Expanding Phakic Possibilities

Phakic IOLs offer several approaches for refractive correction of myopia and presbyopia in patients aged 40 to 55 years, with numerous advantages documented in the literature, according to Víctor Lázaro-Rodríguez MD.

Phakic IOLs have emerged as a compelling option thanks to their strong performance, anatomical preservation, and reversibility compared to in-the-bag IOL exchange, making them especially suitable for presbyopia correction in myopic patients.

“As myopia increases, so does the risk of retinal detachment,” Dr Lázaro-Rodríguez said. “To this, we should add the risk introduced by cataract or refractive lens exchange surgeries in myopic patients. Young age represents an additional factor.”

However, the risk of retinal detachment in patients undergoing phakic IOL implantation remains close to the intrinsic risk associated with their myopia, making this approach safer. Phakic IOLs also have a low risk of endophthalmitis.

Presbyopia can be managed with phakic IOLs either through monovision or by implanting presbyopia-correcting phakic IOLs. The safety and efficacy of this approach in patients older than 40 years was demonstrated in two Spanish publications.¹ Studies have also shown good binocular vision at all distances and long-term safety and efficacy following monovision implantable collamer lens (ICL) implantation in presbyopic myopes.²

Currently, three phakic IOL options are available for presbyopia: the iris claw IOL (Artiplus, Ophtec) and two posterior chamber phakic IOLs (EVO Viva ICL, STAAR Surgical; IPCL V2.0 Presbyopic, Care Group). Implantation criteria include patients with myopia and symptomatic presbyopia with a transparent crystalline lens, sufficient anterior chamber depth, endothelial cell count greater than 2,000 cells, and an absence of iris anomalies or pupillary dysfunctions without associated ocular pathologies.

It is important to meet the same criteria used for implanting a simultaneous vision IOL when considering refractive lens exchange, he noted. Patients with a history of inflammatory diseases of the anterior segment should be excluded, as well as those with any alteration of the endothelium, recurrent or chronic uveitis, any clinically significant cataract, glaucoma, or IOP higher than 21 mmHg. The anterior chamber depth for the iris claw IOL must be equal to or greater than 2.8–3.0 mm and equal to or greater than 2.8 mm for posterior chamber phakic IOLs.

Many studies have shown presbyopia-correcting phakic IOLs are effective. A prospective multicentre clinical study on the EVO Viva ICL demonstrated improved distance, intermediate, and near visual acuity, increasing independence from glasses and a high level of patient satisfaction.³ Two prospective clinical studies evaluating the IPCL V2.0 showed the lens was safe and effective in achieving spectacle independence for several distances in myopic patients with presbyopia.⁴ Regarding the iris claw IOL, a multicentre clinical trial showed it provides good visual acuity from distance to near with high levels of patient satisfaction and spectacle independence, despite some bothersome and non-bothersome optical disturbances.⁵

Considering all the advantages, a correct evaluation of the patient is crucial, he stressed.

“An appropriate preoperative evaluation is essential for a good indication, as presbyopia-correcting phakic IOLs share similar considerations to other simultaneous vision intraocular lenses,” Dr Lázaro-Rodríguez concluded.

Dr Lázaro-Rodríguez spoke at the 2026 ESCRS Winter Meeting in Helsinki.

Víctor Lázaro-Rodríguez MD, FEBO, FICO is a surgeon at Institut Català de Retina (ICR) and Hospital de Sant Pau, Barcelona, Spain.

1. Tañá-Rivero P, et al. J Ophthalmol, 2020 Jun 29; 2020: 7457902. doi:10.1155/2020/7457902; Alfonso JF, et al. J Cataract Refract Surg, 2021; 47(4): 459–464. doi:10.1097/j.jcrs.0000000000000486.

2. Kamiya K, et al. Sci Rep, 2017 Sept 12; 7(1): 11302. doi:10.1038/s41598-017-11539-9; Ye Y, et al. Graefes Arch Clin Exp Ophthalmol, 2022; 260(8): 2763–2771. doi:10.1007/s00417-021-05545-x.

3. Packer M, et al. Clin Ophthalmol, 2020 Sept 18; 14: 2717–2730. doi:10.2147/OPTH.S271858

4. Bianchi GR. Cesk Slov Oftalmol, 2020; 76(5): 211–219. doi:10.31348/2020/30; Stodůlka P, et al. J Cataract Refract Surg, 2020; 46(1): 40–44. doi:10.1097/j.jcrs.0000000000000033

5. Wanten JC, et al. J Cataract Refract Surg, 2025; 51(11): 963–971. doi:10.1097/j.jcrs.0000000000001722