Phakic Presbyopic Intraocular Lenses: A Systematic Review

Area of Science:

• Ophthalmology
• Refractive Surgery
• Optometry

Background:

• Presbyopia affects billions globally, presenting a significant challenge in refractive surgery.
• Current treatments like corneal procedures or refractive lens exchange can impair accommodation and optical quality.
• Phakic presbyopia intraocular lenses (PIOLs) aim to restore vision without removing the natural lens.

Purpose of the Study:

• To systematically review the visual, refractive, and safety outcomes of PIOLs designed for presbyopia correction.
• To compare different optical designs and fixation types of PIOLs.
• To assess adverse events associated with presbyopia-correcting PIOLs.

Main Methods:

• Systematic review following PRISMA guidelines, registered on PROSPERO.
• Searches conducted across major databases (MEDLINE, PubMed, EMBASE, Cochrane Library) up to July 2025.
• Included clinical trials and observational studies; assessed risk of bias using Cochrane and ROBINS-I tools.

Main Results:

• Six studies (354 eyes) analyzed contemporary PIOL designs (EVO Viva ICL, trifocal IPCL, ArtiPlus).
• High refractive accuracy (≥75% within ±0.50 D) and spectacle independence (80-90%) were achieved.
• Mild glare and halos were common; no sight-threatening adverse events reported in short-term follow-up.

Conclusions:

• Presbyopia-correcting PIOLs demonstrate favorable short-term safety and functional results.
• These lenses preserve the crystalline lens and accommodative function, offering a potentially reversible option.
• Limited evidence due to short follow-up and small sample sizes necessitates further independent, long-term research.