Comparison of the efficacy and safety of laser corneal refractive surgery versus implantable collamer lens implantation for high myopia: a meta-analysis and health economics analysis

2026，No. 04, Current Issue, Highlights, Meta-Analysis
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Authors: Zhang Xue, Yang Shuhui, Chen Taiwei, Zhan Siyan, Li Shiming
DOI: 10.3760/cma.j.cn115989-20251022-00355
   

Citation

Zhang Xue, Yang Shuhui, Chen Taiwei, et al. Comparison of the efficacy and safety of laser corneal refractive surgery versus implantable collamer lens implantation for high myopia: a meta-analysis and health economics analysis[J]. Chin J Exp Ophthalmol, 2026, 44(4):381-389. DOI: 10.3760/cma.j.cn115989-20251022-00355.

ABSTRACT                   [Download PDF]  [Read Full Text]

Objective  To systematically evaluate the differences in effectiveness, safety, and cost-effectiveness between laser corneal refractive surgery and implantable collamer lens (ICL) implantation in patients with high myopia.

Methods  A comprehensive search was conducted in the China National Knowledge Infrastructure, VIP Chinese Science and Technology Journal Database, China Biology Medicine Disc, Wanfang Data, PubMed, Embase Cochrane Library, and Web of Science databases from their inception to July 10, 2024 for randomized controlled trial or cohort studies comparing laser corneal refractive surgery and ICL implantation for high myopia. Literature was screened according to inclusion and exclusion criteria and data extraction and quality assessment performed. Effectiveness (postoperative uncorrected visual acuity/preoperative best-corrected visual acuity [BCVA]) and safety (postoperative BCVA/preoperative BCVA) were evaluated. Meta-analysis and statistical analyses were conducted using Stata 17.0, and a cost-effectiveness model was established for health economic evaluation.

Results  A total of 25 studies involving 1 776 patients were included, of whom 933 underwent laser corneal surgery and 868 underwent ICL implantation. Meta-analysis showed that effectiveness was superior in the ICL group; regarding visual quality, postoperative higher-order aberrations and objective scattering index were significantly greater after laser surgery; as for safety, ICL implantation was better. Health economics analysis showed that both procedures achieved exceptionally high patient satisfaction rates (94.9% to 96.1%). The incremental cost-effectiveness ratios for laser in situ keratomileusis and femtosecond small incision lenticule extraction compared to ICL implantation were 18 140 and 8 760 RMB per 1% gain in satisfaction rate, respectively.

Conclusions  Compared with laser corneal refractive surgery, ICL implantation demonstrates slightly superior short-term effectiveness, visual quality and safety outcomes, and the long-term differences are not significant. Laser corneal refractive surgery offers distinct cost-effectiveness.

High myopia; Refractive surgical procedures; Effectiveness; Safety; Health economics; Laser corneal refractive surgery; Implantable collamer lens implantation; Meta-analysis

Authors Info & Affiliations

Zhang Xue
Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
Yang Shuhui
Optometry Center, the Affiliated Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
Chen Taiwei
Optometry Center, the Affiliated Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
Zhan Siyan
Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing 100871, China
Li Shiming
Optometry Center, the Affiliated Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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