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Wei C, Liu J, Zhang C, Liu JY, Lu YM. Clinical outcomes of SMILE and WFG-LASIK used to treat myopia and astigmatism: A systematic review and meta-analysis. J Fr Ophtalmol 2024; 47:104085. [PMID: 38377878 DOI: 10.1016/j.jfo.2024.104085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/18/2023] [Indexed: 02/22/2024]
Abstract
PURPOSE To evaluate the safety, efficacy and postoperative visual quality of small incision lenticule extraction (SMILE) and Wavefront-Guided Laser in situ keratomileusis (WFG-LASIK) and to analyze their efficacy in correcting astigmatism. METHODS A systematic literature search was performed using Cochrane Collaboration methodology. Databases searched included PubMed, Embase, the Cochrane Library and Web of Science. RevMan software version 5.3.0 was used for meta-analysis. RESULTS A total of 976 eyes were included in 8 studies, of which 539 eyes underwent SMILE and 437 eyes underwent WFG-LASIK. There were no statistically significant differences in the proportion of eyes achieving uncorrected distance visual acuity of 20/20 or better (P=0.18), the proportion of eyes within±0.50 diopter of target refraction postoperatively (P=0.10), or the postoperative magnitude of cylinder (P=0.10). Regarding the Alpins vector analysis of astigmatism, there was no statistically significant difference in the surgical magnitude of error (P=0.09) between the two groups. WFG-LASIK has a lower surgical angle of error (P= 0.002) and higher surgical correction index of cylinder (P=0.03) than SMILE. In terms of aberrations, higher order aberrations (P=0.46), spherical aberrations (P=0.22) and trefoil (P=0.56) were not statistically different, while WFG-LASIK induced less coma than SMILE surgery (P=0.02). CONCLUSION Both SMILE and WFG-LASIK are safe and effective ways to correct myopia and astigmatism. Compared with SMILE, WFG-LASIK has a lower surgical angle of error, higher surgical correction index of cylinder and induces less coma.
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Affiliation(s)
- C Wei
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - J Liu
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - C Zhang
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - J Y Liu
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - Y M Lu
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China.
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Chao CC, Lin MY, Chang CK. The Association Between Ocular Residual Astigmatism and the Efficacy of Astigmatism Correction Via Small Incision Lenticule Extraction (SMILE). Ophthalmol Ther 2023; 12:2631-2640. [PMID: 37470969 PMCID: PMC10441899 DOI: 10.1007/s40123-023-00766-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/26/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Astigmatism correction after small-incision lenticule extraction (SMILE) surgery is affected by several factors, including ocular residual astigmatism (ORA), which accounts for the vector difference between refractive and corneal astigmatism. Previous studies revealed the relationship between ORA and astigmatism correction after laser-assisted in situ keratomileusis (LASIK). However, in SMILE surgery, no comprehensive study exploring the link between these two variables has been performed. We have therefore assessed the association between ORA and astigmatism correction after SMILE. METHODS This was a retrospective, single-centered study. Patients with myopia or myopic astigmatism who underwent SMILE surgery using the 500-kHz Visumax laser platform and were followed up for at least 3 months were included. Patients' demographic and clinical characteristics, such as visual acuity, refractive status and corneal tomography, were recorded. ORA was calculated using Alpins Statistical System for Ophthalmic Refractive Surgery Techniques (ASSORT) Ocular Residual Astigmatism calculator. RESULTS A total of 888 eyes (408 eyes from males and 480 eyes from females) from 444 patients (mean age [standard deviation] 32.4 ± 7.1 years) were included in our study. Mean (± SD) preoperative sphere and cylinder were - 5.45 ± 1.98 (range - 10.00-0.00) diopter (D) and - 0.89 ± 0.70 (range - 4.00-0.00) D, respectively. Calculated mean ORA was 0.68 ± 0.35 (range 0.07-3.53) D. Postoperative logMAR uncorrected visual acuity was 0.03 ± 0.31. Mean postoperative sphere and cylinder were - 0.10 ± 0.56 (range - 1.5 to 1.0) D and - 0.51 ± 0.37 (- 1.5 to 0.0) D, respectively. The Pearson correlation test revealed preoperative sphere, steep keratometry (steep-K) and ORA were statistically correlated with the amplitude of astigmatism correction (P < 0.001), and the generalized estimating equations analysis showed that ORA was negatively correlated with the amplitude of astigmatism correction (P < 0.001). CONCLUSION The results of our study suggest that preoperative higher ORA may be associated with a lower magnitude of astigmatism correction after SMILE surgery in patients with all levels of astigmatism preoperative. TRIAL REGISTRATION ClinicalTrials.gov: NCT05604872. Registered 3 November 2022-Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT05604872.
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Affiliation(s)
- Chen-Cheng Chao
- Nobel Eye Institute, Taipei, Taiwan
- Department of Optometry, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Meng-Yin Lin
- Department of Ophthalmology, Shuang Ho Hospital-Taipei Medical University, New Taipei City, Taiwan
- Department of Ophthalmology, School of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Chao-Kai Chang
- Nobel Eye Institute, Taipei, Taiwan.
- Department of Optometry, Da-Yeh University, Chunghua, Taiwan.
