Comparison Of Early Outcomes Of Monovision Surgery With Icl (V4c) Or Clear-Q–Optimized Fs-Lasik In Patients With Presbyopia

Aimed to compare the early visual quality outcomes of monovision surgery with implantable Collamer lens (ICL V4c) and Clear-Q (EX500)–optimized femtosecond laser-assisted in situ keratomileusis (FS-LASIK) in myopic patients with presbyopia.

This prospective study included a total of 60 presbyopic myopic patients (120 eyes) who underwent either ICL (V4c) implantation or Clear-Q FS-LASIK (30 patients with 60 eyes in each treatment group) at Hospital(Chongqing eye and vision care hospital). between 2024 and 2025. We conducted follow-up evaluations and comparative analyses at 1, 3, and 6 months postoperatively for both patient groups.

The analyzed parameters included multiple refractive and visual indices, particularly visual acuity and optical quality of the right eye (OD), left eye (OS), and both eyes (OU) at testing distances of 40 cm, 80 cm, and 5 m. Optical quality was assessed using the Optical Quality Analysis System II (OQAS II) and expressed as the Objective Scatter Index (OSI) value. Patient-reported visual quality questionnaires were collected at 3 and 6 months after surgery. The Mann–Whitney U test was used for intergroup comparisons of continuous variables. Line charts, bar charts, and box plots were used for data visualization. P-values < 0.05 were considered statistically significant.

both treatment methods showed a general trend of visual improvement during follow-up. At a testing distance of 5 m for OS, the ICL (V4c) group demonstrated significantly better visual acuity than the Clear-Q group at all three follow-up time points (P < 0.001).  OQAS II assessments further confirmed that the ICL (V4c) group maintained significantly better optical quality throughout postoperative follow-up (P < 0.001). In addition, results from the subjective visual quality questionnaire indicated higher postoperative satisfaction in the ICL (V4c) group, with only 10% reporting “general” ratings at 3 months and 3.3% at 6 months, whereas 60% of patients in the Clear-Q group reported “general” ratings at both two follow-ups.

Both ICL (V4c) monovision and Clear-Q FS-LASIK significantly improved visual outcomes in presbyopic patients. However, ICL (V4c) demonstrated significant advantages in early postoperative visual acuity, optical quality, and patient satisfaction, making it a more suitable treatment option for presbyopic patients with high demands for visual quality. Nevertheless, larger studies with long-term follow-up are warranted to validate its sustained efficacy.