Visual Quality Comparison Between ICL Implantation with Steep-Meridian Incision and FS-LASIK in Correcting Low to Moderate Astigmatism

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Method: Retrospective analysis of 53 eyes (41 patients, 18 to 40y) with myopic astigmatism (SE: -3.00D to -9.25D). In this study, 26 eyes were subjected to ICL-SMCI, while 27 eyes were treated with FS-LASIK. Refractive outcomes, vector analysis was evaluated preoperatively, 1 month, 6 months and 1 year postoperatively. Objective visual quality was measured at 1 year. Results: At 1 year, all the patients in both groups achieved an uncorrected distance visual acuity (UDVA) of 20/20 or better. The gain in lines of corrected distant visual acuity (CDVA) was maximum in FS-LASIK group (93%). The difference vector (DV) showed that the residual astigmatism in the FS-LASIK group was much smaller than that in the ICL-SMCI group (P<0.0001), and the correction index (CI) was significant statistical different (P<0.0001). The postoperative objective visual quality include objective scatter index(OSI)，modulation transfer function (MTF) cutoff frequency and the strehl ratio (SR) have no significant difference in two groups. Conclusions: Both ICL-SMCI and FS-LASIK effectively corrected low-to-moderate astigmatism. ICL-SMCI preserved postoperative visual quality comparable to FS-LASIK. Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction At present, the primary surgical interventions for correcting refractive errors are corneal refractive surgery and intraocular lens implantation [1, 2] . Among these, FS-LASIK is a widely adopted procedure within corneal refractive surgery, effectively treating myopia, hyperopia, and astigmatism. But FS-LAISK requires the ablation of corneal tissue, which reduces the biomechanical stability of the cornea and increases the impact of higher-order aberrations on the patient's postoperative visual quality [3-5] . The ICL (Implantable Collamer Lens) is a viable method for correcting myopia and astigmatism, which can avoid complications related to the cutting of corneal tissue. TICL, a toric version of the ICL, can correct astigmatism up to 6.0D. Compared to ICL, TICL is more costly, requires a longer period for customization, and carries the risk of rotation and displacement post-implantation, which can impact the patient's postoperative visual quality and satisfaction. Furthermore, for patients with low to moderate astigmatism (≤1.50D), the degree of astigmatism increases in increments of 0.5D for TICL, which cannot correct all low to moderate astigmatism degrees, and the calculation formula does not account for surgically induced astigmatism [6-8] . Therefore, can patients with low to moderate astigmatism (≤1.5D) achieve satisfactory postoperative visual quality through ICL instead of TICL? Some researchers advocate for placing the main corneal incision on the steep meridian to reduce corneal astigmatism [9, 10] . This method is straightforward, cost-effective, and does not require additional incisions, thereby lowering the risk of infection and demonstrating good outcomes for patients with low to moderate astigmatism. However, these research concentrates on the short-term correction effects of astigmatism and lacks a thorough evaluation of postoperative visual quality [10, 11] . Femtosecond laser-assisted ICL surgery, while capable of achieving good correction effects for astigmatism, is limited in clinical application due to its high cost [12] . To investigate these issues, we intend to compare the corrective outcomes of ICL-SMCI and FS-LASIK in patients suffering from low to moderate astigmatism. Our aim is to ascertain whether ICL-SMCI can effectively correct low to moderate astigmatism, achieving favorable treatment results and postoperative visual quality as an alternative to TICL. This comparison may provide a scientific foundation for the selection of clinical surgical methods. Patients and Methods This retrospective study encompassed 53 eyes from 41 patients, with astigmatism ranging from -0.25 to -1.50D preoperatively. The patients were divided into two groups: the first group underwent ICL-SMCI, while the control group received FS-LASIK. Ethical approval was obtained from the Medical Ethics Committee of the authors’hospital (IRB 2024010). The inclusion criteria were as follows: age ranging from 18 to 40 years; stable refraction for a minimum of 2 years; for ICL patients, preoperative chamber depth of at least 2.8mm, endothelial count of at least 2000 cells/mm 2 ; cylinder diplomer not exceeding 1.50D; for FS-LASIK patients, central corneal thickness exceeding 480μm, and residual stroma thicker than 280μm; Exclusion criteria: active inflammatory or infectious lesions of the eye; unstable period of keratoconus or other corneal ectatic disorders; corneal endothelial dystrophy; severe dry eye syndrome; severe ocular surface diseases; glaucoma, cataract, and fundus diseases affecting vision; severe anxiety, depression, and other mental or psychological diseases; severe hyperthyroidism and its associated exophthalmos condition that has not yet stabilized; no other ocular diseases and systemic organic diseases. Surgical Techniques All surgeries were performed by the same experienced surgeon (Z.QZ.). During the ICL procedure, the size of the implanted ICL V4c was determined based on the anterior chamber depth (ACD), horizontal corneal white-to-white diameter, and the diameter from sulcus to sulcus. For patients in the ICL-SMCI group, after topical anesthesia, a 3.0mm clear corneal incision was made near the limbus along the steep meridian. A viscoelastic surgical substance was then injected into the anterior chamber, followed by the implantation of the ICL V4c, which was subsequently positioned in the posterior chamber. Finally, the viscoelastic agent was flushed out using a compound sodium chloride solution. Postoperatively, patients were prescribed topical antibiotic eye drops and pranoprofen eye drops, to be used four times daily for 14 days. During the FS-LASIK surgical procedure, a VisuMax femtosecond laser machine (Zeiss, Germany) or an FS-200 (Alcon, USA) was utilized to create corneal flaps with a thickness ranging from 100 to 110μm and a diameter of 8.1 to 8.5mm. After the corneal flap was lifted, ablation was executed using either the Amaris 1050 excimer laser or the EX500. Subsequently to the ablation, the corneal flap and stromal surface were irrigated with a balanced saline solution, and the flap was then repositioned. Postoperatively, patients were prescribed topical antibiotic eye drops, Chlortetracycline eye drops, and Sodium Hyaluronate eye drops, to be used four times daily for a duration of 14 days. Data collection All patients underwent a comprehensive series of ophthalmic evaluations, encompassing uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, slit-lamp examination, intraocular pressure (IOP, Canon, Japan), corneal topography, endothelial cell density, and OQAS. Data for UDVA, CDVA, IOP, and objective refraction were compiled at 1, 6, and 12months post-surgery. ICL vault, ACD, and endothelial cell density (ECD) measurements were taken at 1and 12 months post-surgery. OQAS was used to acquire the optical quality parametersat the 12-month postoperative. Vector analysis, employing the Alpins method, was conducted for eyes that underwent astigmatic correction. All evaluations were performed by a seasoned professional. Statistical Analyses