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Yao L, Zhang M, Wang D, Zhao Q, Wang S, Bai H. Small Incision Lenticule Extraction (SMILE) and Laser in Situ Keratomileusis (LASIK) Used to Treat Myopia and Myopic Astigmatism: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Semin Ophthalmol 2023; 38:283-293. [PMID: 35912896 DOI: 10.1080/08820538.2022.2107399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSES The purpose of this meta-analysis is to systematically compare the safety, efficacy, and predictability of small incision lenticule extraction (SMILE) and laser in situ keratomileusis (LASIK). METHODS This study covered the data searched from the PubMed, the EMBASE and the Cochrane Library. The Cochrane Handbook was also referred to as evaluating the quality of the included studies. In addition, this meta-analysis was performed using Revman 5.4 software. RESULTS A total of 11 randomized controlled trails (RCTs) were included. The proportion of eyes with refraction within ±0.5D was higher in LASIK group compared with SMILE group (RR, 0.91; 95% CI, 0.83 to 0.99; p = .04). The spherical aberration (SA) was smaller in SMILE group compared with LASIK group (RR, -0.12; 95% CI, -0.23 to -0.01; p = .04). There were no significant differences between two groups with regard to final mean refractive spherical equivalent (SE) (MD, -0.04; 95% CI, -0.12 to 0.03; p = .22), proportion of eyes losing one or more lines of corrected distance visual acuity (CDVA) (RR, 1.14; 95% CI, 0.58 to 2.27; p = .70), proportion of eyes with uncorrected distance visual acuity (UCVA) of 20/20 or better (RR, 0.99; 95% CI, 0.94 to 1.05; p = .71), postoperative mean logMAR UCVA (MD, 0.01; 95% CI, -0.00 to 0.03; p = .13), postoperative refraction within ±1.0D (RR, 1.00; 95% CI, 0.98 to 1.02; p = .60), postoperative astigmatism within ±0.25, 0.5 and 1.0D (RR, 0.80, 0.99, 1.00; 95% CI, 0.35 to 1.83, 0.94 to 1.05, 0.98 to 1.02; p = .60, 0.86, 0.87), postoperative higher order aberrations (HOAs) (RR, 0.00; 95% CI, -0.16 to 0.16; p = .99). CONCLUSION For predictability, LASIK was superior to SMILE. There were comparably safety and efficacy for the correction of myopia and myopic astigmatism in SMILE and LASIK. SA was smaller after SMILE than after LASIK.
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Affiliation(s)
- Lin Yao
- Qingdao Aier Eye Hospital, Qingdao, SD, China
| | | | | | - Qian Zhao
- Qingdao Aier Eye Hospital, Qingdao, SD, China
| | | | - Haiqing Bai
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, SD, China
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Gan ATL, Fenwick EK, Ang M, Mehta JS, Lamoureux EL. Bilateral sequential small-incision lenticule extraction and LASIK result in similar short-term quality-of-life outcomes. J Cataract Refract Surg 2023; 49:305-311. [PMID: 36730347 DOI: 10.1097/j.jcrs.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/16/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare quality of life (QoL) between patients who receive bilateral small-incision lenticule extraction (SMILE) or laser in situ keratomileusis (LASIK) vs bilateral sequential SMILE-LASIK (BSSL) surgery. SETTING Singapore National Eye Centre, Singapore. DESIGN Retrospective cohort study. METHODS 2 patient cohorts were recruited (2010-2012; 2014-2016). The bilateral SMILE (BS) and bilateral LASIK (BL) groups comprised patients (mean ± SD age: 30.3 ± 6.5, 50% male) from a prospective nonrandomized study who chose SMILE and LASIK, respectively. The BSSL group comprised patients (mean ± SD age: 28.6 ± 6.2, 64.3% male) randomized to receive SMILE in 1 eye and LASIK in the other. Rasch-scaled scores of the QoL Impact of Refractive Correction questionnaire between groups postoperatively at 1 and 3 months were compared. RESULTS At month 1, scores on 3 QoL without emotional well-being items were worse in the BSSL (n = 70) compared with the BL group (n = 25), specficially, "using sunglasses" (β: -20.6, 95% CI, -34.3 to -6.9), "reliance on refractive correction" (-23.1, 95% CI, -40.9 to -5.4), and "medical complications from optical correction" (β: -14.8, 95% CI, -27.9 to -1.7). Emotional well-being (overall), and items "feeling able to do things" (β: 11.0, 95% CI, 1.6-20.4) and "feeling eager to try new things" (β: 14.1, 95% CI, 3.6-24.6) were better in the BSSL compared with the BS group (n = 25). No substantive differences were observed at month 3. CONCLUSIONS Refractive correction-related QoL differences at month 1 between BSSL and BS/BL patients attenuated by month 3. Bilateral sequential SMILE-LASIK surgery appeared unlikely to negatively affect QoL beyond 3 months.
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Affiliation(s)
- Alfred T L Gan
- From the Singapore Eye Research Institute and Singapore National Eye Centre, Singapore (Gan, Fenwick, Ang, Mehta, Lamoureux); Duke-NUS Medical School, Singapore (Fenwick, Ang, Mehta, Lamoureux); National University of Singapore, Singapore (Lamoureux); Faculty of Medicine, Dentistry and Health Sciences University of Melbourne, Australia (Lamoureux)
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Tian H, Gao W, Xu C, Wang Y. Clinical outcomes and higher order aberrations of wavefront-guided LASIK versus SMILE for correction of myopia: A systemic review and meta-analysis. Acta Ophthalmol 2023. [PMID: 36726315 DOI: 10.1111/aos.15638] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/27/2022] [Accepted: 01/08/2023] [Indexed: 02/03/2023]
Abstract
To systematically evaluate the clinical effect of wavefront-guided laser in situ keratomileusis (WFG-LASIK) and small incision lenticule extraction (SMILE) in terms of refractive errors and high-order aberrations. A systematic literature search of PubMed, EMBASE, the Cochrane Library, Web of Science and China National Knowledge Internet was performed to identify studies evaluating the clinical outcomes of SMILE and WFG-LASIK ended in May 2022. Meta-analyses were performed according to the PRISMA guidelines. The risk of bias of the RCTs was evaluated using the Cochrane Handbook criteria, and the quality of the non-randomised controlled studies was assessed using the Newcastle-Ottawa Scale. In total, 1385 eyes (SMILE group, 750 eyes; WFG-LASIK group, 635 eyes) from 12 studies were included. The meta-analysis demonstrated that spherical aberration was smaller in the SMILE group than in the WFG-LASIK group (standardised mean difference [SMD]: -0.34, 95% confidence interval [CI]: -0.47, -0.22; p < 0.00001), and that the postoperative values of vertical coma (SMD: 0.83; 95% CI: 0.63, 1.03; p < 0.00001) and trefoil (SMD: 0.37; 95% CI: 0.02, 0.72; p = 0.04) were higher in the SMILE group compared to the WFG LASIK group. There were no significant differences in the clinical outcomes and the values of induced total higher order aberrations between the WFG-LASIK and SMILE groups (SMD: 0.05; 95% CI: -0.09, 0.19; p = 0.47). Both SMILE and WFG-LASIK were found to be safe, effective, and predictable. SMILE may induce more vertical coma and trefoil, whereas WFG LASIK may induce more spherical aberrations, but no significant differences were found in the total higher order aberrations between SMILE and WFG-LASIK.
