Sequential implantable collamer lens and LASIK for the treatment of high compound hyperopic astigmatism

Author Block: Daniel Q. Li ¹, Mathieu Gauvin², Guillermo Rocha³, Avi Wallerstein¹.  ¹McGill University Department of Ophthalmology, ²Vision Group Canada, ³University of Manitoba Department of Ophthalmology.

Author Disclosure Block: D.Q. Li:  None.  M. Gauvin:  None.  G. Rocha:  None.  A. Wallerstein:  None., Daniel Li: Not Current  Mathieu Gauvin: Not Current  Guillermo Rocha: Not Current  Avi Wallerstein: Not Current

Abstract Title: Sequential Implantable Collamer Lens and LASIK for Treatment of High Compound Hyperopic Astigmatism

Abstract Body: Purpose:  Implantable Collamer Lens (ICL) can treat high hyperopia beyond the safe limits of LASIK, however a Toric version of ICL is not yet commercially available in North America. We implemented a sequential approach using hyperopic ICL followed by LASIK (bioptics) for treating high compound hyperopic astigmatism and report on the outcomes.  Study Design:  Prospective consecutive case series.  Methods:  We included 48 consecutive eyes with ≥3.50 D hyperopia and ≥2.00 D of astigmatism that underwent planned bioptics (ICL followed by LASIK) at our tertiary refractive centres between 2018 and 2021. Pre- and post-operative manifest sphere, cylinder, spherical equivalent (SEQ), and visual acuity were analyzed.  Results:  Patients had a pre-operative sphere of 6.18 ± 1.35 D and cylinder of 2.69 ± 0.89 D. At the last post-bioptics follow-up, 94% of eyes achieved a UDVA within 1 line of pre-operative CDVA. Efficacy and safety indices were 0.94 ± 0.13 and 1.00 ± 0.13. We obtained near-to-emmetropia SEQ postoperatively (mean -0.03 ± 0.43D), and the scatterplot of attempted versus achieved refractive correction revealed a predictable procedure (R² = 0.89). 93.8% and 100% of eyes achieved target SEQ within 0.75 and 1.00 D. 87.5% and 100% of eyes were within 0.50 and 0.75 D of intended plano cylinder.  Conclusions:  Sequential ICL and LASIK is a safe and effective refractive approach for high compound hyperopic astigmatism.