Comparison of Implantable Collamer Lens (ICL) and Laser-assisted In Situ Keratomileusis (LASIK) for Low Myopia

Abstract

To compare the results of laser-assisted in situ keratomileusis (LASIK) and implantable collamer lenses (ICL) in the correction of myopia -4 to -7.88 D. A total of 1678 LASIK eyes from the Davis Duehr Eye Center, Madison, WI, and 144 ICL eyes from the 14-site US FDA Clinical Trial for ICL for Myopia were compared. Both series were concurrently operated on with 4 to 7.88 D of preoperative spherical equivalent of the manifest refraction and were examined at 1 day, 1 week, 1 month, and 6 months postoperatively. The mean baseline myopia was slightly higher in the ICL group (ICL: -6.4 +/- 1.1 D; LASIK: -5.6 +/- 1.1 D). Best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), and refractions were collected prospectively in both series. BSCVA loss of at least 2 lines was significantly higher in the LASIK series in the early healing period (1 week: 6% vs. 0.7%; P = 0.008), whereas a BSCVA gain of at least 2 lines was statistically better with the ICL at 1 (5% vs. 0.9%, P = 0.001) and 6 months (4% vs. 0.8%, P = 0.013). Proportion of cases seeing 20/15 or better uncorrected (21.6% vs. 7.8%, P < 0.001) and 20/20 or better (67% vs. 57%, P = 0.027) at 6 months postoperatively was better in the ICL group. The ICL was statistically more predictable (attempted vs. achieved) at 6 months; +/-0.50 D (79% ICL vs. 70% LASIK, P = 0.034) and +/-1.0 D (97% ICL vs. 88% LASIK, P < 0.001). Stability was achieved (95% < or = 1.0 D) at the 1-week to 1-month interval for both groups (95% LASIK; 98% ICL). The stability of refraction (< or =0.5 D change) was significantly better in the ICL group than the LASIK group through 6 months. No serious complications occurred in either series. The ICL was safer and more effective than LASIK and seems to be a viable alternative to corneal refractive excimer surgery in the treatment of low myopia.