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Affiliation(s)
- He Tian
- School of Medicine, Nankai University, Tianjin, China.,Nankai University Eye Institute, Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, China.,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, China
| | - Wenjing Gao
- Nankai University Eye Institute, Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, China.,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, China.,Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Caohui Xu
- School of Medicine, Nankai University, Tianjin, China.,Nankai University Eye Institute, Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, China.,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, China
| | - Yan Wang
- Nankai University Eye Institute, Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, China.,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, China.,Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
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6
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Zhao W, Zhao J, Zhang Z, Han T, Wang J, Zhou X. Evaluating early-stage disk halo changes after small incision lenticule extraction. Eur J Ophthalmol 2022; 33:11206721221138306. [PMID: 36377271 DOI: 10.1177/11206721221138306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE To investigate early changes in the disk halo under different light conditions after myopic small incision lenticule extraction (SMILE). METHODS This prospective study included 70 eyes of 70 myopic patients aged 18-33 years, with a spherical equivalent (SE) of -5.87 ± 1.86 D, who underwent SMILE. The subjective refraction, higher-order aberrations (HOAs), pupillometry, and halo were measured preoperatively and postoperatively to analyse disk halo variations and correlated factors. RESULTS At 5 cd/m2 and 1 cd/m2 luminance, the halo radius in the high myopia (HM) group reached a postoperative peak after 1 week (p = 0.000 and 0.019, respectively), and recovered to baseline after 3 months. In the low-to-moderate (LM) myopia group, the halo radius did not differ 1 week postoperatively compared to the preoperative level (p = 0.015), but significantly improved after 3 months (p = 0.000). The halo radius correlated with SE, uncorrected distance visual acuity (UDVA), ocular HOAs, coma, and the pupillary light reflex in the LM group at all time points, but there were no correlations in the HM group. CONCLUSIONS Halo symptoms occurred early after SMILE, but recovered within 3 months. The recovery process was slower in the HM group than in the LM group, and the halo radius correlated with SE, UDVA, ocular HOAs, coma, and the pupillary light reflex.
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Affiliation(s)
- Wuxiao Zhao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
- Present at Center for Optometry and Visual Science, Guangxi Academy of Medical Sciences, Nanning, China
| | - Jing Zhao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Zhe Zhang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Tian Han
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Jifang Wang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
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7
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Fu M, Li M, Xian Y, Yu Z, Zhang H, Choi J, Niu L, Wang X, Zhou X. Two-Year Visual Outcomes of Evolution Implantable Collamer Lens and Small Incision Lenticule Extraction for the Correction of Low Myopia. Front Med (Lausanne) 2022; 9:780000. [PMID: 35492322 PMCID: PMC9043127 DOI: 10.3389/fmed.2022.780000] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/07/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To investigate the 2-year visual quality of Evolution Implantable Collamer Lens (EVO-ICL) and small incision lenticule extraction (SMILE) for the correction of low myopia. Methods In this prospective study, we included 25 eyes of 25 patients (7 men) who underwent EVO-ICL and 36 eyes of 36 patients (16 men) who underwent SMILE between January 2018 and December 2018. Subjective and objective visual outcomes were compared between ICL and SMILE. All patients were followed for 2 years. Results At the postoperative 2-year visit, the percentage of patients with uncorrected distance visual acuity (UDVA) greater than or equal to preoperative corrected distance visual acuity (CDVA) was comparable in the ICL group (80%, 20/25) and SMILE group (88.89%, 32/36). Spherical equivalent (SE) was within ± 0.50 D in 96% (24/25) of the ICL group and 94.44% (34/36) of the SMILE group. No eyes lost more than 2 lines of CDVA. Postoperative high-order aberrations (HOAs) were significantly increased in the ICL group (p < 0.01) and in the SMILE group (p < 0.01). The most common visual complaint was halo after ICL and starburst after SMILE. There was no correlation between HOAs and visual complaints (p > 0.05). Conclusion Evolution Implantable Collamer Lens provides comparable safety, efficacy, long-term visual stability, and high patient satisfaction when compared to SMILE in correcting low myopia. EVO-ICL could be a favorable alternative for low myopia. Key messages What was known? What this paper adds?
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Affiliation(s)
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yiyong Xian
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Zhiqiang Yu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | | | - Joanne Choi
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Lingling Niu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaoying Wang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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8
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Chiang B, Valerio GS, Manche EE. Prospective, Randomized Contralateral Eye Comparison of Wavefront-Guided Laser In Situ Keratomileusis and Small Incision Lenticule Extraction Refractive Surgeries. Am J Ophthalmol 2022; 237:211-220. [PMID: 34788593 DOI: 10.1016/j.ajo.2021.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE Wavefront-guided laser in situ keratomileusis (WFG-LASIK) and small incision lenticule extraction (SMILE) are keratorefractive surgeries that can improve uncorrected visual acuity in myopic patients. Comparison of visual outcomes in myopic patients treated with LASIK and SMILE is needed. DESIGN Prospective, randomized contralateral eye-controlled trial. METHODS We performed a single-center prospective, randomized contralateral eye comparison of WFG-LASIK and SMILE (NCT03067077). Myopic patients with low levels of astigmatism were treated with WFG-LASIK in one eye and SMILE in the fellow eye from March 2017 to March 2021. Treatments were randomized by ocular dominance. WFG-LASIK and SMILE were performed. Postoperative evaluation at 1 day consisted of uncorrected distance visual acuity (UDVA), wavefront aberrometry, and a slit-lamp examination. On subsequent postoperative visits at 1 month, 3 months, 6 months, and 12 months, UDVA, manifest refraction, 5% and 25% low-contrast visual acuity, wavefront aberrometry, and slit-lamp examination were performed. MAIN OUTCOME MEASURE The primary outcome measure was UDVA at 12 months. RESULTS Eighty-eight eyes of 44 patients with myopia were enrolled in the study. Seventy-four eyes of 37 patients had successful treatments and completed 12 months of follow-up. At postoperative month 12, there were a significantly higher proportion of WFG-LASIK eyes that had ≥20/20 UDVA compared with SMILE eyes (94% vs 83%, P < .05). There was no difference between spherical equivalent between WFG-LASIK eyes and SMILE eyes (-0.17 ± 0.25 vs -0.29 ± 0.38, P > .05); there was no difference in higher order aberrations, including coma, trefoil, and spherical aberrations (P > 0.05); and there were a significantly higher proportion of WFG-LASIK eyes that had improved 5% and 25% low-contrast visual acuity compared with SMILE eyes (P < 0.05). CONCLUSIONS WFG-LASIK and SMILE both offered marked improvements in corrected distance visual acuity and excellent predictability in both eyes. Compared with SMILE, WFG-LASIK resulted in faster visual recovery, better low-contrast visual acuity, and greater gains in uncorrected visual acuity.
