Abstract: This review included three RCTs with a total of 228 eyes. The range of myopia of included patients was -6.0 D to -20.0 D of myopia with up to 4.0 D of myopic astigmatism. The percentage of eyes with uncorrected visual acuity (UCVA) of 20/20 or better at 12 months postoperative was not significantly different between the two groups. Phakic IOL surgery was safer than excimer laser surgical correction for moderate to high myopia as it results in significantly less loss of best spectacle corrected visual acuity (BSCVA) at 12 months postoperatively. However there is a low risk of developing early cataract with phakic IOLs. Phakic IOL surgery appears to result in better contrast sensitivity than excimer laser correction for moderate to high myopia. Phakic IOL surgery also scored more highly on patient satisfaction/preference questionnaires. The results of this review suggest that, at one year post surgery, phakic IOLs are safer than excimer laser surgical correction for moderate to high myopia in the range of -6.0 to -20.0 D and phakic IOLs are preferred by patients. While phakic IOLs might be accepted clinical practice for higher levels of myopia (greater than or equal to 7.0 D of myopic spherical equivalent with or without astigmatism), it may be worth considering phakic IOL treatment over excimer laser correction for more moderate levels of myopia (less than or equal to 7.0 D of myopic spherical equivalent with or without astigmatism). Further RCTs adequately powered for subgroup analysis are necessary to further elucidate the ideal range of myopia for phakic IOLs. This data should be considered alongside comparative data addressing long-term safety as it emerges.

Plain-language summary: This review included three randomised controlled trials with a total of 228 eyes. The range of myopia of included patients was -6.0 D to -20.0 D with up to 4.0 D of myopic astigmatism. The results of this review showed that the chance of the uncorrected visual acuity being 20/20 or better was not different between the two groups. Phakic IOL surgery was safer than excimer laser surgical correction for moderate to high myopia as it results in significantly less loss of best spectacle corrected visual acuity (BSCVA) at 12 months postoperatively. Phakic IOL surgery appears to result in better contrast sensitivity than excimer laser correction for moderate to high myopia. Phakic IOL surgery also scored more highly on patient satisfaction/preference questionnaires. Neither technique resulted in any complication that caused a loss of final BSCVA. Only studies that fulfilled the proper requirements were selected for inclusion in the analysis. The limitations of the studies that we included were the relatively short follow up period of one year as well as the fact that many of the interventions studied have now been superseded by more technologically advanced alternatives. In the present day the technology available for both excimer laser and phakic IOL surgical correction of high myopia is better than during the period of the included studies. This review showed that phakic IOLs for the treatment of high myopia were safer and preferred by patients when compared with excimer laser. Studies looking at more up to date technology with longer follow to determine long term safety issues are needed.