In High Myopia, Implantable Collamer Lenses Have Superior Visual Quality to SMILE

Implantable collamer lenses outperform small-incision lenticule extraction for the treatment of high myopia.

Implantable collamer lenses (ICLs) have superior visual outcomes compared with small-incision lenticule extraction (SMILE) surgery in eyes with high myopia, according to findings presented at the American Academy of Ophthalmology (AAO) 2022 annual meeting, held September 30 through October 3, 2022, in Chicago.

Investigators from University Munich in Germany sourced data for this study from a database. Eyes that underwent SMILE (n=1634) or ICL (n=225) implantation were matched 1:1 on the basis of preoperative manifest refraction spherical equivalent, age, and pupil size. The primary outcomes of this study were visual outcomes assessed using the Quality of Vision questionnaire.

At baseline, all eyes had manifest refraction spherical equivalents ranging between -6.00 and -10.00 D.

Plano target refraction outcomes within +0.50 D was achieved by 90% of eyes that received ICL compared with 72.5% of eyes that received SMILE. In addition, ICL was associated with significantly better efficacy (P <.001) and safety indices.

No significant difference in uncorrected distance visual acuity was observed between ICL and SMILE groups.

The major limitation of this study was the small sample size. These findings should be confirmed among an independent cohort.

“ICL implantation for high myopia yielded better refractive accuracy, better uncorrected distance visual acuity, fewer higher-order aberrations, and better subjective quality of vision than SMILE,” the study authors report. 


Dirisamer M, Siedlecki J, Schmelter V, et al. SMILE vs ICL implantation for high myopia: A matched comparative study. Presented at: the American Academy of Ophthalmology 2022 annual meeting; September 30 to October 3, 2022; Chicago. Abstract PO308.