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Affiliation(s)
- Bryce Chiang
- From the Department of Ophthalmology, Byers Eye Institute at Stanford, Stanford University, Palo Alto, California, USA
| | - Gabriel S Valerio
- From the Department of Ophthalmology, Byers Eye Institute at Stanford, Stanford University, Palo Alto, California, USA
| | - Edward E Manche
- From the Department of Ophthalmology, Byers Eye Institute at Stanford, Stanford University, Palo Alto, California, USA..
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9
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Du R, Fang L, Peng W, Yang R, Nie S, Xiao H, Gong J, Dai Y, Deng J. Wave front aberrations induced from biomechanical effects after customized myopic laser refractive surgery in finite element model. Int Ophthalmol 2021; 42:81-94. [PMID: 34392473 DOI: 10.1007/s10792-021-02003-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 08/06/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE A customized myopic refractive surgery was simulated by establishing a finite element model of the human eye, after which we studied the wave front aberrations induced by biomechanical effects and ablation profile after wave front-guided LASIK surgery. METHODS Thirty myopia patients (i.e., 60 eyes) without other eye diseases were selected. Their ages, preoperative spherical equivalent, astigmatism, and wave front aberration were then obtained, in addition to the mean spherical equivalent error range - 4 to - 8D. Afterward, wave front-guided customized LASIK surgery was simulated by establishing a finite element eye model, followed by the analysis of the wave front aberrations induced by the surface displacement from corneal biomechanical effects, as well as customized ablation profile. Finally, the preoperative and induced aberrations were statistically analyzed. RESULTS Comatic aberrations were the main wave front abnormality induced by biomechanical effects, and the wave front aberrations induced by the ablation profile mainly included coma and secondary coma, as well as sphere and secondary-sphere aberrations. Overall, the total high-order aberrations (tHOAs), total coma (C31), and sphere ([Formula: see text]) increased after wave front-guided customized LASIK surgery. According to our correlation analyses, coma, sphere, and tHOAs were significantly correlated with decentration. Additionally, the material parameters of ocular tissue were found to affect the postoperative wave front aberrations. When the material parameters of the sclera remained constant but those of cornea increased, the induced wave front aberrations were reduced. CONCLUSION All biomechanical effects of cornea and ablation profile had significant effects on postoperative wave front aberrations after customized LASIK refractive surgery; however, the effects of the ablation profile were more notorious. Additionally, the characteristics of biomechanical materials have influence on the clinical correction effect.
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Affiliation(s)
- Ruirui Du
- Nanchang Hangkong University, Nanchang, 330063, China
| | - Lihua Fang
- Key Laboratory of Nondestructive Test (Ministry of Education), Nanchang Hangkong University, Nanchang, 86-18170938193, 330063, China.
| | - Weijian Peng
- Nanchang Hangkong University, Nanchang, 330063, China
| | - Ruizhi Yang
- Nanchang Hangkong University, Nanchang, 330063, China
| | - Shifeng Nie
- Nanchang Hangkong University, Nanchang, 330063, China
| | - Huirong Xiao
- Nanchang Hangkong University, Nanchang, 330063, China
| | - Jiahui Gong
- Nanchang Hangkong University, Nanchang, 330063, China
| | - Yu Dai
- Nanchang Hangkong University, Nanchang, 330063, China
| | - Jiahao Deng
- Nanchang Hangkong University, Nanchang, 330063, China
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10
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Zhang R, Wei H, Jhanji V, Sun L, Li J, Jiang J, Zhuang S, Zhang M. Comparison of corneal aberrations and refractive outcomes after small-incision lenticule extraction and femtosecond-assisted laser-assisted in situ keratomileusis. Int Ophthalmol 2021; 41:2521-2531. [PMID: 33783676 DOI: 10.1007/s10792-021-01810-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
PURPOSES To retrospectively compare the short-term refractive outcomes and corneal aberrations after small-incision lenticule extraction (SMILE) and femtosecond-assisted laser-assisted in situ keratomileusis (FS-LASIK) combined with smart pulse technology (SPT) in patients with compound myopic astigmatism. METHODS A total of 91 eyes (91 patients) were included, 43eyes in FS-LASIK group and 48 eyes in the SMILE group. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refractive results and corneal topography were evaluated 1 and 3 months postoperatively. Corneal aberrations of anterior corneal surface were calculated from the topography data over 6 mm-diameter. RESULTS There was no significant difference in UCVA, BCVA, and refractive results between the two groups. There were no statistical difference in TIA (target induced astigmatism), SIA (surgery induced astigmatism), DV (difference vector), ME (magnitude of error), AE (angle of error), AE (absolute value) and CI (correction index) between both groups at 1 and 3 months. Coma and spherical aberration improved in all the patients in both groups at 1 and 3 months postoperatively. The amount of induced spherical aberrations was higher in FS-LASIK group compared to SMILE group. CONCLUSIONS Both FS-LASIK and SMILE achieved similar refractive outcomes in patients with myopia and compound myopic astigmatism. FS-LASIK combined with SPT resulted in higher spherical aberration than SMILE in early postoperative period.
