Purpose: To compare safety, efficacy, stability, and predictability of implantable collamer lens (ICL) with femtosecond-laser in situ keratomileusis (FS-LASIK) or small incision lenticule extraction (SMILE) for the correction of moderate-to-high myopia/myopic astigmatism.

Study design: We retrospectively collected data from patients with moderate-to-high myopia/myopic astigmatism (spherical equivalent [SE] ≥ −3.00 diopters [D]) who underwent ICL (48 eyes), FS-LASIK (36 eyes), or SMILE (86 eyes) at Hai Yen Eye Center from October 2016 to February 2018.

Materials and methods: The Wilcoxon Mann-Whitney U test was used to compare pre- and postoperative patients’ characteristics of ICL with SMILE or FS-LASIK. Generalized linear models with unstructured correlation matrix and robust standard errors were used to analyze efficacy and safety indices; logistic regression was used for cylinder predictability.

Results: After controlling for age, preoperative SE, and preoperative corrected distance visual acuity (pCDVA), SMILE had significantly lower safety indices (Coefficient = −0.04, 95% CI = −0.07–−0.01) and efficacy indices (Coefficient = −0.10, 95% CI = −0.20–−0.01) than did ICL, while FS-LASIK was not significantly different from ICL (Coefficient = −0.02, 95% CI = −0.06–0.02 and Coefficient = −0.01, 95% CI= −0.10–0.09, respectively). ICL SEs
were stable over 12 months after surgery. However, in FS-LASIK and SMILE, SEs significantly decreased at 12 months compared with 6 months after surgery. The percentage of eyes that underwent FS-LASIK and had target SEs within ±0.5 D at 12 months was significantly lower than those that underwent ICL (OR = 0.14, 95% CI = 0.02–0.85), after controlling for age, preoperative SE, and pCDVA.

Conclusion: For the correction of moderate-to-high myopia/myopic astigmatism, ICL seems to perform better than SMILE and FS-LASIK.