A Comprehensive Investigation of Contrast Sensitivity and Disk Halo in High Myopia Treated With SMILE and EVO Implantable Collamer Lens Implantation

Abstract

Purpose To investigate the clinical outcomes in small incision lenticule extraction (SMILE) and EVO implantable Collamer lens (ICL)–treated high myopia. Methods Thirty-three SMILE-treated and 32 EVO ICL-treated patients were included and followed up for 6 months. Subjective refraction, contrast sensitivity, and disk halo size were measured preoperatively and postoperatively. Patient-reported outcomes (PROs) were obtained at the final visit. Results Significant differences in efficacy and safety indices were observed between the SMILE and EVO ICL groups at 6 months postoperatively ( P < 0.05). In the SMILE group, the mesopic contrast sensitivity at 2.2 cycles per degree (cpd) and photopic contrast sensitivity at 0.5, 3.4, and 7.1 cpd were significantly improved. In the EVO ICL group, the mesopic contrast sensitivity at 7.1 cpd and photopic contrast sensitivity at 0.5, 7.1, and 14.6 cpd were significantly improved. The halo radii after SMILE were significantly increased at 1 week, showed a decreasing trend at 1 month, returned to baseline at 3 months, and progressed stably at 6 months. However, it was unchanged in the EVO ICL group. Regarding subjective experience, haloes were the most common disturbance with mild and little bothersomeness after EVO ICL in contrast to starbursts after SMILE. Conclusions EVO ICL implantation yielded better visual outcomes, improved contrast sensitivity particularly at high spatial frequencies, had a stabler disk halo size, and increased incidence of haloes, with less influence than that of SMILE. Translational Relevance The disk halo and PRO findings will be of benefit for consultations and evaluations in visual performance and disturbances.

Analysis of perioperative problems related to intraocular Implantable Collamer Lens (ICL) implantation

“…58% of the patients reported a worsening in night vision symptoms (mostly nonspecific glare and halo or starburst) after surgery, but overall levels of satisfaction were high [ 46 , 47 ]. The incidence of halo after ICL implantation was 68.8%, and that of starburst was 43.8% [ 48 ]. Glare/halo was present in 39% of eyes at 1 month, 32% at 3 months, 24% at 6 months, and improved to 15% of eyes at 12 months.…”

Intraocular Implantable Collamer Lens with a Central Hole Implantation: Safety, Efficacy, and Patient Outcomes

“…13,17,55 However, three studies reported a higher percentage of eyes gaining one or more lines of CDVA in the ICL group. [16][17][18] The preservation of CDVA is measured as a safety index; importantly, it is similar to or higher after ICL implantation than that after laser refractive surgeries [16][17][18][19]47,48,56 In our review of literature on the safety index of hole-ICL implantation published between October 2018 and October 2022, the weighted average safety index was 1.19 (Table 1), which was slightly higher than the safety index of 1.15 in a previous review by Packer in 2018. 46…”

Four-year visual outcomes and optical quality of SMILE and implantable collamer lens V4c (EVO-ICL) implantation for high myopia: a retrospective study

“…Halo was the most commonly reported night vision disturbance in the ICL group (91%), although it was considered to be non-distressing in more than 90% of cases in both groups. Halos after conventional ICL implantation have been reported in previous studies [ 10 , 11 , 33 ] and were found to be associated with differences between the mesopic pupil size and ICL optic zone diameter, and white-to-white diameter of the cornea [ 11 ]. Regarding EVO-ICL, apart from the edge of the optical zone, the cylindrical inner wall of the central hole can be an additional optical surface causing light phenomena [ 34 , 35 ].…”