Randomized prospective comparison of visian toric implantable collamer lens and conventional photorefractive keratectomy for moderate to high myopic astigmatism.
OBJECTIVE
To compare the Visian Toric Implantable Collamer Lens (TICL), a toric phakic intraocular lens (IOL), and photorefractive keratectomy (PRK) in the correction of moderate to high myopic astigmatism.


METHODS
This prospective, randomized study consisted of 43 eyes implanted with the TICL (20 bilateral cases) and 45 eyes receiving PRK with mitomycin C (22 bilateral cases) with moderate to high myopia (-6.00 to -20.00 diopters [D] sphere) measured at the spectacle plane and 1.00 to 4.00 D of astigmatism. All patient treatment and follow-up occurred at the Naval Medical Center San Diego. Study follow-up was 1 day, 1 week, 1, 3, 6, and 12 months postoperative.


RESULTS
Mean best spectacle-corrected visual acuity (BSCVA), change in BSCVA, proportion of cases with improvement of 1 or more lines of BSCVA, proportion of cases with BSCVA and uncorrected visual acuity (UCVA) 20/12.5 or better, proportion of cases with BSCVA and UCVA 20/16 or better (6 months, 88% vs 54%, P=.002), and predictability +/-1.00 D (6 months, 100% vs 67%, P<.001) were all significantly better in the TICL group than the PRK group at all time periods studied postoperatively. Similarly, contrast sensitivity, tested at both the 5% photopic level and the 25% mesopic level, was significantly better at all postoperative time points in the TICL group. Mean spherical equivalent refraction was closer to emmetropia (0.28+/-0.41 vs 0.76+/-0.86, P=.005), and predictability +/-0.50 D and stability of manifest refraction (+/-0.50 D and +/-1.00 D) were significantly better in the TICL group at all postoperative visits through 6 months. Mean astigmatism correction at 6 months was not significantly different between the two groups (0.52+/-0.33 vs 0.46+/-0.35, P=.450).


CONCLUSIONS
The TICL performed better than PRK in all measures of safety (BSCVA), efficacy (UCVA), predictability, and stability in this comparison, supporting the TICL as a viable alternative to existing refractive surgical treatments.
Department of Ophthalmology, Navy Medical Center San Diego, San Diego, CA, USA.
Steven
S
Schallhorn
David
D
Tanzer
Donald R
DR
Sanders
Monica L
ML
Sanders
D000328:Adult; D001251:Astigmatism / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D015350:Contrast Sensitivity; D005139:Eyeglasses; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054018:Lasers, Excimer; D019654:Lens Implantation, Intraocular / Q000009:adverse effects; D008297:Male; D009216:Myopia / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D054120:Phakic Intraocular Lenses / Q000009:adverse effects; D018903:Photorefractive Keratectomy / Q000009:adverse effects; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012029:Refraction, Ocular; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014792:Visual Acuity