All statistical analyses were conducted using GraphPad Prism 8.0 statistical software; quantitative variables were presented as mean± standard deviation; independent samples t-tests were employed to compare clinical variables and astigmatic vector analysis between the two groups; differences were considered statistically significant when P < 0.05. Results In this research, the demographic details and initial preoperative measures are presented in Table 1. Table 1. Baseline of the two groups ICL-SMCI group FS-LASIK group P value Patients/eyes (n) 21/26 23/27 — Eye，right（%） 46% 56% — Sex, Male(%) 10% 43% — Age(y) 28.43±6.98 20.74±5.30 0.0002 SE(D) -6.04±1.80 -5.40±1.17 0.45 Cylinder(D) -1.06±0.26 -0.94±0.26 0.09 Pre-CDVA (logMAR) 0.02±0.04 0.01±0.03 0.25 D: diopters; SE: spherical equivalent; Values presented as means ± standard deviation (range) Refractive Outcomes At 1 year, all patients in both groups attained an uncorrected distance visual acuity (UDVA) of 20/20 or better, with no eyes in either group losing 1 or more lines (Fig.1A,2A,1B,2B). All surgeries were uneventful, with no intraoperative or postoperative complications. One- year post-operative, 22 eyes (85%) in the ICL-SMCI group and 25 eyes (92%) in the FS-LASIK group experienced an improvement of one or more lines in the corrected distance visual acuity (CDVA) (Fig.1C,2C). The attempted versus achieved spherical equivalent correction is depicted in Figs. 1D and 2D. The percentage of eyes with postoperative spherical equivalent (SE) within±0.5D and±1.0D was 96% and 100% in the ICL-SMCI group, and 93% and 100% in the FS-LASIK group, respectively (Figs.1E, 2E).The change in SE is illustrated in Figs. 1F and 2F. Astigmatism Vector Analysis At 1 year, the percentage of eyes with postoperative refractive astigmatism within ±0.5 D and ±1.0 D was 19% and 77% in the ICL-SMCI group, and 89% and 100% in the FS-LASIK group, respectively (Figure 1G, 2G). Vector analysis results indicated that there were no significant differences in TIA and AE between the FS-LASIK and ICL-SMCI groups (P>0.05) (Table 2, Fig.3). However, significant differences were observed in SIA, CI, and DV between the two groups (P<0.001) (Table 2, Fig.3). The CI for the ICL-SMCI group and FS-LASIK groups were 0.46±0.34 and 1.13±0.38 D, respectively (P<0.0001). At 12 months postoperative, the mean magnitude of SIA was 0.42±0.35 and 0.92±0.36D (P<0.0001), respectively. The DV indicated that residual astigmatism was -0.89±0.29 D in the FS-LASIK group and -0.29±0.22 D in the ICL-SMCI group, with a significant difference (P<0.0001) (Table 2). Table 2 Vector analysis results after ICL-SMCI and FS-LASIK at 1,6 and 12 months 1month 6month 12month ICL-SMCI group FS-LASIK group P- value ICL-SMCI group FS-LASIK group P- value ICL-SMCI group FS-LASIK group P- value TIA 0.91±0.19 0.82±0.21 0.1062 0.91±0.19 0.82±0.21 0.1062 0.91±0.11 0.82±0.22 0.1062 SIA 0.52±0.49 0.98±0.36 0.0003 0.39±0.37 0.91±0.28 0.0001 0.42±0.35 0.92±0.36 0.0001 DV 0.80±0.32 0.32±0.24 0.0001 0.82±0.28 0.26±0.16 0.0001 0.88±0.28 0.29±0.22 0.0001 AE 2.05±45.9 -1.88±18.01 0.4312 5.19±45.22 -0.85±10.33 0.197 -5.47±48.01 1.52±8.49 0.9008 CI 2.54±0.56 1.21±0.42 0.0001 0.42±0.36 1.13±0.31 0.0001 0.46±0.34 1.13±0.38 0.0001 Objective Visual Quality After one year, the Strehl ratio for both the ICL-SMCI group and the FS-LASIK group was 0.20±0.04 and 0.21±0.06 respectively, showing no significant statistical difference between the two (P>0.05). Similarly, the MTF-cutoff values were 33.22±8.57 and 35.62±10.26 for the ICL-SMCI and FS-LASIK groups respectively, with no significant statistical difference (P>0.05). The OSI values were 0.78±0.37 and 0.91±0.62 for the ICL-SMCI and FS-LASIK groups respectively, also indicating no significant statistical difference (P>0.05)(Fig.4 , Table 3) Table 3 Objective visual quality after ICL-SMCI and FS-LASIK at 12 months MTF-cutoff (cpd) OSI Strehl ratio ICL group 33.22±8.57 0.78±0.37 0.20±0.04 FS-LASIK group 35.62±10.26 0.91±0.62 0.21±0.06 P value 0.3581 0.3415 0.5166 MTF-cutoff: the modulation transfer function cutoff frequency; OSI: the objective scatter index; Discussions Refractive outcomes associated with ICL and FS-LASIK have been previously reported. Nevertheless, to the best of our knowledge, no study has yet compared these two methods specifically for the correction of low to moderate astigmatism, nor has there been a comprehensive assessment of their long-term safety, efficacy, and objective visual quality. In our study, we exclusively employed ICL implantation with an incision on the steep meridian, rather than TICL implantation, to correct low to moderate astigmatism. At 1 year, all the patients in both groups achieved an uncorrected distance visual acuity (UDVA) of 20/20 or better. The gain in lines of CDVA was 85% in ICL-SMCI group and 92% in FS-LASIK group. The percentage of the eyes with postoperative SE within ±0.5 D, ±1.0 D, was 96% and 100% in the ICL-SMCI group, 93% and 100% in the FS-LASIK group. Our results indicate that ICL-SMCI group and FS-LASIK group obtained satisfactory refractive outcomes in safety and efficacy. Zheng found that in high myopia correction 83.33% and 77.59% eyes had a UDVA of 20/20 or better in the ICL-SMCI group and the FS-LASIK group, respectively, which was lower than our results. The percentage of the eyes with postoperative SE within ±0.5 D, ±1.0 D, was 97.92% and 100% in the ICL-SMCI group which was consist with our results, and 68.97% and 98.28% in the FS-LASIK group which was much lower than ours [13] . That might due to the fact that FS-LASIK removes a greater amount of corneal tissue, leading to an increase in higher-order aberrations that affect visual quality, and additionally increases the risk of regression. The study by Chen on correcting moderate and high astigmatism showed that the percentage of the eyes with postoperative SE within ±0.5 D and ±1.0 D was 77.27% and 95.45%, 95.45% and 95.45% in the FS-LASIK group and Toric ICL-SMCI group, respectively [14] . The research by Gansh on correcting low to moderate myopic astigmatism showed that T-ICL-SMCI group had the highest percentage of eyes (60%) with gain in lines of CDVA by one or more lines compared to FS-LASIK (40%) and ReLEx SMILE group (50%), which was lower than our results [15] .Therefore, we believe that ICL-SMCI has similar treatment effect as FS-LASIK in the correction of low to moderate astigmatism, and that ICL-SMCI can achieve refractive outcomes similar to TICL implantation in correcting low to moderate astigmatism, without the risk of rotation and displacement. Nevertheless, our study showed that the residual astigmatism in the FS-LASIK group was much smaller than that in the ICL-SMCI group（0.88±0.28 vs.0.29±0.22), and the correction index (CI) and SIA were significantly difference in the two groups(CI: 0.46±0.34 vs.1.13±0.38; SIA:0.42±0.35 vs.0.92±0.36). Our findings indicated that there was an undercorrection of astigmatism in the ICL-SMCI group and a slight overcorrection in the FS-LASIK group. Liu et al found that ICL implantation with a steep-meridian corneal incision to correct low to moderate astigmatism can alleviate corneal astigmatism and decrease the cylindrical diopter compared with non-steep-meridian corneal incision (DV:0.21±0.21vs. 0.47±0.35;CI:0.84±0.30 vs. 0.71±0.43;SIA:0.59±0.25 vs. 0.40± 0.20) [11] . Their research has a better effect on astigmatism correction than our research, possibly because our observation period was 