Visual outcomes of implantable Collamer lens and laser-assisted in situ keratomileusis for all levels of myopia

To compare the clinical outcomes of the current V4c model of the myopic implantable Collamer lens (ICL) with those of laser in situ keratomileusis (LASIK) for the correction of myopia ranging from −2.0 to −18.0 diopters (D).

This prospective, non-randomized study enrolled participants who underwent either LASIK or implantation of the ICL V4c at Bolor Melmii Eye Hospital. In the LASIK group, participants received Intralase LASIK (I-LASIK) using the Intralase FS-200 femtosecond laser and the MEL-80 excimer laser. Each group comprised the same number of participants and eyes (38 participants, 73 eyes).

A total of 146 eyes from 76 participants were analyzed. Among the LASIK group, 76.3% were female, with a mean age at surgery of 29.76±5.95y (range, 20–43y). In the ICL group, 92.1% were female, with a mean age of 31.59±8.32y (range, 20–49y). Preoperative best-corrected visual acuity (BCVA) did not differ significantly between the LASIK and ICL groups (P=0.68). Postoperatively, the ICL group consistently demonstrated better BCVA (20/20 or better) at all follow-up points, with statistically significant differences observed at 1d (56.2% vs 30.1%, P=0.003) and 3mo (54.8% vs 32.9%, P=0.012). The mean BCVA improvement also favored the ICL group for up to 6mo postoperatively. A higher proportion of eyes in the ICL group achieved uncorrected distance visual acuity (UDVA) of 20/20 or better at 1mo (50.7% vs 41.1%, P=0.319) and 6mo (57.5% vs 43.8%, P=0.136), although these differences were not statistically significant. Predictability was comparable between the groups, except at 6mo, where fewer ICL-treated eyes were within ±0.5 D of the intended correction (49.3% vs 64.4%, P=0.094). Nevertheless, both groups achieved identical outcomes within ±1.0 D (90.4%, P=1.000). Between 1 and 6mo, 78.1% of eyes in the ICL group showed a change in spherical equivalent refraction of no more than 0.5 D, compared to 65.8% in the LASIK group. Refraction stability, defined as a change of less than 1.0 D, remained good in both groups throughout all follow-up periods.

Both LASIK and ICL implantation leads to significant improvements in visual outcomes, with early postoperative gains observed in both groups. However, the ICL group demonstrates greater long-term improvement in BCVA compared to the LASIK group, particularly among participants with higher degrees of myopia. Visual outcomes in both groups stabilized by 6mo postoperatively.