Phakic IOLs Step into the Presbyopia Spotlight

Phakic IOLs are a safe and effective approach for myopia and presbyopia correction in patients with early and advanced disease stages, although some adaptation issues may occur, according to Erik L Mertens MD.

“The advantages of phakic IOLs are many,” Dr Mertens explained. “They preserve the natural crystalline lens and any possible residual accommodation. Retinal detachment rates for IOL exchange are much higher than after phakic IOL implantation, and looking at the literature, the latter has a lower risk of endophthalmitis. Finally, phakic IOLs are reversible implants and easier to remove than in-the-bag IOL exchanges.”

Regarding accommodation for those between the ages of 45 and 50 years old, there is a drop from approximately 4.00 D to 2.00 D, but some residual accommodation could be helpful when implanting a phakic IOL. Despite the prevailing view that these kinds of lenses should not be implanted in this population, two peer-reviewed studies showed good results, demonstrating a safety index of 1.00 and an efficacy index of 0.95 and 1.00 in patients between 40 and 56.¹ Dr Mertens said with such results, phakic IOLs should be considered for correcting myopia and myopic astigmatism in older patients with a clear lens.

Presbyopia-correcting implantable collamer lenses (ICLs) are available on the market, including the EVO Viva™ by STAAR Surgical, an aspheric refractive collamer lens. Its powers are in the myopic range (-0.50 D to 18.00 D in 0.50 D steps) and the lengths are from 12.1 mm to 13.7 mm. It is a single piece, CE-marked lens with concave/convex optics, and it features a 360-μm hole in the middle to avoid iridotomies and blockage after surgery. The indications for the lens include the correction of myopia with mild presbyopia in the range of -0.50 D to -20.00 D. The refractive optic of the lens works in conjunction with the crystalline lens and residual accommodation. It induces spherical aberration, but with a downside: it can cause coma when not well centred, which can impact near and distance vision, leading to potential patient dissatisfaction, he noted.

A prospective multicentre open-label clinical study involving five centres in Europe evaluated the safety and efficacy of this lens in phakic subjects with presbyopia.² The indication for the EVO Viva lens was the correction of myopia with presbyopia between -0.50 D and -20.00 D at the spectacle plane. The primary efficacy endpoint of this study was met: 98% of eyes achieved monocular uncorrected near visual acuity of 20/40 or better at six months postoperatively. There was a significant improvement in distance vision and especially in intermediate and near vision, which were the main objectives of the study. Improvements reached 8 lines for intermediate vision and 6.5 lines for near vision, demonstrating significant gains across all distances.

“There was a transient decrease in corrected distance visual acuity due to induction of coma and spherical aberration. At six months postoperatively, 91% of patients were satisfied,” Dr Mertens concluded.

Dr Mertens spoke during the 2026 ESCRS Winter Meeting in Helsinki.

Erik L Mertens MD, FEBO, PCEO, FWCRS, FEBOS-CR is Founder and Medical Director of Medipolis Eye Centre in Antwerp (Wilrijk), Belgium. e.mertens@medipolis.be

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