1 year while the observation period was only half a year, and the astigmatism caused by corneal relaxation incision may have regressed. But the objective visual quality 1 year after surgery include OSI, MTF-cutoff, SR have no significant difference in two groups. Gansh et al showed that the quality of vision and patient satisfaction with T-ICL was better than FS-LASIK, which was not consist with our results [15] . Zheng et al found that ICL implantation produced a similar impact on objective optical quality in the central vision compared with other laser refractive surgeries which was consist with our research. A previous study indicated that ICL implantation will provide better optical quality of vision if the patient’s cornea was not too aberrated [16] . Our study shows that ICL-SMCI achieves significantly lower astigmatic correction compared to FS-LASIK. Nevertheless, both procedures result in satisfactory postoperative visual acuity. Moreover, there is no significant difference in objective visual quality parameters one year after surgery between the two groups. The reason why the ICL-SMCI group, despite lower astigmatic correction, attains comparable visual quality may be attributed to several factors. Firstly, the proportion of spherical and cylindrical lenses affecting visual quality. In our patient groups, the ICL-SMCI group comprised 46% of patients with high myopia, whereas the FS-LASIK group included 37% of patients with high myopia. For low to moderate astigmatism, a higher spherical lens power reduces the proportion of astigmatism, potentially diminishing its impact on visual acuity. Thus, even if the ICL is under-corrected for astigmatism, its impact on visual quality may be minimal；Secondly, the anatomic position of the crystalline lens, which is closer to the nodal point, may result in superior postoperative visual quality；Thirdly, the corneal tissue ablation performed in FS-LASIK may lead to an increase in higher-order aberrations postoperative, thereby affecting visual quality [17, 18] .Our study indicating that the correction of myopia combined with low to moderate astigmatism can be effectively managed without the use of toric lenses. However, our study has some limitations. First, our assessment of visual quality is not comprehensive enough, lacking objective visual quality assessments at various preoperative and postoperative time points. Second, our sample size is small, and the corrective effect of using ICL-SMCI for patients with low to moderate astigmatism needs further validation; additionally, the ratio of cylinder to sphere may affect the results; therefore, in future studies, we will collect more cases and improve the visual quality assessments at various preoperative and postoperative time points, and conduct further research on the impact of astigmatism proportion on visual quality. Conclusion In conclusion, our findings indicate that the ICL-SMCI and FS-LASIK yields favorable corrective outcomes for low to moderate astigmatism. Nonetheless, the use of ICL-SMCI over a one-year period demonstrates restricted corrective efficacy for low to moderate astigmatism, yet it may not compromise the patient's visual quality post-surgery. Declarations Conflicts of Interest The authors declare that there are no conflicts of interest regarding the publication of this paper. Acknowledgements Not applicable. Abbrevations ICL-SMCI implantable collamer lens implantation with steep-meridian incision FS-LASIK femtosecond laser assisted laser in situ keratomileusis Authors’ contributions JL, and QZZ were responsible for study design; YG and BQS were involved in data collection; JL and QZZ conducted data analysis; JL and QZZ drafted and wrote the manuscript; All authors have read and approved the manuscript. Funding Not applicable Availability of data and materials The datasets used and analysed during the current study available from the corresponding author on reasonable request. Ethics approval and consent to participate This study was approved by the ethics committee of Chongqing Eye and Vision Care Hospital and performed in accordance with the tenets of the Declaration of Helsinki. Written informed consents were obtained from all participants. Consent for publication Not applicable Competing interest The authors declare that they have no competing interests. References CHUCK R S, JACOBS D S, LEE J K, et al. Refractive Errors & Refractive Surgery Preferred Practice Pattern® [J]. Ophthalmology, 2018, 125(1): P1-p104. BARSAM A, ALLAN B D. Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia [J]. Cochrane Database Syst Rev, 2014, 2014(6): Cd007679. QAZI M A, SANDERSON J P, MAHMOUD A M, et al. Postoperative changes in intraocular pressure and corneal biomechanical metrics Laser in situ keratomileusis versus laser-assisted subepithelial keratectomy [J]. J Cataract Refract Surg, 2009, 35(10): 1774-88. BAO F, LOPES B T, ZHENG X, et al. Corneal Biomechanics Losses Caused by Refractive Surgery [J]. Curr Eye Res, 2023, 48(2): 137-43. WU W, WANG Y. Corneal Higher-Order Aberrations of the Anterior Surface, Posterior Surface, and Total Cornea After SMILE, FS-LASIK, and FLEx Surgeries [J]. Eye Contact Lens, 2016, 42(6): 358-65. MOSHIRFAR M, BUNDOGJI N, TUKAN A N, et al. Toric Implantable Collamer Lens for the Treatment of Myopic Astigmatism [J]. Clin Ophthalmol, 2021, 15(2893-906. CANO-ORTIZ A, S NCHEZ-VENTOSA Á, MEMBRILLO A, et al. Astigmatism correction with toric implantable collamer lens in low and high astigmatism groups [J]. Eur J Ophthalmol, 2022, 32(1): 183-92. ZHU M, ZHU L, ZHU Q, et al. Clinical Effect and Rotational Stability of TICL in the Treatment of Myopic Astigmatism [J]. J Ophthalmol, 2020, 2020(3095302. HE W, ZHU X, DU Y, et al. Clinical efficacy of implantation of toric intraocular lenses with different incision positions: a comparative study of steep-axis incision and non-steep-axis incision [J]. BMC Ophthalmol, 2017, 17(1): 132. BORASIO E, MEHTA J S, MAURINO V. Torque and flattening effects of clear corneal temporal and on-axis incisions for phacoemulsification [J]. J Cataract Refract Surg, 2006, 32(12): 2030-8. LIU S, LIU J, LIN F, et al. Efficacy Comparison Between Steep-Meridian Incision and Non-Steep-Meridian Incision in Implantable Collamer Lens Surgery with Low-to-Moderate Astigmatism [J]. Ophthalmol Ther, 2023, 12(3): 1711-22. ZHOU J, LI S, HE G, et al. Predicting the impact of femtosecond-assisted arcuate keratotomy combined with tri-planar clear corneal incisions on astigmatism in implantable collamer lens surgery: one-year follow-up [J]. Graefes Arch Clin Exp Ophthalmol, 2024, JIANG Z, WANG H, LUO D Q, et al. Optical and visual quality comparison of implantable collamer lens and femtosecond laser assisted laser in situ keratomileusis for high myopia correction [J]. Int J Ophthalmol, 2021, 14(5): 737-43. CHEN K, HU Z, ZHOU J, et al. Vector Analysis of the Effects of FS-LASIK and Toric ICL for Moderate to High Astigmatism Correction [J]. J Ophthalmol, 2018, 2018(6952710. GANESH S, BRAR S, PAWAR A. Matched population comparison of visual outcomes and patient satisfaction between 3 modalities for the correction of low to moderate myopic astigmatism [J]. Clin Ophthalmol, 2017, 11(1253-63. GARC A C, CAMPS V J, CABALLERO M T, et al. Comparison of the optical quality vision between real post-LASIK myopic laser surgery and the simulated implantation of a phakic IOL in low myopia [J]. Sci Rep, 2022, 12(1): 18942. BLANCO-DOMINGUEZ I, DUCH F, POLO V, et al. Correlation and regression analysis between residual gradation and uncorrected visual acuity one year after refractive surgery with LASIK, FS-LASIK, PRK, PRK Xtra techniques and the implantation of ICL® posterior chamber phakic lens in myopic correction [J]. PLoS One, 2020, 15(9): e0238399. LIU Z, ZHAO Y, SUN S, et al. Effect of preoperative pupil offset on corneal higher-order aberrations after femtosecond laser-assisted in situ keratomileusis [J]. BMC Ophthalmol, 2023, 23(1): 247. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6520824","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":463048835,"identity":"00daf282-ba5b-4972-b868-5214304dfabf","order_by":0,"name":"Jia Li","email":"","orcid":"","institution":"Hangzhou Aier Eye Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jia","middleName":"","lastName":"Li","suffix":""},{"id":463048836,"identity":"e663f05b-1823-40ec-9c4c-c779da96827a","order_by":1,"name":"Biqi Shao","email":"","orcid":"","institution":"Hangzhou Aier Eye Hospital","correspondingAuthor":false,"prefix":"","firstName":"Biqi","middleName":"","lastName":"Shao","suffix":""},{"id":463048837,"identity":"0ce8b49b-1091-4542-afb9-f6c4efd1c84e","order_by":2,"name":"Yang Gao","email":"","orcid":"","institution":"Chongqing Eye and Vision Care Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Gao","suffix":""},{"id":463048838,"identity":"c48116fb-5850-4d77-8ecb-5ed66c95a4e4","order_by":3,"name":"Qizhi Zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIie3QMQrCMBSA4ZRCugTnVyr2Ck8KonfwEAlKJxHBxUFKIBCvIFj0Ck7OSqGTB3BsdfUADg5WOqnQdnTIPzwI5IPkEWIy/WPwHkg4dVSS8QV0/OaEpSFm537QlY0IIZzAEN1cLwQ51gh/o1K4z6JpCxii2AK3pJ1fLxXEitPQjZHOqadnmTjA1CE0CCYVxIZJz2PIhG4neyzI3JKMelWElgSEBl7MGIQ81hBWEizIuCCyAQEIR4MYudDvJfMUgq6q+Yu/Hp0u92ckdiuV5I9l1PEdld+qSPm6j5Ndd/2XmEwmk+mrF+haRngUCNDPAAAAAElFTkSuQmCC","orcid":"","institution":"Chongqing Eye and Vision Care Hospital","correspondingAuthor":true,"prefix":"","firstName":"Qizhi","middleName":"","lastName":"Zhou","suffix":""}],"badges":[],"createdAt":"2025-04-24 12:38:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6520824/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6520824/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83892509,"identity":"7e4c83db-9075-4aa0-b4e6-d7b26a2c9939","added_by":"auto","created_at":"2025-06-04 08:20:27","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":408632,"visible":true,"origin":"","legend":"\u003cp\u003eVisual outcomes of the ICL-SMCI group at 1 year postoperative. A: uncorrected distance visual\u003c/p\u003e\n\u003cp\u003eacuity (UDVA) outcomes; B: postoperative UDVA and preoperative corrected distance visual acuity (CDVA); C: change in CDVA; D: distribution of achieved spherical equivalent outcomes; E: spherical equivalent refractive accuracy; F: stability of spherical equivalent refraction; G: refractive astigmatism; H: target induced versus surgically induced astigmatism vectors; I: refractive astigmatism angle of error distribution.\u003c/p\u003e","description":"","filename":"image1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6520824/v1/765862e0581e46a98b7b6bfd.jpeg"},{"id":83892511,"identity":"b3d11815-67af-4464-b753-f2b90f6a6b5b","added_by":"auto","created_at":"2025-06-04 08:20:27","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":396565,"visible":true,"origin":"","legend":"\u003cp\u003eVisual outcomes of the FS-LASIK group at 1 year postoperative. A: uncorrected distance visual\u003c/p\u003e\n\u003cp\u003eacuity (UDVA) outcomes; B: postoperative UDVA and preoperative corrected distance visual acuity (CDVA); C: change in CDVA; D: distribution of achieved spherical equivalent outcomes; E: spherical equivalent refractive accuracy; F: stability of spherical equivalent refraction; G: refractive astigmatism; H: target induced versus surgically induced astigmatism vectors; I: refractive astigmatism angle of error distribution.\u003c/p\u003e","description":"","filename":"image2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6520824/v1/4694bd434e4d65f8b6cd5e2b.jpeg"},{"id":83892512,"identity":"5f8d1e6f-ccac-484d-a5f4-61c7e9eaa0c3","added_by":"auto","created_at":"2025-06-04 08:20:28","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":246078,"visible":true,"origin":"","legend":"\u003cp\u003eSingle-angle polar plots at 1 year postoperative. A: correction index of ICL-SMCI group; B: correction index of the FS-LASIK group; C difference vector of the ICL-SMCI group. D: difference vector of the FS-LASIK group; E surgically induced astigmatism vector of the ICL-SMCI group; F: surgically induced astigmatism vector of FS-LASIK group; G: target induced astigmatism vector of ICL-SMCI\u003c/p\u003e\n\u003cp\u003egroup; H: target induced astigmatism vector of the FS-LASIK group.\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-6520824/v1/d1fd0f4a7efdbb1526da6801.png"},{"id":83893648,"identity":"3d0a3c91-dbe1-4aeb-b171-8ff48b768e19","added_by":"auto","created_at":"2025-06-04 08:28:27","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":84371,"visible":true,"origin":"","legend":"\u003cp\u003eComparative analysis of objective visual quality between the ICL-SMCI group and the FS-LASIK group one- year post-operative.\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-6520824/v1/33b696daeebf8dc760b0df5d.png"},{"id":86130033,"identity":"dee87ecf-1744-4833-b3a4-1a142139b77b","added_by":"auto","created_at":"2025-07-07 06:38:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1617850,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6520824/v1/bf763920-c1de-4356-820b-e644da57d950.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Visual Quality Comparison Between ICL Implantation with Steep-Meridian Incision and FS-LASIK in Correcting Low to Moderate Astigmatism","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAt present, the primary surgical interventions for correcting refractive errors are corneal refractive surgery and intraocular lens implantation\u003csup\u003e[1, 2]\u003c/sup\u003e.\u0026nbsp;Among these, FS-LASIK is a widely adopted procedure within corneal refractive surgery, effectively treating myopia, hyperopia, and astigmatism. But FS-LAISK requires the ablation of corneal tissue, which reduces the biomechanical stability of the cornea and increases the impact of higher-order aberrations on the patient\u0026apos;s postoperative visual quality\u003csup\u003e[3-5]\u003c/sup\u003e. The ICL (Implantable Collamer Lens) is a viable method for correcting myopia and astigmatism, which can avoid complications related to the cutting of corneal tissue. TICL, a toric version of the ICL, can correct astigmatism up to 6.0D. Compared to ICL, TICL is more costly, requires a longer period for customization, and carries the risk of rotation and displacement post-implantation, which can impact the patient\u0026apos;s postoperative visual quality and satisfaction. Furthermore, for patients with low to moderate astigmatism (\u0026le;1.50D), the degree of astigmatism increases in increments of 0.5D for TICL, which cannot correct all low to moderate astigmatism degrees, and the calculation formula does not account for surgically induced astigmatism\u003csup\u003e[6-8]\u003c/sup\u003e. Therefore, can patients with low to moderate astigmatism (\u0026le;1.5D) achieve satisfactory postoperative visual quality through ICL instead of TICL?