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Affiliation(s)
- Riping Zhang
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China.
| | - Heng Wei
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
| | - Vishal Jhanji
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China.,Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lixia Sun
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
| | - Jinyu Li
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
| | - Jingjing Jiang
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
| | - Suoqing Zhuang
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
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11
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Yang LJ, Liu X, Mi SJ, Sun L, Chen MX. Early visual function outcomes of topography-guided FS-LASIK and SMILE in treatment of myopia and myopic astigmatism. Int J Ophthalmol 2021; 14:423-429. [PMID: 33747820 PMCID: PMC7930544 DOI: 10.18240/ijo.2021.03.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the quality outcomes of vision at early phase after topography-guided femtosecond laser-assisted in situ keratomileusis (FS-LASIK-CV) and small incision lenticule extraction (SMILE) in treatment of myopia and myopic astigmatism. METHODS Retrospective comparative analysis of 49 patients that underwent FS-LASIK (n=23) or SMILE (n=26) procedure for myopia and myopic astigmatism between April and September in 2019. Pre- and postoperative uncorrected visual acuity (UCVA), spherical equivalent refraction (SEQ), cylindrical refraction, contrast sensitivity function (CSF), and corneal higher-order aberrations (HOAs) were evaluated. Independent t-test was used for inter-group comparison, while repeated measures ANOVA was used to analyze changes at different time points. RESULTS In both groups, 100% of the eyes obtained a UCVA of 20/20 or better at 1wk, 1, and 3mo postoperatively. At 1d and 3mo postoperatively, UCVA was better in FS-LASIK-CV group than in SMILE group. At 1wk postoperatively, SEQ was lower in SMILE group than in FS-LASIK-CV group (P=0.006). At 3mo postoperatively, the SEQ reached target refraction in both groups. The residual astigmatism was reduced in both groups without intergroup difference (P>0.05). At 3mo postoperatively, the spherical aberration and coma under 6 mm pupil size were higher than preoperative levels in both groups (P<0.05). However, the increase in the corneal HOAs in the FS-LASIK-CV group was less than the SMILE group (P<0.05). At 3mo postoperatively, the logCS were better than preoperative levels under scotopic conditions without glare and scotopic conditions with glare in both groups (P<0.05). At 1 and 3mo postoperatively, under scotopic conditions without glare and scotopic conditions with glare, FS-LASIK-CV group showed more improvement in logCS at two spatial frequencies (12.0 c/d and 18.0 c/d; P<0.05). CONCLUSION Both FS-LASIK-CV and SMILE demonstrate to be safe, effective, and predictable in treatment of myopia and myopic astigmatism. Early postoperative improvement in UCVA and CSF at high spatial frequency under scotopic conditions were better after FS-LASIK-CV than SMILE.
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Affiliation(s)
- Lin-Juan Yang
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Xuan Liu
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Sheng-Jian Mi
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Le Sun
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Meng-Xin Chen
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
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12
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Siedlecki J, Schmelter V, Schworm B, Mayer WJ, Priglinger SG, Dirisamer M, Luft N. Corneal wavefront aberrations and subjective quality of vision after small incision lenticule extraction. Acta Ophthalmol 2020; 98:e907-e913. [PMID: 32212414 DOI: 10.1111/aos.14420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 03/04/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE To analyse in depth the associations between objectively measured corneal higher-order aberrations (HOAs) and subjectively perceived visual quality after small incision lenticule extraction (SMILE) as quantified with the standardized and clinically validated quality of vision (QOV) questionnaire. METHODS This cross-sectional study included patients after bilateral simultaneous SMILE for the treatment of myopia and/or myopic astigmatism with plano target refraction. Scheimpflug imaging (Pentacam HR; Oculus Optikgeräte GmbH, Wetzlar, Germany) was used to objectively quantify corneal HOAs. The standardized and validated QOV questionnaire was employed to gauge patients' subjectively perceived visual quality regarding frequency, severity and bothering effect of visual disturbances. RESULTS A total of 394 eyes of 197 patients with a mean age of 32.4 ± 7.7 years and a mean postoperative follow-up of 24.3 ± 14.1 months were included. SMILE induced a statistically significant (p < 0.001) increase in spherical aberration (0.074 ± 0.131 µm), coma (0.142 ± 0.179 µm), trefoil (0.018 ± 0.067 µm) as well as in total HOAs (0.191 ± 0.176 µm). Surgically induced and postoperative levels of HOA showed no correlation with the three QOV scores representative of overall visual symptom frequency, severity and bothering effect (all R2 values ≤ 0.016). In addition, the associations between specific visual symptoms (e.g. starburst) and singular HOA terms (e.g. haloes) were very weak (all Rho values ≤ 0.164). CONCLUSIONS Small incision lenticule extraction induced significant amounts of corneal HOAs that, however, showed no clear relationships to patient-reported QOV or specific long-term visual symptoms.
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Affiliation(s)
- Jakob Siedlecki
- University Eye Hospital Ludwig‐Maximilians‐University Munich Germany
- SMILE Eyes Clinic Linz Austria
| | - Valerie Schmelter
- University Eye Hospital Ludwig‐Maximilians‐University Munich Germany
| | - Benedikt Schworm
- University Eye Hospital Ludwig‐Maximilians‐University Munich Germany
- SMILE Eyes Clinic Linz Austria
| | - Wolfgang J. Mayer
- University Eye Hospital Ludwig‐Maximilians‐University Munich Germany
| | - Siegfried G. Priglinger
- University Eye Hospital Ludwig‐Maximilians‐University Munich Germany
- SMILE Eyes Clinic Linz Austria
| | - Martin Dirisamer
- University Eye Hospital Ludwig‐Maximilians‐University Munich Germany
- SMILE Eyes Clinic Linz Austria
| | - Nikolaus Luft
- University Eye Hospital Ludwig‐Maximilians‐University Munich Germany
- SMILE Eyes Clinic Linz Austria
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13
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Uceda-Montañés A, Rogers M, Piñero DP. Visual and Refractive Outcomes with a New Topography-integrated Wavefront-guided Lasik Procedure. Curr Eye Res 2020; 46:615-621. [PMID: 32903100 DOI: 10.1080/02713683.2020.1822418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of laser in situ keratomileusis (LASIK) using a new approach for the calculation of the ablation profile based on wavefront vertexing from pupil plane to corneal. METHODS One hundred eyes of 50 patients (age, 21-41 years) with low and moderate myopia were enrolled in this prospective case series. All of them underwent topography-integrated wavefront-guided (TI-WFG) LASIK using the STAR S4IR excimer laser platform (Johnson & Johnson Vision). Visual, refractive, ocular aberrometric, ocular scattering index (OSI) and patient satisfaction outcomes were evaluated after a 90-day follow-up period. Astigmatic changes were evaluated by vector analysis. RESULTS A significant reduction in sphere and cylinder (p < .001) was observed, with a significant improvement in uncorrected (UDVA) and corrected distance visual acuity (CDVA) (p < .001). Postoperative spherical equivalent was within ±0.50 and ±1.00 D in 91.1% (82/90) and 98.9% (89/90) of eyes, respectively. UDVA was 20/20 or better in 98.9% (89/90) of eyes. A total of 50.0% (45/90) of eyes gained 1 line of CDVA. Mean postoperative astigmatic correction index and angle of error were 1.01 ± 0.56 and 0.17 ± 0.18º. Postoperative high-order aberrometric coefficients were below 0.50 μm in 92.2% (83/90) of eyes. Mean postoperative OSI was 0.71 ± 0.44. All patients referred to be satisfied with the final outcomes and would recommend the procedure to their friends and relatives. CONCLUSIONS TI-WFG LASIK is a new approach for myopia and myopic astigmatism correction, with preservation of the ocular optical quality and high level of patient satisfaction associated.
