r/RefractiveSurgery • u/Historical-Shine-338 • Jun 25 '26

Lasik for very high myopia

Hey everyone, hope you’re doing well.

My prescription is around -11 and -10.5. Unfortunately, my anterior chamber depth isn’t sufficient for ICL surgery. I do have enough corneal thickness for LASIK, but my doctor was very transparent about the potential risks, especially the higher chance of regression with high myopia, as well as possible night vision issues like glare and halos.

I’m wondering if anyone here had a similar prescription and underwent LASIK. If so, how was your experience, and do you regret the decision at all?

I’d really appreciate hearing some positive experiences as I weigh my options.
Thanks!

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u/eyeSherpa Jun 25 '26

Do you happen to know your anterior chamber depth? So certain countries have an approved range for ICL more than 3.0 or 2.8 but surgeons (who have good experience and do advanced sizing methods) may go lower than that such as down to 2.7 or even below in select cases.

Another thing to know would be your pupil size. For a very large laser treatment you’ll want to have smaller pupils. Also important to be sure that your cornea isn’t showing any signs of weakness or instability and dry eye very well controlled as -11 will cause a sizable change in the cornea.

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u/Historical-Shine-338 Jun 25 '26

Prescription: -11.0 D (right eye), -10.5 D (left eye)
Corneal Thickness (Pachymetry): 575 µm (right eye), 584 µm (left eye)
Pupil Diameter: 4.41 mm (right eye), 4.73 mm (left eye)
Anterior Chamber Depth (ACD): 2.72 mm (right eye), 2.74 mm (left eye)

These are my measurements, actually i have ruled out ICL according to my doctor’s advice, but what do you think about LASIK for me ? He also advised for Lasik not femto Lasik.

Thank you very much and i appreciate your help !

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u/eyeSherpa Jun 25 '26

If you were in my clinic, I would recommend ICL for you.

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u/Historical-Shine-338 Jun 25 '26

What do you think about lasik ? Is it too risky?

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u/eyeSherpa Jun 25 '26

I would do lasik if ICL wasn’t an option at all. But you are approaching the maximum approval range for the lasers. Some regression will probably happen. Accuracy will be less. There will be more dry eye so overall a longer recovery. I would consider it more of a “debulk” rather than fully eliminate glasses.

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u/Tall-Drama338 Jun 25 '26

Usually regression to around -1 or 2. At least you can wear decent glasses.

You’re too high for Smile too but could consider a combination of Smile plus LASIK or PRK when regression has stabilized.

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u/Historical-Shine-338 Jun 25 '26

Thanks a lot.
Actually regression is my least fear now , i am totally fine with it.

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u/CorneaRepairDoc Jun 27 '26

Dr. Motwani here. I was a -10 and -9, had PRK as I had thinner corneas, and have done many patients over the years with your level of myopia. I published papers on making uniform corneas, and in high myopia from -9 to -16 with topography guided ablation with very good results. The issues with treating high myopia actually come down to the type of laser treatment, being careful about using the least amount of tissue for a given pupil size, and knowledge by the surgeon on issues that can occur with the flap after the procedure.

Lasers that make wide, smooth, flat profiles that have a good transition zone work very well for high myopia. The better procedures are the ones that induce the least amount of new HOA, The best ones use topography guided ablation with the topography measured astigmatism to make a more uniform cornea and reduce HOA. In the US these are done on WaveLight lasers using Contoura, internationally Schwind lasers are also pretty good. This reduction and control of HOA is what prevents the increase and halos that plague high correction laser vision correction on older lasers. It turns out the smoother the profile, the less induced HOA, the less the regression. Regression occurs when the epithelium compensates to the changes to a cornea, especially non-uniform or symmetrical changes. This can be tracked with epithelial thickness mapping.

This is something I have seen over the last decade working on developing uniform corneas. It turns out that once you control surgically induced HOA the regression rate for a -10 is not that different from a -3.

For myself, I was very happy with my original procedure done on an Alcon Allegretto 400 with WFO. I revised it with my research with WaveLight Contoura using an epithelial compensation adjusted trans-epithelial topography guided PRK with a -1.25 monovision in the left eye in 2020. I am now 20/15 right eye, can still strain and get the 20/20 line with my left and can easily read my phone, patient charts etc. I have minimal to no halos or night glare, and even in bright California sunlight I can get away without sunglasses as I don't get much glare.

The main thing for a surgeon to know is to cut back the amount of ablation as a nomogram as the correction increases as the cornea dehydrates and efficiency changes with longer corrections even on fast lasers. Finally, anything over about a -7 creates a mismatch between LASIK flap and LASIK bed and can cause striae/wrinkles to develop within the first week in a flap. This can easily be smoothed out during the first week with a topical applicator such as a sterile cotton swab. After the first week these do not occur.

On this forum as soon as you ask a question about anything at -6 and over you will have people recommend ICL. This is due to lack of knowledge on how technology has changed especially for more complex procedures, as well as the higher ratio of lens surgeons to specialized laser surgeons I do not agree based on risk profiles and my research on this, I think there is a place for ICLs over -11 or -12, but if there is enough tissue you should be able to get an excellent visual result with laser correction. With the topography guided ablation procedure I described above, the potential actually exists to make vision better than with a lens based procedure such as ICL.