\u003c/p\u003e\n\u003cp\u003eSome researchers advocate for placing the main corneal incision on the steep meridian to reduce corneal astigmatism\u003csup\u003e[9, 10]\u003c/sup\u003e. This method is straightforward, cost-effective, and does not require additional incisions, thereby lowering the risk of infection and demonstrating good outcomes for patients with low to moderate astigmatism. However, these research concentrates on the short-term correction effects of astigmatism and lacks a thorough evaluation of postoperative visual quality\u003csup\u003e[10, 11]\u003c/sup\u003e. Femtosecond laser-assisted ICL surgery, while capable of achieving good correction effects for astigmatism, is limited in clinical application due to its high cost\u003csup\u003e[12]\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo investigate these issues, we intend to compare the corrective outcomes of ICL-SMCI and FS-LASIK in patients suffering from low to moderate astigmatism. Our aim is to ascertain whether ICL-SMCI can effectively correct low to moderate astigmatism, achieving favorable treatment results and postoperative visual quality as an alternative to TICL. This comparison may provide a scientific foundation for the selection of clinical surgical methods.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cp\u003eThis retrospective study encompassed 53 eyes from 41 patients, with astigmatism ranging from -0.25 to -1.50D preoperatively. The patients were divided into two groups: the first group underwent ICL-SMCI, while the control group received FS-LASIK. Ethical approval was obtained from the Medical Ethics Committee of the authors’hospital (IRB 2024010).\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria were as follows: age ranging from 18 to 40 years; stable refraction for a minimum of 2 years; for ICL patients, preoperative chamber depth of at least 2.8mm, endothelial count of at least 2000 cells/mm\u003csup\u003e2\u003c/sup\u003e; cylinder diplomer not exceeding 1.50D; for FS-LASIK patients, central corneal thickness exceeding 480μm, and residual stroma thicker than 280μm;\u003c/p\u003e\n\u003cp\u003eExclusion criteria: active inflammatory or infectious lesions of the eye; unstable period of keratoconus or other corneal ectatic disorders; corneal endothelial dystrophy; severe dry eye syndrome; severe ocular surface diseases; glaucoma, cataract, and fundus diseases affecting vision; severe anxiety, depression, and other mental or psychological diseases; severe hyperthyroidism and its associated exophthalmos condition that has not yet stabilized; no other ocular diseases and systemic organic diseases.\u003c/p\u003e\n\u003cp\u003eSurgical Techniques\u003c/p\u003e\n\u003cp\u003eAll surgeries were performed by the same experienced surgeon (Z.QZ.). During the ICL procedure, the size of the implanted ICL V4c was determined based on the anterior chamber depth (ACD), horizontal corneal white-to-white diameter, and the diameter from sulcus to sulcus. For patients in the ICL-SMCI group, after topical anesthesia, a 3.0mm clear corneal incision was made near the limbus along the steep meridian. A viscoelastic surgical substance was then injected into the anterior chamber, followed by the implantation of the ICL V4c, which was subsequently positioned in the posterior chamber. Finally, the viscoelastic agent was flushed out using a compound sodium chloride solution. Postoperatively, patients were prescribed topical antibiotic eye drops and pranoprofen eye drops, to be used four times daily for 14 days.\u003c/p\u003e\n\u003cp\u003eDuring the FS-LASIK surgical procedure, a VisuMax femtosecond laser machine (Zeiss, Germany) or an FS-200 (Alcon, USA) was utilized to create corneal flaps with a thickness ranging from 100 to 110μm and a diameter of 8.1 to 8.5mm. After the corneal flap was lifted, ablation was executed using either the Amaris 1050 excimer laser or the EX500. Subsequently to the ablation, the corneal flap and stromal surface were irrigated with a balanced saline solution, and the flap was then repositioned. Postoperatively, patients were prescribed topical antibiotic eye drops, Chlortetracycline eye drops, and Sodium Hyaluronate eye drops, to be used four times daily for a duration of 14 days.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients underwent a comprehensive series of ophthalmic evaluations, encompassing uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, slit-lamp examination, intraocular pressure (IOP, Canon, Japan), corneal topography, endothelial cell density, and OQAS. Data for UDVA, CDVA, IOP, and objective refraction were compiled at 1, 6, and 12months post-surgery. ICL vault, ACD, and endothelial cell density (ECD) measurements were taken at 1and 12 months post-surgery. OQAS was used to acquire the optical quality parametersat the 12-month postoperative. Vector analysis, employing the Alpins method, was conducted for eyes that underwent astigmatic correction. All evaluations were performed by a seasoned professional.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were conducted using GraphPad Prism 8.0 statistical software; quantitative variables were presented as mean± standard deviation; independent samples t-tests were employed to compare clinical variables and astigmatic vector analysis between the two groups; differences were considered statistically significant when P \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn this research, the demographic details and initial preoperative measures are presented in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1. Baseline of the two groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eICL-SMCI group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eFS-LASIK group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003ePatients/eyes (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e21/26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e23/27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEye，right（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e46%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e56%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eSex, Male(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e43%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eAge(y)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e28.43\u0026plusmn;6.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e20.74\u0026plusmn;5.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.0002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eSE(D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e-6.04\u0026plusmn;1.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e-5.40\u0026plusmn;1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eCylinder(D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e-1.06\u0026plusmn;0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e-0.94\u0026plusmn;0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003ePre-CDVA (logMAR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.02\u0026plusmn;0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.01\u0026plusmn;0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eD: diopters; SE: spherical equivalent; Values presented as means \u0026plusmn; standard deviation (range)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRefractive Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt 1 year, all patients in both groups attained an uncorrected distance visual acuity (UDVA) of 20/20 or better, with no eyes in either group losing 1 or more lines (Fig.1A,2A,1B,2B). All surgeries were\u0026nbsp;\u003c/p\u003e\n\u003cp\u003euneventful, with no intraoperative or postoperative complications. One- year post-operative, 22 eyes (85%) in the ICL-SMCI group and 25 eyes (92%) in the FS-LASIK group experienced an improvement of one or more lines in the corrected distance visual acuity (CDVA) (Fig.1C,2C).