Implantable Collamer Lens Versus Laser-Assisted In Situ Keratomileusis In Myopia: A Systemic Review And Meta-Analysis
Published 2023 - 41st Congress of the ESCRS
Reference: PO0966 | Type: Free paper | DOI: 10.82333/m5pa-7188
Authors: Abdullah Al-Kaabi* 1 , Arnav Gupta 1 , Jobanpreet Dhillon 1 , Bader AlQahtani 1 , Bader AlQahtani 1 , Tushar Tejpal 2 , Ajaykumar Shanmugaraj 3 , Kevin Min 1 , Mohammed Taha 4 , Mona Koaik 1
1University of Ottawa,Ottawa,Canada, 2McMaster University,Hamilton,Canada, 3University of British Colombia,Vancouver,Canada, 4King Saud bin Abdulaziz University for Health Sciences,Riyadh,Saudi Arabia
Purpose
Femtosecond laser-assisted in situ keratomileusis (FS-LASIK) creates a flap in the cornea following which an excimer laser is used to reshape the cornea. This achieves the required curvature to correct the patient’s refractive error. However, FS-LASIK can potentially lead to corneal thinning and ectasia. Implantable collamer lens (ICL) implantation is another option that corrects the patient’s refractive error without causing any corneal weakening; however, this procedure requires intraocular surgery to implant the ICL. Here, we aim to compare ICL and FS-LASIK in myopic eyes in terms of visual acuity, safety index, efficacy index, and visual quality in terms of objective scatter index (OSI) and modulation transfer function (MTF).
Setting
This study is a systemic review and meta-analysis.
Methods
A systematic review and meta-analysis was conducted. A literature search was performed using MEDLINE, EMBASE, and PubMed for studies comparing FS-LASIK and ICL. Two reviewers independently extracted the relevant data from the included articles. The primary outcome was best correct visual acuity (BCVA) at various time points post-operatively. The secondary outcomes included the safety index, efficacy index and visual quality outcomes (e.g., MTF, OSI). A random effects meta-analysis was performed to calculate an odds ratio (OR) for dichotomous variables or a pooled standardized mean difference (SMD) for continuous variables with a 95% confidence interval (CI).
Results
Ten studies involving 1663 eyes were included in this review. 789 eyes belonged to the FS-LASIK group whereas 663 eyes were in the ICL group. The mean follow up was 37.7 weeks (SD = 11.5). At one year follow up, the difference in best corrected visual acuity (SMD = -0.12, 95% CI: -0.93 to 0.69), efficacy (SMD = -0.57, 95% CI: -1.33 to 0.19) and safety indices (SMD = -0.67, 95% CI: -1.52 to 0.19) were non-significant between the two groups. MTF at 3 months was significantly lower among FS-LASIK patients compared to ICL (SMD = -0.59, 95%CI -0.85– -0.34, p = 0.02). However, OSI at 3 months was not significantly different between the FS-LASIK and ICL groups (SMD = -0.35, 95%CI -2.51–1.81).
Conclusions
Compared to FS-LASIK, ICL demonstrates similar outcomes in terms of BCVA, safety and efficiency indices in myopic patients. ICL implantation is usually recommended to patients who are not eligible for FS-LASIK and other laser vision correction surgeries, however we suggest that in myopic patients considering refractive surgery, the option of ICL implantation should be offered along with the option of FS-LASIK as it has similar visual outcomes, is reversible, and does not alter the structure of the cornea.