Comparison of Collamer toric contact lens implantation and wavefront-guided laser in situ keratomileusis for high myopic astigmatism

PURPOSE: To compare the postoperative visual outcomes after implantation of a Collamer toric implantable contact lens (ICL) and after wavefront-guided laser in situ keratomileusis in high myopic astigmatism. SETTING: Department of Ophthalmology, Kitasato University, Kanagawa, Japan. METHODS: This study comprised 30 eyes (18 patients) having toric ICL implantation and 24 eyes (17 patients) having wavefront-guided LASIK (Technolas 217z) to correct high myopic astigmatism (manifest spherical equivalent [SE] <= -6.0 diopters [D]; manifest refractive cylinder >= 1.0 D). The safety, efficacy, predictability, stability, and adverse events were assessed preoperatively and 1 week and 1, 3, and 6 months postoperatively. RESULTS: At 6 months, the mean safety index was 1.28 +/- 0.25 (SD) in the ICL group and 1.01 +/- 0.16 in the LASIK group and the mean efficacy index, 0.87 +/- 0.15 and 0.83 +/- 0.23, respectively. All eyes in the ICL group and 71% of eyes in the LASIK group were within +/- 1.00 D of the targeted SE correction at 6 months. The mean change in manifest refraction from 1 week to 6 months was -0.04 +/- 0.24 D in the ICL group and -0.60 +/- 0.49 D in the LASIK group. There were no significant complications in the ICL group; 2 eyes (8.3%) in the LASIK group required enhancement ablations. CONCLUSION: Toric ICL implantation was better than wavefront-guided LASIK in eyes with high myopic astigmatism in almost all measures of safety, efficacy, predictability, and stability, suggesting that toric ICL implantation may become a viable surgical option to treat high myopic astigmatism.