\u003c/p\u003e\n\u003cp\u003eThe attempted versus achieved spherical equivalent correction is depicted in Figs. 1D and 2D. The percentage of eyes with postoperative spherical equivalent (SE) within\u0026plusmn;0.5D and\u0026plusmn;1.0D was 96% and 100% in the ICL-SMCI group, and 93% and 100% in the FS-LASIK group, respectively (Figs.1E, 2E).The change in SE is illustrated in Figs. 1F and 2F.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAstigmatism Vector Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt 1 year, the percentage of eyes with postoperative refractive astigmatism within\u0026nbsp;\u0026plusmn;0.5 D and\u0026nbsp;\u0026plusmn;1.0 D was 19% and 77% in the ICL-SMCI group, and 89% and 100% in the FS-LASIK group, respectively (Figure 1G, 2G). Vector analysis results indicated that there were no significant differences in TIA and AE between the FS-LASIK and ICL-SMCI groups (P\u0026gt;0.05) (Table 2, Fig.3). However, significant differences were observed in SIA, CI, and DV between the two groups (P\u0026lt;0.001) (Table 2, Fig.3). The CI for the ICL-SMCI group and FS-LASIK groups were 0.46\u0026plusmn;0.34 and 1.13\u0026plusmn;0.38 D, respectively (P\u0026lt;0.0001). At 12 months postoperative, the mean magnitude of SIA was 0.42\u0026plusmn;0.35 and 0.92\u0026plusmn;0.36D (P\u0026lt;0.0001), respectively. The DV indicated that residual astigmatism was -0.89\u0026plusmn;0.29 D in the FS-LASIK group and -0.29\u0026plusmn;0.22 D in the ICL-SMCI group, with a significant difference (P\u0026lt;0.0001) (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2 Vector analysis results after ICL-SMCI and FS-LASIK at 1,6 and 12 months\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e1month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e6month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e12month\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003eICL-SMCI group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eFS-LASIK group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cem\u003eP-\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eICL-SMCI group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eFS-LASIK group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cem\u003eP-\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eICL-SMCI group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003eFS-LASIK group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cem\u003eP-\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003eTIA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.91\u0026plusmn;0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.82\u0026plusmn;0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.1062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.91\u0026plusmn;0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.82\u0026plusmn;0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.1062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.91\u0026plusmn;0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.82\u0026plusmn;0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.1062\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003eSIA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.52\u0026plusmn;0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.98\u0026plusmn;0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.39\u0026plusmn;0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.91\u0026plusmn;0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.42\u0026plusmn;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.92\u0026plusmn;0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003eDV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.80\u0026plusmn;0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.32\u0026plusmn;0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.82\u0026plusmn;0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.26\u0026plusmn;0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.88\u0026plusmn;0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.29\u0026plusmn;0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003eAE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e2.05\u0026plusmn;45.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-1.88\u0026plusmn;18.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.4312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e5.19\u0026plusmn;45.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-0.85\u0026plusmn;10.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-5.47\u0026plusmn;48.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e1.52\u0026plusmn;8.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.9008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003eCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e2.54\u0026plusmn;0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1.21\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.42\u0026plusmn;0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1.13\u0026plusmn;0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.46\u0026plusmn;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e1.13\u0026plusmn;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eObjective Visual Quality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter one year, the Strehl ratio for both the ICL-SMCI group and the FS-LASIK group was 0.20\u0026plusmn;0.04 and 0.21\u0026plusmn;0.06 respectively, showing no significant statistical difference between the two (P\u0026gt;0.05). Similarly, the MTF-cutoff values were 33.22\u0026plusmn;8.57 and 35.62\u0026plusmn;10.26 for the ICL-SMCI and FS-LASIK groups respectively, with no significant statistical difference (P\u0026gt;0.05). The OSI values were 0.78\u0026plusmn;0.37 and 0.91\u0026plusmn;0.62 for the ICL-SMCI and FS-LASIK groups respectively, also indicating no significant statistical difference (P\u0026gt;0.05)(Fig.4 , Table 3)\u003c/p\u003e\n\u003cp\u003eTable 3 Objective visual quality\u0026nbsp;after ICL-SMCI and FS-LASIK at 12 months\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMTF-cutoff (cpd)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eOSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eStrehl ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eICL group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e33.22\u0026plusmn;8.57\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.78\u0026plusmn;0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.20\u0026plusmn;0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eFS-LASIK group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e35.62\u0026plusmn;10.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.91\u0026plusmn;0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.21\u0026plusmn;0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.3581\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.3415\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.5166\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMTF-cutoff: the modulation transfer function cutoff frequency; OSI: the objective scatter index;\u003c/p\u003e"},{"header":"Discussions ","content":"\u003cp\u003eRefractive outcomes associated with ICL and FS-LASIK have been previously reported. Nevertheless, to the best of our knowledge, no study has yet compared these two methods specifically for the correction of low to moderate astigmatism, nor has there been a comprehensive assessment of their long-term safety, efficacy, and objective visual quality. In our study, we exclusively employed ICL implantation with an incision on the steep meridian, rather than TICL implantation, to correct low to moderate astigmatism.