LASIK vs. Implantable contact lens surgery for refractive errors less than 700 degrees: Which is better?
Singaporeans have one of the highest rates of myopia in the world. Two common vision correction procedures are LASIK and implantable contact lens (ICL) surgery. LASIK is the commonest refractive surgery procedure because of its safety and efficacy. An alternative to LASIK is ICL surgery. There is a lot of information regarding these procedures and it can be difficult to understand which procedure is best for you.
In Singapore, more than 90% of the population have a refractive error that is less than 700 degrees. For the majority of the population within this category, a common question that is asked is which refractive surgical procedure is better and would give a better visual result. There is a lot of materials available on the Internet which may be confusing for individuals who are trying to make a decision regarding which choice to make. In fact, there are pros and cons for each procedure, and this article aims to provide some clarity and summarises some of the more important considerations regarding each procedure when deciding which procedure is best for the individual.
What is LASIK and implantable contact lens surgery?
- LASIK: LASIK is the most commonly performed vision correcting procedure. Many individuals opt for LASIK due to its affordability, quick vision recovery, short downtime, accuracy and its ability to correct a wide range of refractive errors (myopia, hyperopia, astigmatism).
- Implantable Contact Lens (ICL): This involves implanting a lens inside the eye, between the natural lens and iris, to correct refractive errors. ICL is usually offered to those who have extreme myopia or for eyes that are unsuitable for LASIK due to thin or irregularly shaped corneas.
Both LASIK and ICL surgery have proven track records for vision correction.
LASIK and ICL surgery technology
| Treatment range
LASIK can treat all forms of refractive errors (myopia, hyperopia and astigmatism) effectively and has a wide range of treatment. |
Treatment range
ICL can treat all forms of refractive errors and has a wide range of treatment. |
| Tissue removal
LASIK uses an excimer laser to correct the refractive errors, by reshaping the cornea through removal of removes corneal tissue. |
Tissue removal
ICL surgery corrects the refractive error by the insertion of an intraocular lens into the eye, in front of the natural lens. There is no removal of corneal tissue. |
| Invasiveness
LASIK surgery involves the correction at the cornea plane and does not involve entry into the eye. |
Invasiveness
ICL surgery is more invasive as the lens is inserted into the eye. |
Comparison of visual results for LASIK and ICL surgery for 700 degrees or less
| Precision of correction of refractive errors
The excimer laser in LASIK is extremely precise and can more accurately correct refractive errors compared to ICL surgery. LASIK has the option of a Wavefront-guided customised treatment, which aims to reduce minute imperfections of the eye (i.e. higher order aberrations). This can improve the visual outcome with sharper vision. There is also lesser haloes and starbursts at night. Hence, LASIK generally results in a better visual result for refractive errors 700 degrees or below compared to ICL. |
Precision of correction of refractive errors
ICL is relatively less precise in correcting low refractive errors compared to LASIK. ICL surgery does not have a Wavefront- guided treatment and does not aim to correct higher order aberrations. |
| Rate of vision recovery
Relatively faster recovery compared to ICL for this treatment range |
Rate of vision recovery
Relatively slower recovery compared to LASIK for this treatment range |
| Ability to enhance
LASIK can correct small refractive errors more easily and more accurately compared to ICL surgery. |
Ability to enhance
Any remaining refractive error may be corrected through an ICL exchange which involves another invasive procedure that is more difficult and time consuming than a LASIK enhancement. An ICL exchange can increase the risk of cataract. It is less accurate for correcting small refractive errors compared to LASIK. |
| Side effects
LASIK can result in dry eyes and seeing haloes and starburst at night, which improves over time and are rarely significant and permanent. Complications are limited to the external surface of the eye. |
Side effects
There may be haloes and starburst at night, which improves over time. Complications may occur inside the eye. As the ICL is placed adjacent to the natural lens, there is a higher chance of inducing cataracts, which may require cataract surgery if the vision is affected. It does not cause dry eyes. ICL surgery is reversible and should complications occur, the ICL can be removed. |
Summary: LASIK vs ICL surgery for correction of refractive errors less than 700 degrees
In the case where the eyes are suitable for both LASIK and ICL surgery, LASIK surgery would generally provide a more precise correction of the refractive error for those with mild to moderate levels of refractive errors below 700 degrees (i.e. -7.00 dioptres). In this group, LASIK surgery is more likely to result in a better visual result than ICL surgery. Compared to ICL surgery, LASIK can more easily and more accurately enhance any residual small refractive errors. It also carries a lower risk as it is less invasive. LASIK surgery is also more affordable.
On the other hand, ICL surgery would generally give a better visual result when the refractive errors are 900 degrees (-9.00 dioptres) and above.
However, not everyone is suitable for both LASIK and ICL surgery. Corneas that are thin or irregular in shape may not be suitable for LASIK and ICL is the only choice. Conversely, eyes where the internal space is narrow and insufficient to safely insert an intraocular lens may not be suitable for ICL and can only do LASIK surgery. During the detailed evaluation, the doctor will determine whether the eye is suitable for either procedure.
Apart from the technology, selecting an experienced surgeon who is well-versed in all forms of refractive surgery rather than specialising in only one type of surgery is extremely important, as he / she would be in a better position to offer a wider range of surgical options and advise the optimal procedure. In addition, advanced fellowship-trained cornea and refractive surgeons would generally have more expertise and experience in the various refractive surgical options which may translate to better visual results, lower complications, and a higher chance of the patient achieving spectacle freedom.
Conclusion
We hope this article has been informative in helping you gain a better understanding of the differences and visual outcomes of LASIK and ICL surgery for the correction of refractive errors of less than 700 degrees.
If you suffer from myopia and will like to take the first step towards clearer vision, please contact Lang Eye Centre at +65 6684 1000 or manager@langeye to schedule an evaluation to ascertain your suitability and understand the risks vs benefits of each vision correction procedure.
