CASE REPORT: IMPLANTABLE CONTACT LENS VS. LASIK FOR HIGH MYOPIA
A 24 year-old woman was initially referred to the Bochner Eye Institute in 2021 for evaluation of refractive surgery. At that time, she reported stable vision.
Manifest refraction was:
- Right eye: -7.00 -5.50 × 007, achieving best-corrected visual acuity (BCVA) of 20/25.
- Left eye: -4.00 -2.50 × 177, achieving BCVA of 20/20+.
- Corneal pachymetry revealed a minimum corneal thickness of 551 µm OD and 552 µm OS.
- Anterior chamber depth measured 3.01 mm OD and 3.02 mm OS.
- Corneal topography demonstrated regular astigmatism with a classic bow-tie pattern in both eyes. There was no evidence of keratoconus.
Based on these findings, an implantable contact lens (ICL) was recommended for the right eye, and LASIK for the left eye. The procedures were performed and uneventful.
Postoperatively, the patient achieved uncorrected distance visual acuity (UDVA) of 20/20 in both eyes.
Upon return four years later in 2025, she presented with 20/20 UCVA in the right eye, and 20/50 acuity in the left eye correctable to 20/20 with a -1.25 diopters lens.
Corneal topographical images are shown above for the right eye and left eye. The right eye topography is the same as preoperative, since no laser surgery was performed. The left eye topography shows central flattening to reduce the myopia and astigmatism.
ICL vs LASIK vs PRK for High Myopia
ICL implantation shows excellent long-term refractive stability, even in very high myopia. Since no tissue is removed, there is minimal regression, and stability is primarily dependent on lens positioning and minimal vault changes over time.
OVERALL CONCLUSIONS
- ICL offers the best long-term refractive stability in high myopia correction, particularly for very high myopia (> -8 D), with minimal regression.
- LASIK has moderate regression for high myopia, related to stromal ablation depth and biomechanical changes.
- PRK has the highest regression risk for high myopia due to epithelial and stromal remodeling.
FINAL THOUGHTS
This case highlights several important considerations in the management of high myopia with combination refractive surgery. The patient initially underwent ICL implantation in the right eye and LASIK in the left eye based on careful preoperative evaluation, including corneal thickness, anterior chamber depth, and topography. The long-term follow-up demonstrates the expected stability advantage of ICL for very high myopia, with the right eye maintaining excellent uncorrected vision four years postoperatively.
The mild myopic regression observed in the LASIK-treated left eye is consistent with known long-term outcomes in higher myopic corrections, where biomechanical remodeling and subtle stromal changes may contribute to refractive shift over time. Importantly, the residual myopia in the left eye remained fully correctable, and overall binocular function was excellent.
This case reinforces the role of personalized surgical planning in high myopia. ICL implantation offers superior long-term refractive stability for very high myopia, while LASIK remains an excellent option for moderate myopia in appropriately selected eyes with sufficient corneal thickness. Understanding the nuances of postoperative stability allows for better patient counseling and management of long-term expectations.