\u0026nbsp;At 1 year, all the patients in both groups achieved an uncorrected distance visual acuity (UDVA) of 20/20 or better. The gain in lines of CDVA was 85% in ICL-SMCI group and 92% in FS-LASIK group. The percentage of the eyes with postoperative SE within \u0026plusmn;0.5 D, \u0026plusmn;1.0 D, was 96% and 100% in the ICL-SMCI group, 93% and 100% in the FS-LASIK group. Our results indicate that ICL-SMCI group and FS-LASIK group obtained satisfactory refractive outcomes in safety and efficacy. Zheng found that in high myopia correction 83.33% and 77.59% eyes had a UDVA of 20/20 or better in the ICL-SMCI group and the FS-LASIK group, respectively, which was lower than our results. The percentage of the eyes with postoperative SE within \u0026plusmn;0.5 D, \u0026plusmn;1.0 D, was 97.92% and 100% in the ICL-SMCI group which was consist with our results, and 68.97% and 98.28% in the FS-LASIK group which was much lower than ours\u003csup\u003e[13]\u003c/sup\u003e. That might due to the fact that FS-LASIK removes a greater amount of corneal tissue, leading to an increase in higher-order aberrations that affect visual quality, and additionally increases the risk of regression. The study by Chen on correcting moderate and high astigmatism showed that the\u0026nbsp;percentage of the eyes with postoperative SE within \u0026plusmn;0.5 D and \u0026plusmn;1.0 D was 77.27% and 95.45%, 95.45% and 95.45% in the FS-LASIK group and Toric ICL-SMCI group, respectively\u003csup\u003e[14]\u003c/sup\u003e. The research by Gansh on correcting low to moderate myopic astigmatism showed that T-ICL-SMCI group had the highest percentage\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eof eyes (60%) with gain in lines of CDVA by one or more lines compared to FS-LASIK (40%) and ReLEx SMILE group (50%), which was lower than our results\u003csup\u003e[15]\u003c/sup\u003e.Therefore, we believe that ICL-SMCI has similar treatment effect as FS-LASIK in the correction of low to moderate astigmatism, and that ICL-SMCI can achieve refractive outcomes similar to TICL implantation in correcting low to moderate astigmatism, without the risk of rotation and displacement.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Nevertheless, our study showed that the residual astigmatism in the FS-LASIK group was much smaller than that in the ICL-SMCI group（0.88\u0026plusmn;0.28 vs.0.29\u0026plusmn;0.22), and the correction index (CI) and SIA were significantly difference in the two groups(CI: 0.46\u0026plusmn;0.34 vs.1.13\u0026plusmn;0.38; SIA:0.42\u0026plusmn;0.35 vs.0.92\u0026plusmn;0.36). Our findings indicated that there was an undercorrection of astigmatism in the ICL-SMCI group and a slight overcorrection in the FS-LASIK group. Liu et al found that ICL implantation with a steep-meridian corneal incision to correct low to moderate astigmatism can alleviate corneal astigmatism and decrease the cylindrical diopter compared with non-steep-meridian corneal incision (DV:0.21\u0026plusmn;0.21vs. 0.47\u0026plusmn;0.35;CI:0.84\u0026plusmn;0.30 vs. 0.71\u0026plusmn;0.43;SIA:0.59\u0026plusmn;0.25 vs. 0.40\u0026plusmn;\u0026nbsp;0.20)\u003csup\u003e[11]\u003c/sup\u003e. Their research has a better effect on astigmatism correction than our research, possibly because our observation period was 1 year while the observation period was only half a year, and the astigmatism caused by corneal relaxation incision may have regressed.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;But the objective visual quality 1 year after surgery include OSI, MTF-cutoff, SR have no significant difference in two groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGansh et al showed that the quality of vision and patient satisfaction with T-ICL was better than FS-LASIK, which was not consist with our results\u003csup\u003e[15]\u003c/sup\u003e. Zheng et al found that ICL implantation produced a similar impact on objective optical quality in the central vision compared with other laser refractive surgeries which was consist with our research. A previous study indicated that ICL implantation will provide better optical quality of vision if the patient\u0026rsquo;s cornea was not too aberrated\u003csup\u003e[16]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eOur study shows that ICL-SMCI achieves significantly lower astigmatic correction compared to FS-LASIK. Nevertheless, both procedures result in satisfactory postoperative visual acuity. Moreover, there is no significant difference in objective visual quality parameters one year after surgery between the two groups. The reason why the ICL-SMCI group, despite lower astigmatic correction, attains comparable visual quality may be attributed to several factors. Firstly,\u0026nbsp;the proportion of spherical and cylindrical lenses affecting visual quality. In our patient groups, the ICL-SMCI group comprised 46% of patients with high myopia, whereas the FS-LASIK group included 37% of patients with high myopia. For low to moderate astigmatism, a higher spherical lens power reduces the proportion of astigmatism, potentially diminishing its impact on visual acuity. Thus, even if the ICL is under-corrected for astigmatism, its impact on visual quality may be minimal；Secondly,\u0026nbsp;the anatomic position of the crystalline lens, which is closer to the nodal point, may result in superior postoperative visual quality；Thirdly, the corneal tissue ablation performed in FS-LASIK may lead to an increase in higher-order aberrations postoperative, thereby affecting visual quality\u003csup\u003e[17, 18]\u003c/sup\u003e.Our study indicating that the correction of myopia combined with low to moderate astigmatism can be effectively managed without the use of toric lenses.\u003c/p\u003e\n\u003cp\u003eHowever, our study has some limitations. First, our assessment of visual quality is not comprehensive enough, lacking objective visual quality assessments at various preoperative and postoperative time points. Second, our sample size is small, and the corrective effect of using ICL-SMCI for patients with low to moderate astigmatism needs further validation; additionally, the ratio of cylinder to sphere may affect the results; therefore, in future studies, we will collect more cases and improve the visual quality assessments at various preoperative and postoperative time points, and conduct further research on the impact of astigmatism proportion on visual quality.