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Significant long-term myopic regression observed after LASIK for high myopia
J Refract Surg. 2009;25(2):195-200.
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LASIK for high myopia was safe and stable over the long term but only moderately predictable.
A retrospective study included 77 eyes of 47 patients with at least 10 D of myopia who underwent LASIK. Mean patient age was 33 years. Mean preoperative spherical refraction was –12.3 D with mean astigmatism of 1.3 D. Intended correction was 10.5 D.
LASIK was performed with the Visx STAR S2 excimer laser (Abbott Medical Optics). Follow-up examinations were performed at 1, 3, 6 and 12 months and between 2 years and 5 years.
At 2 years to 5 years after surgery, 40% of eyes attained spherical equivalent refraction within 1 D of intended refraction, 70% of eyes were within 2 D and 91% were within 3 D. Eyes showed a mild, significant regression toward myopia; mean spherical equivalent refraction was –1.21 D at 1 month, –1.82 at 6 months and –1.95 D at 2 years to 5 years. The differences between the time points were statistically significant (P < .001 and P = .03).
Right now most people believe, and I believe, that phakic IOLs are a better option than laser in these highly myopic patients. But we always need to consider that lasers may still be an option in individual cases. The take-homes are the fact that this is a very good study because it shows the long-term effects were safe. But it’s not as accurate as phakic IOLs. Several head-to-head studies have shown that phakic IOLs have better quality vision in this above –10 D group. If phakic IOLs are the primary procedure, laser can still be an alternative in select cases.
I’m not doing any patients above –10 D with lasers now because we have three different phakic IOLs available that almost everybody can qualify for. Historically, we don’t have a lot of long-term papers that have been presented on high myopia LASIK. I don’t think anybody is suggesting as a primary procedure to do LASIK in people above –10 D. This is a great work and provides historical basis that LASIK can be done above –10 D. But put in modern perspective, it’s not as accurate and doesn’t have the high-quality vision of phakic IOLs, so it should only be used as a backup if somebody is not a candidate for a phakic IOL.
– Daniel S. Durrie, MD
OSN Refractive Surgery Section Editor