Indications and Outcomes of Surgery for High Myopia: STAAR Intraocular Collamer Lens (ICL) vs. LASIK

ABSTRACT

Purpose: Although the ICL is more invasive than laser-assisted in situ keratomileusis (LASIK), it is indicated for patients with very high myopia, commonly over -7D. ICL is associated with certain risks including cataract and glaucoma which may develop years after surgery requiring additional procedures. In this study, we examined the outcome and safety profile of ICL vs. LASIK at 1 week, 1 month, and 1 year postoperatively. Methods: In this retrospective study, we examined records from a single surgeon (KK) as well as 2 patients with post ICL complications requiring ICL removal. An important aim of this study was to use the 1 year follow up data since this is one of the standard ICL follow up visits. We hypothesized that the FDA approved ICL (2005) would have a comparable target refractive outcome and safety profile when compared to LASIK. Results: There were a total of 45 ICL eyes and 65 LASIK eyes. Preoperatively, ICL patients had a significantly higher manifest refraction spherical equivalent (MRSE) and cycloplegic refraction spherical equivalent (CRSE) than LASIK patients (p<0.05). For patients who received the ICL implants, the average MRSE at 1-week, 1-month, 1-year post-op was -0.37D±(0.13), -0.29D±(0.09), -0.53D±(0.15);and -1.60D±(0.16), -0.36D±(0.15), -0.36D±(0.07) for patients who received LASIK. The differences in post-op MRSE between ICL and LASIK were not statistically significant (p>0.05). The only significant differences were 1 month LogMAR best corrected visual acuity and 1 year LogMAR distance uncorrected visual acuity (p<0.05), in which LASIK had better visual acuity. Common postoperative findings in both groups were refractive target deviations and punctate keratitis. Reoperation rates in the ICL and LASIK groups were 21.4% and 10.8% respectively, which was not statistically significant (p>0.05). 42.6% of ICL patients underwent the procedure during the COVID-19 pandemic compared to 26.2% of LASIK. Conclusions: Our results demonstrate that ICL is safe and effective for patients with high myopia. Although ICL patients had a significantly higher preoperative MRSE compared to the LASIK group, the ICL patients were able to achieve similar refractive targets. There were no cases of glaucoma or cataract at 1 year in the ICL group. In conclusion, ICL surgery is as safe and effective as LASIK surgery in correcting patients with high myopia, regardless of pre-operative refractive error.