Ring-shaped dysphotopsia associated with posterior chamber phakic implantable collamer lenses with a central hole.
OBJECTIVE
To evaluate the incidence of central hole-induced ring-shaped dysphotopsia after posterior chamber phakic implantable collamer lens (ICL) with central hole (hole ICL) implantation and to investigate the causes of central hole-induced dysphotopsia.


METHODS
The clinical study enrolled 29 eyes of 15 consecutive myopic patients implanted with hole ICL. The incidence of ring-shaped dysphotopsia after hole ICL implantation was evaluated. In the experimental simulation study, non-sequential ray tracing was used to construct myopic human eye models with hole ICL and ICL without a central hole (conventional ICL). Simulated retinal images measured in log-scale irradiance were compared between the two ICLs for an extended Lambertian light-emitting disc object 20 cm in diameter placed 2 m from the corneal vertex. To investigate the causes of hole-induced dysphotopsia, a series of retinal images were simulated using point sources at infinity with well-defined field angles (0 to -20°) and multiple ICL models.


RESULTS
Of 29 eyes, 15 experienced ring-shaped dysphotopsia after hole ICL implantation. The simulation study using an extended Lambertian source showed that hole ICL-evoked ring-shaped dysphotopsia was formed at a retinal field angle of ±40°. Component-level analysis using a well-defined off-axis point source from infinity revealed that ring-shaped dysphotopsia was generated by stray light refraction from the inner wall of the hole and the posterior ICL surface.


CONCLUSIONS
Hole ICL-evoked ring-shaped dysphotopsia was related to light refraction at the central hole structure. Surgeons are advised to explain to patients the possibility of ring-shaped dysphotopsia after hole ICL implantation.
Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.
Youngsub
Y
Eom
College of Optical Sciences, University of Arizona, Tucson, Arizona, USA.
Dae Wook
DW
Kim
Space Optics Laboratory, Department of Astronomy, Yonsei University, Seoul, South Korea.|Center for Galaxy Evolution Research, Yonsei University, Seoul, South Korea.|Yonsei University Observatory, Yonsei University, Seoul, South Korea.
Dongok
D
Ryu
Joeunnun Vision Clinic, Seoul, South Korea.
Jun-Heon
JH
Kim
Space Optics Laboratory, Department of Astronomy, Yonsei University, Seoul, South Korea.|Center for Galaxy Evolution Research, Yonsei University, Seoul, South Korea.|Yonsei University Observatory, Yonsei University, Seoul, South Korea.
Seul Ki
SK
Yang
Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.
Jong Suk
JS
Song
Space Optics Laboratory, Department of Astronomy, Yonsei University, Seoul, South Korea.|Center for Galaxy Evolution Research, Yonsei University, Seoul, South Korea.|Yonsei University Observatory, Yonsei University, Seoul, South Korea.
Sug-Whan
SW
Kim
Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.
Hyo Myung
HM
Kim
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D009216:Myopia / Q000503:physiopathology / Q000601:surgery*; D054120:Phakic Intraocular Lenses / Q000009:adverse effects*; D057972:Posterior Eye Segment / Q000601:surgery*; D011474:Prosthesis Design; D012029:Refraction, Ocular / Q000502:physiology*; D012189:Retrospective Studies; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014792:Visual Acuity; D055815:Young Adult
central hole; dysphotopsia; posterior chamber phakic implantable collamer lenses