Phakic Intraocular Lenses: An Update and Review for the Treatment of Myopia and Myopic Astigmatism in the United States

Majid Moshirfar; Court R. Webster; Yasmyne C. Ronquillo


Curr Opin Ophthalmol. 2022;33(5):453-463. 

In This Article

Abstract and Introduction


Purpose of Review: To review all phakic intraocular lenses (pIOLs) available in the United States for the correction of myopia or myopic astigmatism and offer a clinical approach to their proper use, postoperative follow-up, and analysis of visual and adverse outcomes.

Recent Findings: In March 2022, the FDA approved the EVO/EVO+ Visian ICL for widespread use, adding this lens to the two others available (Verisyse, Visian ICL). Cataract formation, endothelial cell loss (ECL) and surgical reintervention remain the most common adverse events. There are discrepancies between studies on ECL following implantation with pIOLs, although trends can be deduced with meta-analysis. Posterior Chamber-pIOLs (PC-pIOLs), especially the EVO/EVO+, have an overall lower mean adverse effect and subjective patient symptom profile when compared to Iris Fixated-pIOLS (IF-pIOLs). Advancements in PC-pIOL sizing have provided a noticeable difference in visual and safety outcomes.

Summary: All pIOLs available in the United States provide high-quality visual correction of moderate to high myopia and/or myopia with astigmatism. Proper follow-up for ECL and cataract formation is warranted.


The first phakic intraocular lenses (pIOLs) implanted by Benedetto Strampelli in 1953, consisted of a rigid angle-supported design.[1] From the 1970 s to the early 2010 s, multiple different angle-supported lens materials were used with various complications, including corneal decompensation and pupil malformation. Eventually, all angle-supported lenses were removed from the global market. Iris-supported lenses, pioneered by Cornelis Binkhorst in 1953, and improved by Jan Worst in 1978, have led to the iris-enclavation technique that is still used today.[1] Posterior chamber (PC) pIOLs were first implanted in the 1990 s and offered another alternative with fewer side effects. The use of these devices for the correction of myopia with or without astigmatism has become a popular topic in the ophthalmology community with the recent announcement of a new phakic IOL and the number of recipients of PC-pIOLs surpassing one million.