could be responsible for the visual acuity detriment. Further studies are needed to evaluate the threshold lens misalignment from which the patient´s visual quality would be affected.