Effect of Light Conditions and Accommodation on Implantable Phakic Contact Lens Vault by Anterior Segment Optical Coherence Tomography

Figures & data

Table 1 The Demographic and Preoperative Data

	Mean±SD	Range
Age	26±5.8	19–37
Sex: N (%)
Males	20 (55.5%)
Females	16 (44.5%)
IOP	13.1±0.97	12–16
SPH	−10.2±2.4	−15 to −6
CYL	−1.5±0.23	−1.5 to −0.5
UCDVA	1.04±0.09	1–1.3
BCDVA	0.06±0.08	0–0.2

Notes: The demographic and preoperative patients’ data including the spherical error (SPH), cylindrical error (CYL), uncorrected distance visual acuity (UCDVA), and best corrected distance visual acuity (BCDVA).

Table 2 The Scotopic and Photopic Measurements

	Scotopic	Photopic	p-value
Vault (µm)	461.6±51.0	417.2±25.6	<0.001
ACD-Lens (mm)	3.09±0.20	3.08±0.19	0.917
ACD-IPCL (mm)	2.10±0.29	2.89±0.31	0.013
LT (mm)	4.27±0.60	4.28±0.61	0.975
Pupil size (mm)	4.57±0.94	3.22±0.41	<0.001

Notes: Notice the change in the pupil size, the vault, anterior chamber depth (ACD)-lens (the distance between the posterior corneal surface and the anterior lens surface), IPCL-lens (the distance between the posterior corneal surface and the anterior IPCL surface), and the lens thickness (LT). All measurements expressed in mm, except the vault, in µm.

Figure 1 The difference between the scotopic and photopic conditions in the ACD-lens, ACD-IPCL, LT, pupil size (A) and the vault (B).

Table 3 The Accommodative and Non-Accommodative Conditions

	Accommodative	Non-Accommodative	p-value
Vault (µm)	475.3±76.7	525.3±74.7	0.022
ACD-Lens (mm)	3.09±0.32	3.92±0.62	0.035
ACD-IPCL (mm)	2.04±0.38	2.88±0.45	0.042
LT (mm)	4.01±0.37	3.06±0.32	0.039
Pupil size (mm)	4.03±0.89	4.85±0.964	0.028

Figure 2 The differences between the accommodative and non-accommodative conditions in the ACD-lens, ACD-IPCL, LT, pupil size (A) and the vault (B).

Table 4 Table Summarizing the Reported Literature on ICL

Study	Patients and Methods	Results
Xiong, Y et al., 2021^Citation12	68 eyes from 68 patients who had Myopic EVO ICLs implanted and 60 eyes from 60 patients who had Toric EVO ICLs implanted. The ACD, pupil size, and vault were assessed 1 week after the operation using a Visante OCT under various lighting circumstances	No significant differences in the ACD were seen in either group between mesopic and photopic settings. Under photopic conditions, both groups showed a considerable reduction in vault and pupil size
Petternel et al., 2004^Citation13	Partial coherence interferometry was used to compare the pupil size and vault in eyes with a V3 or V4 ICL under photopic and mesopic conditions	A significant light-induced change in ACD-lens, but ACD-ICL was significantly increased by 0.10 mm, whereas vault was significantly decreased by 73 μm.
Lee et al., 2014^Citation14	The Visante OCT was used to compare ACD, pupil size, and postoperative vaulting in eyes implanted with V4c and V4 ICL under photopic and mesopic conditions 1 month after surgery	They found no significant differences in ACD between photopic and mesopic conditions in either group,and significant decreases in vaulting and pupil size under photopic conditions in both groups.
Lindland et al., 2012 ^Citation15	investigated the anterior chamber anatomy under mesopic (2 lx) and photopic (257 lx) circumstances	The shift from mesopic to photopic vision resulted in a 1.8 mm decrease in pupil size, a decrease in ACD-lens, an increase in ACD-ICL, and a 35 um decrease in vault.
Lee et al., 2015 ^Citation16	Compare vaulting and movement variations during accommodation in 35 eyes (18 patients) with the V4 ICL and 51 eyes (26 patients) with the V4c ICL. The Visante OCT was used to assess ACD, posterior corneal surface-to-ICL distance (endo-ICL distance), pupil size, and postoperative vaulting	In eyes with the V4 or V4c ICL, ICL vaulting did not alter significantly during accommodation. During accommodation, however, both groups experienced significant reductions in ACD, endo-ICL distance, and pupil size.
Gonzalez-Lopez et al., 2018 ^Citation17	conducted an experimental evaluation with low (0.5 LUX) and high (18500 LUX) light intensity in 39 eyes of myopic patients, using an anterior segment OCT and measuring different anterior chamber parameters, including the ICL vault values	They found that in photopic conditions the mean vault was 374 ± 208 µm, whereas in scotopic conditions it increased to 540 ± 252 µm, generating a difference of 167 ± 70 µm
Kato et al., 2019 ^Citation18	the vault of the ICL was evaluated under different lighting conditions	they found a mean value of 476.1 ± 219.6 µm under photopic conditions, which grew to 521.1 ± 220 µm under scotopic conditions and concluded that the vault can be significantly lowered by light-induced pupil constriction and accommodation in eyes with ICL
Srirampur A et al., 21 ^Citation19	Included 32 eyes from 16 patients who had V4c ICLs implanted. The ICL vault was measured using AS-OCT in both its undilated and completely dilate states	The undilated and post-dilated ICL vault measurements showed no statistically significant difference. As a result, the postoperative vault can be measured in the pupil’s resting, undilated, or completely dilated state, and the results will be equivalent regardless of pupil size
Zhu, Y et al., 2019 ^Citation20	Investigated the effect of pharmacological mydraisis on 45 eyes of 24 patients with ICL V4 implantation and 128 eyes of 65 patients with ICL V4c implantation using Mydrin-P (Santen, Japan). Pentacam (Oculus, Wetzlar, Germany) was used to assess the ACD and vault.	Significant vault and ACD increases generated by mydriasis were observed in both the ICL V4 and V4c groups at 1, 3, and 6 months postoperatively

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