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, our findings indicate that the ICL-SMCI and FS-LASIK yields favorable corrective outcomes for low to moderate astigmatism. Nonetheless, the use of ICL-SMCI over a one-year period demonstrates restricted corrective efficacy for low to moderate astigmatism, yet it may not compromise the patient\u0026apos;s visual quality post-surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interest regarding the publication of this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbrevations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eICL-SMCI\u003c/p\u003e\n\u003cp\u003eimplantable collamer lens implantation with steep-meridian incision\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFS-LASIK\u003c/p\u003e\n\u003cp\u003efemtosecond laser assisted laser in situ keratomileusis\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJL, and QZZ were responsible for study design; YG and BQS were involved in data collection; JL and QZZ conducted data analysis; JL and QZZ drafted and wrote the manuscript; All authors have read and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethics committee of Chongqing Eye and Vision Care Hospital and performed in accordance with the tenets of the Declaration of Helsinki. Written informed consents were obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCHUCK R S, JACOBS D S, LEE J K, et al. Refractive Errors \u0026amp; Refractive Surgery Preferred Practice Pattern\u0026reg; [J]. Ophthalmology, 2018, 125(1): P1-p104.\u003c/li\u003e\n\u003cli\u003eBARSAM A, ALLAN B D. Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia [J]. Cochrane Database Syst Rev, 2014, 2014(6): Cd007679.\u003c/li\u003e\n\u003cli\u003eQAZI M A, SANDERSON J P, MAHMOUD A M, et al. Postoperative changes in intraocular pressure and corneal biomechanical metrics Laser in situ keratomileusis versus laser-assisted subepithelial keratectomy [J]. J Cataract Refract Surg, 2009, 35(10): 1774-88.\u003c/li\u003e\n\u003cli\u003eBAO F, LOPES B T, ZHENG X, et al. Corneal Biomechanics Losses Caused by Refractive Surgery [J]. Curr Eye Res, 2023, 48(2): 137-43.\u003c/li\u003e\n\u003cli\u003eWU W, WANG Y. Corneal Higher-Order Aberrations of the Anterior Surface, Posterior Surface, and Total Cornea After SMILE, FS-LASIK, and FLEx Surgeries [J]. Eye Contact Lens, 2016, 42(6): 358-65.\u003c/li\u003e\n\u003cli\u003eMOSHIRFAR M, BUNDOGJI N, TUKAN A N, et al. Toric Implantable Collamer Lens for the Treatment of Myopic Astigmatism [J]. Clin Ophthalmol, 2021, 15(2893-906.\u003c/li\u003e\n\u003cli\u003eCANO-ORTIZ A, S NCHEZ-VENTOSA \u0026Aacute;, MEMBRILLO A, et al. Astigmatism correction with toric implantable collamer lens in low and high astigmatism groups [J]. Eur J Ophthalmol, 2022, 32(1): 183-92.\u003c/li\u003e\n\u003cli\u003eZHU M, ZHU L, ZHU Q, et al. Clinical Effect and Rotational Stability of TICL in the Treatment of Myopic Astigmatism [J]. J Ophthalmol, 2020, 2020(3095302.\u003c/li\u003e\n\u003cli\u003eHE W, ZHU X, DU Y, et al. Clinical efficacy of implantation of toric intraocular lenses with different incision positions: a comparative study of steep-axis incision and non-steep-axis incision [J]. BMC Ophthalmol, 2017, 17(1): 132.\u003c/li\u003e\n\u003cli\u003eBORASIO E, MEHTA J S, MAURINO V. Torque and flattening effects of clear corneal temporal and on-axis incisions for phacoemulsification [J]. J Cataract Refract Surg, 2006, 32(12): 2030-8.\u003c/li\u003e\n\u003cli\u003eLIU S, LIU J, LIN F, et al. Efficacy Comparison Between Steep-Meridian Incision and Non-Steep-Meridian Incision in Implantable Collamer Lens Surgery with Low-to-Moderate Astigmatism [J]. Ophthalmol Ther, 2023, 12(3): 1711-22.\u003c/li\u003e\n\u003cli\u003eZHOU J, LI S, HE G, et al. Predicting the impact of femtosecond-assisted arcuate keratotomy combined with tri-planar clear corneal incisions on astigmatism in implantable collamer lens surgery: one-year follow-up [J]. Graefes Arch Clin Exp Ophthalmol, 2024,\u003c/li\u003e\n\u003cli\u003eJIANG Z, WANG H, LUO D Q, et al. Optical and visual quality comparison of implantable collamer lens and femtosecond laser assisted laser in situ keratomileusis for high myopia correction [J]. Int J Ophthalmol, 2021, 14(5): 737-43.\u003c/li\u003e\n\u003cli\u003eCHEN K, HU Z, ZHOU J, et al. Vector Analysis of the Effects of FS-LASIK and Toric ICL for Moderate to High Astigmatism Correction [J]. J Ophthalmol, 2018, 2018(6952710.\u003c/li\u003e\n\u003cli\u003eGANESH S, BRAR S, PAWAR A. Matched population comparison of visual outcomes and patient satisfaction between 3 modalities for the correction of low to moderate myopic astigmatism [J]. Clin Ophthalmol, 2017, 11(1253-63.\u003c/li\u003e\n\u003cli\u003eGARC A C, CAMPS V J, CABALLERO M T, et al. Comparison of the optical quality vision between real post-LASIK myopic laser surgery and the simulated implantation of a phakic IOL in low myopia [J]. Sci Rep, 2022, 12(1): 18942.\u003c/li\u003e\n\u003cli\u003eBLANCO-DOMINGUEZ I, DUCH F, POLO V, et al. Correlation and regression analysis between residual gradation and uncorrected visual acuity one year after refractive surgery with LASIK, FS-LASIK, PRK, PRK Xtra techniques and the implantation of ICL\u0026reg; posterior chamber phakic lens in myopic correction [J]. PLoS One, 2020, 15(9): e0238399.\u003c/li\u003e\n\u003cli\u003eLIU Z, ZHAO Y, SUN S, et al. Effect of preoperative pupil offset on corneal higher-order aberrations after femtosecond\u0026ensp;laser-assisted in situ keratomileusis [J]. BMC Ophthalmol, 2023, 23(1): 247.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6520824/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6520824/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: To compare the long-term effect and visual quality outcomes in correcting low to moderate astigmatism through implantable collamer lens implantation with steep-meridian incision (ICL-SMCI) and femtosecond laser assisted laser in situ keratomileusis (FS-LASIK).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eRetrospective analysis of 53 eyes (41 patients, 18 to 40y) with myopic astigmatism (SE: -3.00D to -9.25D). In this study, 26 eyes were subjected to ICL-SMCI, while 27 eyes were treated with FS-LASIK. Refractive outcomes, vector analysis was evaluated preoperatively, 1 month, 6 months and 1 year postoperatively. Objective visual quality was measured at 1 year.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e At 1 year, all the patients in both groups achieved an uncorrected distance visual acuity (UDVA) of 20/20 or better. The gain in lines of corrected distant visual acuity (CDVA) was maximum in FS-LASIK group (93%). The difference vector (DV) showed that the residual astigmatism in the FS-LASIK group was much smaller than that in the ICL-SMCI group (P\u0026lt;0.0001), and the correction index (CI) was significant statistical different (P\u0026lt;0.0001). The postoperative objective visual quality include objective scatter index(OSI)，modulation transfer function (MTF) cutoff frequency and the strehl ratio (SR) have no significant difference in two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Both ICL-SMCI and FS-LASIK effectively corrected low-to-moderate astigmatism. ICL-SMCI preserved postoperative visual quality comparable to FS-LASIK.\u003c/p\u003e","manuscriptTitle":"Visual Quality Comparison Between ICL Implantation with Steep-Meridian Incision and FS-LASIK in Correcting Low to Moderate Astigmatism","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-04 08:20:23","doi":"10.21203/rs.3.rs-6520824/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"15ebd4ff-c6c4-4b75-8b1d-e82d08bb7eb4","owner":[],"postedDate":"June 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T06:38:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-04 08:20:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6520824","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6520824","identity":"rs-6520824","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}