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Lenses may offer alternative to LASIK

J Cataract Refract Surg. 2008;34(10):1687-1693.

Issue: November 10, 2008

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Collamer toric implantable contact lenses yielded better clinical and refractive outcomes than wavefront-guided LASIK in eyes with moderate to high myopic astigmatism.

The toric ICLs (STAAR Surgical) also outscored LASIK on predictability, stability and adverse event measures.

The study included 30 eyes of 18 patients implanted with toric ICLs and 24 eyes of 17 patients who underwent wavefront-guided LASIK.

At 6 months, all eyes in the ICL group and 71% of eyes in the LASIK group were within 0.5 D of targeted spherical equivalent correction. The mean safety index was 1.28 in the ICL group and 1.01 in the LASIK group.

LASIK outperformed ICL implantation in the predictability of high myopic astigmatism correction. At 6 months, 100% of LASIK eyes and 96% of ICL eyes were within 1 D of targeted refractive cylinder correction.

I think that people need to look at phakic IOLs as being an alternative to LASIK more than they have in the past. We are finding several studies now showing that it is truly an alternative in patients and can provide accuracy, safety and quality of vision. In the past, we just thought mainly about LASIK for correction of myopia, but IOLs are definitely proving to be a good alternative.

For doctors to be comprehensive refractive surgeons, they are going to have to be well-versed not only in LASIK but also in both phakic and pseudophakic lens implants for the future. Toric phakic IOLs are one of many advances that are going to be coming. There is another series of new phakic IOLs that is going to be introduced in the next few years. Surgeons just need to know about all the alternatives to be able to provide their patients with the best care.

There definitely needs to be a larger number of eyes to help surgeons decide when they use the toric IOLs and when they use LASIK surgery. There is a lot of confusion for the doctors. This is a small study with very few patients, and we need larger prospective studies to help doctors decide, now that we know that both of these are good options, which patients should have which procedures.

Daniel S. Durrie, MD
OSN Refractive Surgery Section Editor