Phakic Presbyopic Intraocular Lenses: A Systematic Review

Topic: Presbyopia affects nearly two billion individuals worldwide and remains a major unmet challenge in refractive surgery. This systematic review evaluated the visual, refractive, and safety outcomes of phakic intraocular lenses (PIOLs) specifically designed for presbyopia correction, including multifocal and extended depth-of-focus (EDOF) models. Eligible participants were presbyopic adults undergoing unilateral or bilateral PIOL implantation. Comparisons across optical designs and fixation types were examined in relation to visual performance and adverse events. Clinical relevance: Current presbyopia-correcting options, including corneal procedures and refractive lens exchange, may compromise accommodation or optical quality. Phakic presbyopic IOLs aim to restore full-range vision while preserving the crystalline lens, potentially offering a safer, reversible alternative. Methods: This review followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD420251138158). Comprehensive searches were conducted in MEDLINE, PubMed, EMBASE, Registers, and the Cochrane Library through July 2025. Eligible studies included clinical trials and observational studies reporting visual, refractive, safety, or patient-reported outcomes of presbyopia-correcting PIOLs. Risk of bias was assessed using the Cochrane and ROBINS-I tools. Results: Six studies (354 eyes) were included. Contemporary PIOL designs; EVO Viva ICL, trifocal IPCL, and ArtiPlus achieved at least 75% of eyes within ±0.50 D of target refraction, and 80–90% of patients attained functional spectacle independence. Glare and halos were commonly reported but generally mild. No sight-threatening adverse events occurred during short-term follow-up. Conclusions: Early evidence suggests favorable short-term safety and functional outcomes for presbyopia-correcting PIOLs while preserving the crystalline lens and residual accommodative function. However, evidence remains limited by short follow-up, small sample sizes, and industry sponsorship. Independent, long-term studies are required to establish their definitive role in refractive surgery.