Phakic IOLs correct high myopia more accurately than all-laser LASIK, study finds

Implantable contact lenses (ICLs) appear to correct high myopia more accurately than customized all-laser LASIK (IntraLASIK), and the phakic lenses also provide a better quality of vision, according to G. Peyton Neatrour, MD. He is an assistant professor of ophthalmology at Eastern Virginia Medical School, Norfolk, VA, and is in private practice with Beach Eye Care, Virginia Beach, VA.

Dr. Neatrour and colleagues conducted a retrospective study of 79 consecutive eyes undergoing vision correction for high myopia. Patients chose either to undergo phakic IOL implantation or IntraLASIK (CustomVue IR, Advanced Medical Optics [AMO]) after receiving recommendations from their ophthalmologists.

Researchers measured uncorrected visual acuity (UCVA), gain or loss of best spectacle-corrected visual acuity (BSCVA), accuracy, high-order aberrations (HOAs), contrast sensitivity, complication rate, and enhancement frequency. They found that the phakic IOLs provided results superior to LASIK in regard to UCVA, gain in BSCVA, accuracy within 0.05 D, fewer HOAs, and contrast sensitivity.

The investigators also measured patient satisfaction by having each patient rate effects on a scale of one (very satisfied) to five (very unsatisfied).

"We asked about sharpness, comfort, consistency, day and night vision, and glare, and we found the ICLs had a very slightly lower score (1.5) versus 1.6 with custom endpoints," Dr. Neatrour said. "When we looked at condition occurrences of dryness, blurriness, fluctuation in vision, glare, halos, difficulty at night, or ghosting, we found the custom IntraLASIK group did slightly better than the ICL group.

"Then we asked that question about, 'How was your vision with glasses or contacts before versus how your vision is afterward without any vision correction?' and all the way down the line on those symptoms, ICLs surpassed the custom IntraLASIK," Dr. Neatrour said.

The groups had similar equivalent enhancement rates, according to wavefront analysis (WaveScan WaveFront, AMO). The amount of preoperative astigmatism with lens implantation was a predisposing factor to requiring an enhancement. The need for astigmatism-correcting enhancements should be minimized with the future availability of toric ICLs, Dr. Neatrour concluded.