Emmanuel Eric Pazo

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Long-term follow-up adherence after implantable collamer lens implantation in high-myopia patients: a single-center retrospective cohort and KAP survey study

Tongxin Niu, Xin Li, Ying Liu, Xin Li, Jingran Cao, Emmanuel Eric Pazo, S Z Zhao, Zhe Jia, Ruibo Yang

Research Square, 2026 · preprint · doi:10.21203/rs.3.rs-10004973/v1 · Open access (CC BY)

Cataract & anterior segment surgeryMyopia & refractive error

Abstract

Abstract Background High myopia carries the risk of sight-threatening complications, including glaucoma, retinal degeneration, and peripheral retinal breaks. Although phakic intraocular lens (PIOL) implantation surgery effectively corrects refractive error and provides good visual outcomes, it does not reduce the ocular risks associated with high myopia. Therefore, regular long-term follow-up remains important for the timely detection of high myopia–related complications in these patients. Methods This mixed-methods study included 2,393 patients with high myopia who underwent V4c implantable collamer lens (ICL) implantation between 2016 and 2023 at a single tertiary center. Long-term follow-up attendance trends were analyzed in a subgroup of 133 patients with available longitudinal follow-up records. A separate subgroup of 128 patients with more than 1 year of completed follow-up was assessed for detected ocular complications. A cross-sectional Knowledge–Attitude–Practice (KAP) survey was conducted among postoperative patients. Of 1,064 distributed questionnaires, 174 valid responses were included in the analysis. Logistic regression was performed to identify factors associated with follow-up adherence. Results Long-term follow-up attendance declined progressively over time, with rates falling below 15% after four years and to 3% by nine years. A total of 174 valid KAP questionnaires were collected and analyzed, with a valid response rate of 16.35% (1,064 questionnaires were distributed). Major barriers included a lack of eye healthcare awareness, absence of symptoms, and limited access to follow-up care. Ocular complications, including normal-tension glaucoma (2.34%) and retinal lesions associated with high myopia (3.13%), were detected during postoperative follow-up examinations. Notably, all confirmed glaucoma cases occurred in patients aged ≥ 40 years. In patients with high myopia, normal intraocular pressure, normal central visual acuity, atypical optic disc morphology, myopic peripapillary atrophy, and a thinner retina may contribute to delayed detection. Logistic regression showed that better knowledge and a positive attitude toward monitoring were independent protective factors for adherence. Conclusions Poor long-term follow-up after ICL implantation may lead to delayed detection of high myopia–related ocular complications. Targeted health education, risk-stratified monitoring for middle-aged and high myopia subgroups, and improved access to care are urgently needed to enhance early detection and prevent irreversible vision loss in these patients.

Keywords: implantable collamer lens; high myopia; phakic intraocular lens; normal-tension glaucoma; myopic retinal degeneration; patient education; middle-aged patients; retinal thickness

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How to cite

Niu, T., Li, X., Liu, Y., Li, X., Cao, J., Pazo, E. E., Zhao, S. Z., Jia, Z., Yang, R. (2026). Long-term follow-up adherence after implantable collamer lens implantation in high-myopia patients: a single-center retrospective cohort and KAP survey study. Research Square. https://doi.org/10.21203/rs.3.rs-10004973/v1

@article{niu2026long,
  title = {{Long-term follow-up adherence after implantable collamer lens implantation in high-myopia patients: a single-center retrospective cohort and KAP survey study}},
  author = {Niu, Tongxin and Li, Xin and Liu, Ying and Li, Xin and Cao, Jingran and Pazo, Emmanuel Eric and Zhao, S Z and Jia, Zhe and Yang, Ruibo},
  journal = {Research Square},
  year = {2026},
  doi = {10.21203/rs.3.rs-10004973/v1},
  url = {https://doi.org/10.21203/rs.3.rs-10004973/v1},
}

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