Accommodation after an implantable collamer lens implantation in high myopia patients

Purpose: The purpose of the current study was to investigate the pathogenesis of visual fatigue in patients after implantable collamer lens (ICL) implantation based on an evaluation of accommodation function. Methods: Thirty patients (12 males and 18 females) with high myopia underwent a toric or non-toric ICL procedure. Accommodation function was tested pre-operatively and 1, 3, and 6 months post-operatively. Testing included amplitude of accommodation (AMP), accommodation facility (AF), accommodative response (AR), negative and positive relative accommodation (NRA/PRA), and ultrasound biomicroscopy (UBM) to analyze the relationship between the ICL loop and the ciliary body during accommodation. Results: After the ICL procedure, the AMP and PRA decreased, but the AF increased significantly compared to pre-operative values. The BCC and NRA were not significantly different before and after ICL plantation. Based on UBM, we surmised that when accommodation was relaxed, the partial foot loop of the artificial crystal contacted the ciliary body. When accommodation was tense, the ICL loop was in closer contact with the ciliary body, and even attached to the suspensory ligament. Conclusion: Contact between the ICL loop and ciliary body may affect ciliary muscle function, which resulted in a decrease in accommodation, and even visual fatigue while working at a near distance.