Monovision by Implantation of Posterior Chamber Phakic Intraocular Lens with a Central Hole (Hole ICL) for Early Presbyopia

This study was aimed to evaluate visual performance at near to far distances in early presbyopic patients undergoing monovision by implantation of an ICL with a central hole (hole ICL). This pilot study comprised thirty-four eyes of 17 early presbyopic patients (age, 40 to 53 years) who underwent hole ICL implantation, and whose targeted refraction was set at emmetropia for the dominant eye, and at slight myopia (−0.5 to −1.0 diopters (D)) for the non-dominant eye. Corrected distance visual acuity was significantly improved, from −0.11 ± 0.07 preoperatively to −0.19 ± 0.09 logMAR postoperatively (p < 0.001, Wilcoxon signed-rank test). Uncorrected distance visual acuity was also significantly improved from 1.43 ± 0.35 preoperatively to −0.04 ± 0.18 logMAR postoperatively (p < 0.001). The mean binocular visual acuity was 0.01 logMAR or better at all distances (5.0, 3.0, 2.0, 1.0, 0.7, 0.5, and 0.3 m). All eyes were within ± 0.5 D of the targeted correction. All patients had within the normal range of near stereopsis. Neither cataract formation, significant intraocular pressure rise, nor vision-threatening complications occurred. Monovision by hole ICL implantation provided good binocular vision at near to far distances, without developing cataract, suggesting its feasibility as a new surgical presbyopic approach for early presbyopia.