A European Journal of Ophthalmology report evaluated whether implantation of a foldable iris-fixated phakic intraocular lens (pIOL) for myopic astigmatism is associated with measurable changes in accommodation over 6 months, a clinically relevant question for refractive surgeons treating younger phakic patients. Mariano Royo and colleagues stated that the study purpose was “to analyze the amplitude of accommodation and its changes at a 6-month follow-up in healthy subjects implanted with an anterior chamber pIOL.”¹
The article focuses on accommodative function after implantation of an anterior chamber, iris-fixated pIOL, with keywords identifying the device class as an Artiflex-type foldable iris-fixated lens.¹ Fifty-seven subjects (aged 18-45 years) participated in the study, all of whom received the Artiflex pIOL (Ophtec) and were evaluated postoperatively at one week and again at six months.1
The study evaluated changes in manifest refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), to name a few. Additionally, using the Sheard method, researchers measued the amplitutde of accommodation (AA) under photopic conditions.1
Accommodation is particularly important in this population because many candidates for phakic lens implantation are prepresbyopic and expect spectacle independence not only at distance but also for near and intermediate tasks. A clinically meaningful reduction in accommodative amplitude after surgery could affect patient counseling, satisfaction, and procedure selection.
Key takeaways
- Refractive error decreased significantly after IOL implantation and remained stable across follow-up, with both uncorrected and corrected distance visual acuity showing significant improvement from baseline at 1 week and 6 months (P < .001 for all).
- Anterior chamber depth–related accommodative amplitude showed no clinically or statistically meaningful change postoperatively, with a mean shift of just 0.10 ± 0.86 D from baseline to 6 months (P = .096 at 1 week; P = .317 at 6 months).
- Accommodative outcomes were comparable between spherical and toric IOL models (P ≥ .092 for all comparisons), but patient age was significantly correlated with the magnitude of accommodative change at both 1 week (ρ = 0.378; P = .004) and 6 months (ρ = 0.336; P = .011).
Phakic IOLs are used for refractive correction in patients who are not ideal candidates for corneal laser refractive surgery, including some patients with higher myopia, thin corneas, or refractive error beyond the preferred range for keratorefractive procedures. Unlike cataract surgery or refractive lens exchange, pIOL implantation preserves the crystalline lens, making maintenance of accommodation a central theoretical advantage in younger patients.²
Iris-fixated anterior chamber pIOLs are designed to correct refractive error by adding lens power in front of the crystalline lens while maintaining the natural accommodative apparatus. The lens is fixated to the midperipheral iris rather than supported in the angle or placed behind the iris, distinguishing it from angle-supported anterior chamber lenses and posterior chamber phakic lenses.² Foldable designs permit smaller incisions than rigid polymethyl methacrylate models, which may reduce surgically induced astigmatism and facilitate recovery.
Prior studies have shown that iris-fixated pIOLs can provide substantial refractive correction in moderate to high myopia, but long-term safety surveillance remains important. Reported concerns for this device category include endothelial cell loss, inflammation, pigment dispersion, elevated intraocular pressure, pupil ovalization, cataract formation, and the need for secondary procedures.²˒³ In a prospective multicenter evaluation of a foldable toric iris-fixated pIOL, investigators reported favorable short-term refractive outcomes for myopic astigmatism, supporting the device concept while also emphasizing postoperative monitoring.⁴
The accommodation-focused endpoint is notable because refractive outcomes such as uncorrected distance visual acuity, residual cylinder, and predictability do not fully capture functional vision after pIOL implantation. If accommodative amplitude remains stable after implantation, that would support one of the key clinical advantages of phakic correction over lens extraction in younger adults. Conversely, if measurable accommodative decline occurs, surgeons may need to revisit assumptions about anterior segment biomechanics, iris fixation, or postoperative changes in near function.
The next step for clinicians is review of the full article, including baseline patient characteristics, refractive range, lens model, accommodation testing protocol, and safety findings. Until those data are available, the report should be viewed as a focused contribution to an important functional outcome question rather than definitive evidence that iris-fixated pIOL implantation does or does not alter accommodation.
References
Royo M, Jiménez Á, Molina-Martin A, Piñero DP. Accommodative changes after implantation of a foldable iris-fixated phakic intraocular lens for the correction of myopic astigmatism. Eur J Ophthalmol. Published 2026. doi:10.1177/11206721261462300. Accessed June 19, 2026. https://journals.sagepub.com/doi/10.1177/11206721261462300
Güell JL, Morral M, Kook D, Kohnen T. Phakic intraocular lenses part 1: historical overview, current models, selection criteria, and surgical techniques. J Cataract Refract Surg. 2010;36(11):1976-1993. Accessed June 19, 2026. https://pubmed.ncbi.nlm.nih.gov/21029908/
Tahzib NG, Nuijts RMMA, Wu WY, Budo CJ. Long-term study of Artisan phakic intraocular lens implantation for the correction of moderate to high myopia: ten-year follow-up results. Ophthalmology. 2007;114(6):1133-1142. Accessed June 19, 2026. https://pubmed.ncbi.nlm.nih.gov/17275909/
Doors M, Budo CJ, Christiaans BJ, et al. Artiflex Toric foldable phakic intraocular lens: short-term and 1-year results of a prospective European multicenter study. Am J Ophthalmol. 2012;154(4):730-739.e2. Accessed June 19, 2026. https://pubmed.ncbi.nlm.nih.gov/22835511/
