The influence of pupil diameter upon and subjective quality of vision following implantable collamer lens (ICL V4c) implantation An observational study

This study aimed to assess the change in pupil size and its influence on subjective quality of vision (QoV) in subjects with implanted collamer lenses (ICLs). This retrospective study assessed 53 participants (53 eyes) implanted with ICL (V4c) and categorized them into incremental groups according to pupil diameter. Preoperative and postoperative photopic and mesopic pupil diameter, uncorrected distance visual acuity (UDVA), and QoV questionnaire scores were assessed and compared. Postoperatively, at 3 months, UDVA was -0.10 +/- 0.06 logarithm of the minimum angle of resolution (LogMAR), and mean QoV for day and night was 9.34 +/- 0.76 and 8.58 +/- 1.29, respectively. The mean mesopic and photopic pupil diameters were 6.59 +/- 0.79mm and 4.61 +/- 0.74mm, respectively. Photopic pupil diameter negatively correlated with "QoV day" (R-s = -0.413, P = .001), positively correlated with "haloes" (R-s = 0.568*, P < .001) and "blurred vision" (R-s = 0.243, P = .04) respectively. Mesopic pupil diameter negatively correlated with "QoV night" (R-s = -0.426, P = .001), positively correlated with "haloes" (R-s = 0.624*, P < .001), "starburst" (R-s = 0.233, P = .046) and "difficulty focusing" (R-s = 0.27, P = .025), respectively. Participants had excellent VA at 3-month follow-up. Photopic and mesonic pupil diameter negatively correlated with QoV day and QoV night scores, respectively. Pupil diameter was found to have a more significant effect on visual symptoms at night, and lower QoV due to larger pupil size was more noticeable at night. Further investigation is needed to explore the importance of pupil diameter and its impact on the QoV in ICL implanted patients.