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Affiliation(s)
- Antonio Uceda-Montañés
- Refractive Surgery Department, Optilase Eye Clinics, Dublin, Ireland.,EMEA, Jacksonville, USA
| | - Michael Rogers
- Refractive Surgery Department, Optilase Eye Clinics, Dublin, Ireland
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
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14
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Abd El-Fattah EA, El Dorghamy AA, Ghoneim AM, Saad HA. Comparison of corneal biomechanical changes after LASIK and F-SMILE with CorVis ST. Eur J Ophthalmol 2020; 31:1762-1770. [PMID: 32698618 DOI: 10.1177/1120672120945664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate changes in corneal biomechanics after LASIK and F-SMILE. SETTING Elite Eye Center, Tanta, Egypt. DESIGN Prospective, randomized, unmasked, interventional comparative case series. PATIENTS AND METHODS A total of 60 eyes were equally divided into two groups; group A: received LASIK and group B: received F-SMILE. Pentacam and CorVis ST parameters were compared before and 6 months after procedures. P ⩽ 0.05 was used for significance of results. RESULTS bIOP decreased by 0.762 ± 1.211 mmHg in group A (p = 0.092), and by 2.52 ± 1.389 mmHg in group B (p < 0.001) and the difference between groups became significant (p = 0.001). A1 increased significantly in group A only (p = 0.036); while A2 decreased insignificantly in both groups. DAR increased significantly in both groups (p < 0.001, p = 0.022), but the difference between groups remained insignificant (p = 0.461). IR increased significantly in group A only (p < 0.001) and the difference between groups became significant (p = 0.026). ARTH decreased in both groups (p = 0.245, p = 0.695) and the difference remained insignificant (p = 0.928). SP-A1 decreased in group A by 8.89 ± 1.38 mmHg/mm (p = 0.637), and by 32.6 ± 4.39 mmHg/mm in group B (p < 0.001) and the postoperative difference between groups was significant (p = 0.013). CBI increased significantly in group A (p < 0.001), but insignificantly in group B (p = 0.098) and postoperative difference between groups was highly significant (p < 0.001). A significant correlation was found between change in CCT and corresponding changes in DAR, IR, and ARTH after surgery in both groups. CONCLUSION The significant differences between groups postoperatively as regards bIOP (p = 0.001), IR (p = 0.026), SP-A1 (p = 0.013), and CBI (p < 0.001) indicate stiffer corneas after F-SMILE and suggest less influence on corneal biomechanics than LASIK.
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Affiliation(s)
- Eman A Abd El-Fattah
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Alaa A El Dorghamy
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed M Ghoneim
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hisham A Saad
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
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15
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Chiam NP, Mehta JS. Comparing Patient-Reported Outcomes of Laser In Situ Keratomileusis and Small-Incision Lenticule Extraction: A Review. Asia Pac J Ophthalmol (Phila) 2019; 8:377-384. [PMID: 31478935 PMCID: PMC6784778 DOI: 10.1097/apo.0000000000000258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/30/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Laser in situ keratomileusis (LASIK) and small-incision lenticule extraction (SMILE) are popular refractive surgeries. The objective refractive outcomes of LASIK and SMILE have been studied extensively; both procedures have comparable safety, efficacy, and predictability. However, owing to various psychosocial factors, refractive patients may report dissatisfaction despite good postoperative vision. Hence the importance of studies on subjective patient-reported outcomes. This review discusses the role of psychometric-technique-based validated questionnaires when evaluating subjective outcomes. It also summarizes the literature on patient-reported outcomes for LASIK and SMILE. DESIGN A literature search was performed on PubMed database to identify studies that have assessed patient-reported outcomes for LASIK and SMILE. RESULTS Several studies have looked into patient-reported outcome measures for LASIK, but the number of equivalent studies for SMILE is limited. Questionnaires (validated and non-validated) are used to evaluate patient-reported outcomes. Validated questionnaires are designed based on psychometric techniques, such as Classic Test Theory, Item Response Theory, and Rasch analysis. The Quality of Life Impact of Refractive Correction (QIRC) questionnaire, a validated questionnaire administered to both LASIK and SMILE patients, suggests that both groups have comparable vision-related quality of life in the first few months postoperatively; but SMILE might confer a slight advantage in the later postoperative period (postoperative month 6). CONCLUSIONS Future LASIK-SMILE comparative studies utilizing standardized validated questionnaires for patient-reported outcome measures with longer follow-up durations would be a welcome contribution to this important aspect of refractive surgery.
