The rising global burden of phakic intraocular lens complications: a simulation-based projection to 2050

Abstract

BackgroundPhakic intraocular lenses (pIOLs), particularly implantable collamer lenses (ICLs), are increasingly used worldwide among young adults. Long-term complications (cataract, secondary glaucoma, and corneal endothelial decompensation) may impose population burden.Research design and methodsUsing a Global Burden of Disease framework, we modeled 2019-2050 disability-adjusted life years (DALYs) for these three complications across adherence scenarios, including a Monte Carlo nonadherence model with randomized follow-up.ResultsCumulative ICL implantation is projected to surpass 20 million eyes by 2050. In the non-adherence model with 15-year random intervals, the annual incidence of corneal decompensation was 0.08% beginning 12 years after surgery. By 2050, DALYs ranged from 4,058 with full adherence to 11,250 with 5% adherence. From 2025 to 2050, the modeled DALY burden rose across cataract, secondary glaucoma, and corneal endothelial decompensation, and under poor adherence decompensation accounted for 41.9% of total DALYs, whereas with full adherence cataract remained the largest contributor.ConclusionsRoutine follow-up substantially reduces the burden of cataract, secondary glaucoma, and corneal endothelial decompensation after pIOL implantation. The modeled cataract and glaucoma impacts are likely conservative overestimates given age and high-myopia background risk and their treatability. Continuous surveillance and patient education are essential.