Very high myopia presents a specific clinical challenge: the amount of corneal tissue that would need to be removed to correct the prescription with laser surgery is simply too great to be safe. This is not a question of technical capability – it is a question of corneal structural integrity.
As myopia increases, corrective laser treatment requires progressively deeper tissue removal. When the residual stromal bed falls below safe thresholds, the biomechanical stability of the cornea is compromised and ectasia risk rises to unacceptable levels.¹ This is the clinical limit of laser surgery for very high myopia.
ICL surgery resolves this by leaving the cornea entirely untouched. A thin phakic intraocular lens is placed behind the iris in front of the natural crystalline lens, correcting the refractive error without any interaction with the corneal stroma. Modern ICL designs with central ports allow natural aqueous flow and have demonstrated excellent safety and visual outcomes in patients with moderate-to-very-high myopia.²
At Blue Fin Vision®, ICL is the standard recommendation for patients with myopia beyond approximately −10.00 dioptres, and is often preferred from −8.00 upwards where corneal anatomy shows any borderline features. The visual quality achieved with ICL in very high myopes is consistently excellent, frequently superior to what these patients experienced with their optical correction before surgery.³
Anterior chamber depth assessment is the key anatomical prerequisite for ICL eligibility. Where chamber depth is insufficient, lens replacement becomes the alternative pathway.
References
- Roberts CJ, Dupps WJ Jr. Biomechanics of corneal ectasia and biomechanical treatments. J Cataract Refract Surg. 2014;40(6):991–1003.
- Packer M. The Implantable Collamer Lens with a central port: review of the literature. Clin Ophthalmol. 2018;12:2427–2438.
- Shimizu K, Kamiya K, Igarashi A, Shiratani T. Long-term comparison of posterior chamber phakic intraocular lens with and without a central hole implantation for moderate to high myopia and myopic astigmatism. Medicine (Baltimore). 2016;95(14):e3270.
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- ICL vs Lens Replacement for Young High Myopes
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- High Astigmatism: Laser, Toric ICL or Toric Lens?
- Very High Myopia: Why ICL Often Becomes the Preferred Option
- Early Lens Dysfunction: When Laser May No Longer Be the Best Choice
- Enhancements After Laser, ICL or Lens Replacement
- Cataract Risk: Laser vs ICL vs Lens Replacement
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