Visual Performance after Implantable Collamer Lens Implantation and Wavefront-Guided Laser In Situ Keratomileusis for High Myopia

PURPOSE: To compare postoperative visual function after implantable collamer lens (ICL; STAAR Surgical, Nidau, Switzerland) implantation and after wavefront-guided laser in situ keratomileusis (WFG-LASIK) in eyes with high myopia. DESIGN: Retrospective, observational case study. METHODS: We investigated 46 eyes of 33 patients undergoing ICL implantation and 47 eyes of 29 patients undergoing WFG-LASIK (Technolas217z; Bausch & Lomb, Rochester, New York, USA) for the correction of high myopia (manifest spherical equivalent <= -6 diopters). Ocular higher-order aberrations (HOA) and contrast sensitivity (CS) function were measured by Hartmann-Shack aberrometry (KR-9000; Topcon, Tokyo, Japan) and a CS unit (VCTS-6500; Vistech Consultants Inc, Dayton, Ohio, USA) before and 3 months after surgery, respectively. From the CS, the area under the log CS function (AULCSF) was calculated. RESULTS: For a 4-mm pupil, the changes in ocular coma,like aberrations, spherical-like aberrations, and to, tal HOAs after ICL implantation were significantly less than those after WFG-LASIK (P < .001, Mann-Whitney U test). The postoperative AULCSF was significantly increased after ICL implantation (P < .001), whereas after WFG-LASIK, it was significantly de, creased (P < .001). CONCLUSIONS: ICL implantation induces significantly fewer ocular HOAs than WFG-LASIK. Moreover, CS was improved significantly after ICL implantation, but deteriorated after WFG-LASIK in eyes with high myopia. Thus, in the correction of high myopia, ICL implantation seems to be superior in visual performance to WFG-LASIK, suggesting that it may be a better surgical option for the treatment of such eyes. (Am J Ophthalmol 2009;148:164-170. (C) 2009 by Elsevier Inc. All rights reserved.)