Analysis of Accommodation and Optical Quality After Myopia Surgery With Phakic Intraocular Lens Implantation

Purpose To characterize the accommodative function and optical quality in high and moderate myopia after the implantation of a phakic intraocular lens implantable collamer lens (ICL). Methods This was a prospective observational study of 20 myopic patients undergoing bilateral ICL implantation with a mean spherical equivalent (SE) of −7.44 diopters (D) (range: −4.37 to −12.00 D). Amplitude of accommodation, subjective accommodative response, optical quality parameters including modulation transfer function cut-off, Objective Scatter Index, and Strehl ratio, and objective accommodative response with a double-pass system (HD Analyzer; Visiometrics SL) were assessed before surgery and 1 month postoperatively. Results Mean residual refractive error improved to 0.20 ± 0.19 D ( P < .001) at 1 month postoperatively compared to preoperatively. Amplitude of accommodation decreased significantly by 1.65 D ( P < .001) from 7.65 ± 1.33 D at baseline to 6.00 ± 0.95 D at 1 month after ICL implantation. However, no significant changes were found in accommodative response or in the optical quality parameters of modulation transfer function cut-off, Objective Scatter Index, Strehl ratio, and objective accommodative response with HD Analyzer between preoperatively and 1-month postoperative follow-up ( P > .05). Conclusions ICL implantation in healthy patients with moderate to high myopia does not significantly alter accommodative function, as measured by subjective or objective methods, or optical quality parameters, except for a non-clinically relevant decrease in amplitude of accommodation. [ J Refract Surg . 2025;41(4):e325–e332.]