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Affiliation(s)
| | - Jodhbir S. Mehta
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
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16
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Taneri S, Kießler S, Rost A, Schultz T, Dick HB. Clinical outcomes of small incision lenticule extraction versus advanced surface ablation in low myopia. Eur J Ophthalmol 2019; 30:1278-1286. [PMID: 31347395 DOI: 10.1177/1120672119865699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the visual and refractive outcomes of small incision lenticule extraction and advanced surface ablation for low myopia or myopic astigmatism. METHODS Retrospective, observational case series of our first 50 consecutive small incision lenticule extraction patients compared to refraction-matched 50 advanced surface ablation treatments with attempted spherical equivalent correction ⩽-3.5 D, astigmatism ⩽-1.5 D, and corrected distance visual acuity of 1.0 (decimal scale) or better. Only one eye per patient was included. RESULTS Small incision lenticule extraction: mean attempted spherical equivalent correction was -2.80 ± 0.63 D. Uncorrected distance visual acuity was 0.85 and 1.0 at days 1 and 5, respectively. At 3 months, mean spherical equivalent refraction was 0.02 ± 0.32 D (range: -0.5 to +0.75 D), mean cylinder was -0.24 ± 0.21 D (range: 0 to -0.75 D), mean uncorrected distance visual acuity was 1.27, mean efficacy index was 0.96, and mean safety index was 1.05. Uncorrected distance visual acuity was same or better than corrected distance visual acuity in 96%, astigmatism ⩽0.5 D in 98% and ⩽1 D in 100% of eyes, respectively. Advanced surface ablation: mean attempted spherical equivalent correction was -2.75 ± 0.5 D. Uncorrected distance visual acuity was 0.72 and 0.61 at days 1 and 5, respectively. At 3 months, mean spherical equivalent refraction was 0.22 ± 0.32 D, mean cylinder was -0.27 ± 0.27 D, mean uncorrected distance visual acuity was 1.21, mean efficacy index was 1.03, and mean safety index was 1.08. CONCLUSION Small incision lenticule extraction for low myopia was found to be safe and effective with outcomes at 3 months similar to those obtained with advanced surface ablation while offering a quicker visual recovery.
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Affiliation(s)
- Suphi Taneri
- Center for Refractive Surgery, Eye Department, St. Francis Hospital, Münster, Germany.,University Eye Hospital, Ruhr University Bochum, Bochum, Germany
| | - Saskia Kießler
- Center for Refractive Surgery, Eye Department, St. Francis Hospital, Münster, Germany
| | - Anika Rost
- Center for Refractive Surgery, Eye Department, St. Francis Hospital, Münster, Germany
| | - Tim Schultz
- University Eye Hospital, Ruhr University Bochum, Bochum, Germany
| | - H Burkhard Dick
- University Eye Hospital, Ruhr University Bochum, Bochum, Germany
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17
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Lee H, Roberts CJ, Arba-Mosquera S, Kang DSY, Reinstein DZ, Kim TI. Relationship Between Decentration and Induced Corneal Higher-Order Aberrations Following Small-Incision Lenticule Extraction Procedure. Invest Ophthalmol Vis Sci 2019; 59:2316-2324. [PMID: 29847636 DOI: 10.1167/iovs.17-23451] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the amount of lenticule decentration following small-incision lenticule extraction (SMILE) by using the Keratron Scout tangential topography difference map, and the relationship between the magnitudes of total decentration and induced corneal higher-order aberrations (HOAs). Methods This retrospective observational case series study analyzed decentration values obtained from the Keratron Scout tangential topography difference map of 360 eyes (360 patients) that underwent SMILE. Root mean square total HOAs, third order coma aberration, fourth order spherical aberration, as well as individual coefficients for vertical and horizontal coma were measured preoperatively and 3-months postoperatively. Simple linear regression analysis and piecewise regression models were used to determine the relationship between the magnitudes of total decentration and induced corneal HOAs. Results The mean total decentration distance from the corneal vertex was 0.36 ± 0.22 mm (range, 0.02-1.27 mm). There were significant differences in total HOAs, coma, vertical and horizontal comas, and spherical aberration between preoperative and 3-month postoperative assessments. Significant relationships between the magnitudes of total decentration and induced corneal HOAs were noted. Subgroup analysis according to the degree of total decentration (group I, total decentered displacement ≤0.335 mm; and group II, total decentered displacement >0.335 mm) revealed that induced changes in total HOAs, coma, vertical coma, and spherical aberration were significantly larger in group II than in group I. Conclusions A minimal degree of decentration was closely related to a smaller induction of corneal HOAs. Efforts to optimize centration are critical for achieving better surgical outcomes in SMILE.
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Affiliation(s)
- Hun Lee
- Department of Ophthalmology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea.,The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Cynthia J Roberts
- Department of Ophthalmology & Visual Science and Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States
| | | | | | - Dan Z Reinstein
- London Vision Clinic, London, United Kingdom.,Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States.,Centre Hospitalier National d'Ophtalmologie, Paris, France
| | - Tae-Im Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
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18
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Shetty R, Matalia H, Nandini C, Shetty A, Khamar P, Grover T, Sinha Roy A. Wavefront-Guided LASIK Has Comparable Ocular and Corneal Aberrometric Outcomes but Better Visual Acuity Outcomes Than SMILE in Myopic Eyes. J Refract Surg 2018; 34:527-532. [PMID: 30089182 DOI: 10.3928/1081597x-20180607-02] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/25/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare ocular and corneal aberrometric outcomes of wavefront-guided (WFG) LASIK and small incision lenticule extraction (SMILE). METHODS This was a prospective, interventional study where 48 eyes (24 patients) underwent SMILE (Carl Zeiss Meditec, Jena, Germany) and 58 eyes (29 patients) underwent WFG LASIK (Abbott Medical Optics, Abbott Park, IL). Visual acuity and ocular surface disease index were assessed preoperatively and 1 and 3 months postoperatively. Corneal topography and anterior aberrations were assessed with the Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany) and iTrace (Tracey Technologies, Houston, TX), respectively. Ocular aberrations were also assessed with the iTrace. RESULTS Safety and efficacy indexes of WFG LASIK (0.99 and 1.01, respectively) and SMILE (1.01 and 1.13, respectively) were comparable, although WFG LASIK was better (P < .0001). At 3 months postoperatively, all eyes in both groups achieved an uncorrected distance visual acuity of 20/20 or better. Further, 74.14% and 45.83% of the eyes in the WFG LASIK and SMILE groups, respectively, achieved uncorrected distance visual acuity of 20/16 (P = .003). The Pentacam reported an increase in root mean square of higher order aberrations (diameter of 4 mm and 6th order Zernike) and coma with a decrease in spherical aberration in both groups (P < .001). Corneal aberrations from the iTrace also did not yield any definitive differences between the treatments. However, changes in ocular aberrations were clinically insignificant at 3 months after both treatments. The ocular surface disease index increased mildly after WFG LASIK (P > .05) but was unchanged after SMILE. CONCLUSIONS WFG LASIK and SMILE had similar aberrometric outcomes but WFG LASIK had better postoperative visual acuity. Surgeon experience, internal aberrations, small pupil size, and wound healing can enable similar outcomes in both procedures. [J Refract Surg. 2018;34(8):527-532.].
