Toric implantable phakic contact lens versus bioptics for the correction of moderate to high myopia and astigmatism

Purpose To compare refractive and visual outcomes and patient satisfaction of toric implantable phakic contact lens (T-IPCL) versus bioptics (IPCL followed by femtosecond laser assisted in-situ keratomileusis) in myopia (moderate to high) with astigmatism. Patients and methods A total of 13 eyes underwent T-IPCL implantation, and 11 eyes were corrected using bioptics. Complications, uncorrected and corrected distance visual acuities, refraction, safety, efficacy, predictability, tear-film break-up time, contrast sensitivity, and patient satisfaction were assessed 6 months postoperatively. Results No complications were reported. Mean spherical equivalent was −0.62±0.49 D in T-IPCL and −0.55±0.26 D in the bioptics group (P=0.464). In 10 (76.9%) eyes of T-IPCL and 11 (100%) eyes of bioptics, the spherical equivalent and astigmatism were within ±1 D, respectively. A significantly better astigmatic correction was demonstrated in the bioptics group as confirmed by vector analysis (P<0.001). Loss of lines was not reported; both uncorrected and corrected distance visual acuities improved significantly (P<0.05), with no significant differences (P>0.05). Safety indices were 1.15±0.08 and 1.1±0.09 and efficacy indices were 1.04±0.11 and 1.03±0.06 in T-IPCL and bioptics groups, respectively, which were insignificant. The contrast sensitivity and tear-film break-up time were significantly better in the T-IPCL group (P<0.001). Distant vision satisfaction was better in the bioptics group, whereas glare, halos, and dry eye satisfaction were better in the T-IPCL group (P<0.05). Conclusion Both T-IPCL and bioptics can successfully correct moderate to high myopia with astigmatism. The T-IPCL carries better optical quality with less glare, halos, and dry eye. Bioptics gives better astigmatic correction and distant vision satisfaction but carries the risk of a second surgical intervention.