Presbyopic Phakic IOLs

An extended depth of focus (EDOF) phakic intraocular lens (IOL) in both spherical and toric versions significantly improves overall vision and patient satisfaction with vision.

“It is the only refractive and presbyopia correction that allows us to preserve the cornea and lens for future IOL innovations,” said Robert E Ang MD.

Implanted behind the iris, the EDOF and EDOF toric versions of the implantable collamer lens (ICL, Staar Surgical) feature refractive optics with a slightly myopic central region, providing additional depth of focus without diffractive rings that split the wavefront. They can correct myopia, astigmatism, and presbyopia simultaneously, Dr Ang noted.

Good refractive results

In a prospective, open-label clinical study, Dr Ang implanted the EDOF ICL in 47 patients, of which 46 completed 6 months of follow-up. Overall, 26 eyes received spherical EDOF ICLs and 66 received the toric version. All but one patient were Asian, and mean age was 49.2 years, ranging from 42 to 57. Mean preoperative manifest refraction spherical equivalent was -4.87 D, ranging from -10.75 to -1.37 D. The study was supported by Staar Surgical.

At the 6-month follow-up, refractive results were good, with a mean spherical equivalent of -0.02 ± -0.33 D and similar results in toric and non-toric eyes. Results were stable from 1 week to 6 months of follow-up. Dr Ang reported 81.0% of eyes achieved uncorrected distance visual acuity of 20/32 or better—93.0% achieving the same at intermediate distance and 77.0% at near. Rotational stability was also good, with 93.9% of eyes within 10 degrees of axis placement at 6 months.

Patients showed a wider defocus curve after surgery than preoperatively, with similar contrast sensitivity. Several may have retained some accommodation, Dr Ang observed. Mean binocular corrected distance visual acuity was -0.00 before surgery and 0.01 at 6 months.

High patient satisfaction

On a scale of 1.0 to 5.0, mean satisfaction with near vision was 3.5, with 4.1 for intermediate, 4.3 for far, and 4.0 overall. All scores were higher than preoperative values. The lower satisfaction scores for near vision may reflect the fact that the patients were myopic to begin with and possibly used to near vision without spectacles before surgery, Dr Ang said.

No new safety risks were reported, demonstrating the safety of the EDOF and EDOF toric ICL models, Dr Ang said. The EDOF lenses are a great option to meet patient expectations, he concluded.

Dr Ang spoke at the 2025 ASCRS annual meeting in Los Angeles.

Robert Edward Ang MD is a senior consultant, head of cornea and refractive surgery, and head of research and training at the Asian Eye Institute, Makati City, Philippines. angbobby@hotmail.com