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19
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Steinwender G, Shajari M, Mayer WJ, Kook D, Ardjomand N, Vidic B, Kohnen T, Wedrich A. Impact of a Displaced Corneal Apex in Small Incision Lenticule Extraction. J Refract Surg 2018; 34:460-465. [PMID: 30001449 DOI: 10.3928/1081597x-20180514-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/20/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the possible impact of a displaced corneal apex (point of maximum curvature) on visual results and tomographic parameters after small incision lenticule extraction (SMILE). METHODS In this retrospective evaluation, eyes with uncomplicated SMILE for myopia correction were classified in two groups based on their preoperative distance between the corneal apex and corneal vertex (corneal intercept with the patient's line of sight) of 1 mm or greater (large A-V distance) or less than 1 mm (small A-V distance). All surgeries were performed during the early learning curve of two surgeons. Visual outcome parameters included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refractive spherical equivalent (MRSE), and refractive astigmatism 3 months postoperatively. Scheimpflug-derived tomographic outcome parameters included mean keratometry value, root mean square higher order aberrations (RMS HOAs), and optical zone decentration. RESULTS The study comprised 94 eyes of 48 patients: 44 eyes in the large A-V distance group and 50 eyes in the small A-V distance group. Preoperative and postoperative RMS HOAs were significantly higher in the large A-V distance group than in the small A-V distance group (P = .002 and .008, respectively). Postoperative CDVA was significantly better in the small A-V distance group (P = .014). There were no statistically significant differences in postoperative UDVA, MRSE, refractive astigmatism, mean keratometry value, and optical zone decentration. CONCLUSIONS After SMILE, CDVA was significantly worse in eyes with a preoperatively displaced corneal apex compared to eyes with a more central corneal apex. However, good visual results were achieved in both groups. [J Refract Surg. 2018;34(7):460-465.].
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20
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Moshirfar M, Murri MS, Shah TJ, Linn SH, Ronquillo Y, Birdsong OC, Hoopes PC. Initial Single-Site Surgical Experience with SMILE: A Comparison of Results to FDA SMILE, and the Earliest and Latest Generation of LASIK. Ophthalmol Ther 2018; 7:347-360. [PMID: 29959753 PMCID: PMC6258580 DOI: 10.1007/s40123-018-0137-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction The primary objective was to show our initial surgical single-site experience with small incision lenticule extraction (SMILE) after the official enrollment in March 2017 following Food and Drug Administration (FDA) approval for simple myopia in late 2016 in the United States and, subsequently, compare our results to the earliest and most advanced generation of excimer platforms for laser-assisted in situ keratomileusis (LASIK) surgery. Methods This was a retrospective single-site study of 68 eyes from 35 patients who had SMILE surgery. The patients’ preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest sphere, manifest cylinder, intraoperative complications, and preoperative and postoperative visual symptoms were collected. We compared our findings to the results from the FDA SMILE study, and to the three earliest (1999–2000) and three of the most updated (2013–2016) platforms for LASIK. Results The cumulative UDVA was 20/20 and 20/40 or better in 74% and 100% of patients, respectively. The intended target refraction was within ± 0.5 and ± 1.00 D in 80% and 93% of cases, respectively. The prevalence of dry eyes decreased by nearly half from 1-week to the 6-month postoperative interval. Patients noted improvement in glare (17%), halos (17%), fluctuation (25%), and depth perception (8%) at the 6-month interval compared to preoperative levels. Conclusions This study’s findings are consistent with current SMILE reports. Notably, the results are superior to the earliest generation of LASIK, however inferior to the latest excimer platforms. SMILE does meet the efficacy and safety criteria met by FDA; however, there is a definite need for further improvement to reach the superior refractive outcomes produced by the latest generation of LASIK platforms.
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Affiliation(s)
- Majid Moshirfar
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA. .,Utah Lions Eye Bank, Murray, UT, USA. .,HDR Research Center, Hoopes Vision, Draper, UT, USA.
| | - Michael S Murri
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Tirth J Shah
- University of Arizona College of Medicine, Phoenix, Phoenix, AZ, USA
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Burazovitch J, Ferguene H, Naguszewski D. La prédictibilité du small incision lenticule extraction (SMILE) dans la correction de la myopie sphérocylindrique, étude rétrospective, sur cinq ans, à partir de 616 yeux. J Fr Ophtalmol 2018; 41:433-440. [DOI: 10.1016/j.jfo.2018.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/13/2017] [Accepted: 01/03/2018] [Indexed: 11/26/2022]
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Lake D. Medico-legal aspects of corneal refractive laser eye surgery. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2018. [DOI: 10.1177/2516043518766775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is estimated that over 40 million people have had laser vision correction worldwide since 1991. Laser-assisted subepithelial keratomileusis is commonplace in the UK in high street chains and from more bespoke suppliers. The standards around this treatment have always been regulated by the General Medical Council (GMC), but litigation cases have been common. The recent GMC guidance for cosmetic procedures and subsequent guidelines by the Royal College of Ophthalmologists cover advertising, facility regulations, equipment, consent and surgeon training which should improve industry practices and deliver improved patient safety standards.
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Affiliation(s)
- Damian Lake
- The Queen Victoria Hospital & The Eye Bank, The Corneo Plastic Unit, East Grinstead, UK
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