Comparative study of iris-claw intraocular lens implantation and implantable collamer lens : patient-reported outcomes

Abstract

BACKGROUND: Iris-claw phakic intra-ocular lenses (pIOLs) and implantable collamer lenses (ICLs) are the main pIOLs in use. We aim to compare for the first time patient experience and satisfaction of these two techniques.

METHODS: A cross-sectional study design, with no randomization or control groups was utilised. Patients who underwent either surgery between 2010 and 2020 were identified from hospital records. Phone interviews, performed in June 2021 used a semi-structured questionnaire divided into pre-operative build-up, patient experience and post-operative issues. A five-point Likert scale was used for standardisation. Perioperative data was collected from their medical files.

RESULTS: After exclusions, 20 ICL patients (40 eyes) and 17 iris-claw patients (34 eyes) were included. A higher proportion of the ICL cohort completely agreed that the surgery has improved their vision significantly (ICL n=18, 90%; iris-claw n=8, 47%; P=.03) and that they would recommend it (ICL n=19, 95%; iris-claw n=8, 47%; P=.01). Postoperative issues were comparable, but iris-claw patients experienced more long-term glare (iris-claw n=8, 47%; ICL n=1, 5%; P<.01). Both techniques eliminated contact lens use. Astigmatic ICL patients were more satisfied, with 89%(n=17) completely agreeing that they would recommend the surgery, in comparison to 50%(n=6) of astigmatic iris-claw patients (P=.015).

CONCLUSION: ICL is superior to iris-claw in terms of patient satisfaction, efficacy and long-term issues, and also in astigmatic patients. Short-term issues were comparable. Both types of surgery succeeded in decreasing contact lens use, further contributing to an improved quality of life. Clinically this could help guide phakic intraocular lens technique selection for better patient satisfaction.