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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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Du Y, Di Y, Yang S, Mo F, Cui G, Chen D, Li Y. Differences in ocular high order aberrations before and after small incision lenticule extraction for correction of myopia: a systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1274101. [PMID: 38601117 PMCID: PMC11004322 DOI: 10.3389/fmed.2024.1274101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
Objective To examine the causes and factors that lead to high order aberration (HOA) during the treatment of myopia using small incision lenticule extraction (SMILE), as well as the differences between SMILE and other corneal refractive surgeries through a systematic review and meta-analysis. Methods A systematic search was conducted from January 2015 to February 2023 in Pubmed, Embase, Web of Science, and Google Scholar databases to gather relevant studies on SMILE and HOA. Studies meeting specific criteria were chosen, and clinical data was retrieved for analysis. Results This meta-analysis resulted in the inclusion of 19 studies involving 1,503 eyes. Pooled results showed significant induction of total HOA (tHOA, d = -0.21, p < 0.001), spherical aberration (SA, d = -0.11, p < 0.001) and coma aberration (CA, d = -0.18, p < 0.001) after SMILE compared to pre-SMILE, while no significant change in trefoil aberration (TA) was observed (d = -0.00, p = 0.91). There was a significantly lower induction of tHOA after SMILE compared to femtosecond laser-assisted in situ keratomileusis (FS-LASIK, d = 0.04, p < 0.001), and no significant difference was observed compared to wavefront aberration-guided (WFG) refractive surgery (d = 0.00, p = 0.75). There was also a significant association between different levels of myopia and astigmatism, duration of follow-up, lenticule thickness, and preoperative central corneal thickness (CCT) on the induction of tHOA after SMILE (p < 0.05), while the higher preoperative myopia group (sphere > -5D), lower preoperative astigmatism group (cylinder ≤ -1D), larger lenticule thickness group (lenticule thickness > 100 μm), shorter follow-up group (follow-up 1 month postoperatively) and the thicker CCT group (CCT > 550 μm) brought a significant induction of tHOA compared to the opposite comparison group (p < 0.001). Conclusion While SMILE can induce HOA significantly, it induces less HOA than FS-LASIK. Postoperative HOA following SMILE can be affected by factors such as myopia, astigmatism, lenticule thickness, CCT, and duration of follow-up. Future research should continue to explore techniques to decrease the induction of HOA by using this methodology. Systematic review registration https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
| | | | | | | | | | | | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Ma KK, Manche EE. Patient-reported quality of vision in a prospective randomized contralateral-eye trial comparing LASIK and small-incision lenticule extraction. J Cataract Refract Surg 2023; 49:348-353. [PMID: 36539217 DOI: 10.1097/j.jcrs.0000000000001127] [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: 09/06/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To compare patient-reported quality of vision and visual symptoms in participants undergoing laser in situ keratomileusis (LASIK) and small-incision lenticule extraction (SMILE). SETTING Byers Eye Institute, Stanford University, Palo Alto, California. DESIGN Prospective randomized contralateral-eye clinical trial. METHODS Patients with myopia were randomized to receive wavefront-guided femtosecond LASIK in one eye and SMILE in the fellow eye. Participants reported the presence and severity of adverse visual symptoms through the Patient-Reported Outcomes With Laser In Situ Keratomileusis questionnaire and reported which eye had better vision at the preoperative and the postoperative 1-month, 3-month, 6-month, and 12-month visits. RESULTS 80 eyes of 40 participants were treated. There was no difference in the presence or severity of double vision, glare, halos, or starbursts between eyes that underwent LASIK or SMILE at each visit ( P ≥ .85 for each comparison). Scaled scores for the presence of visual symptoms improved from the preoperative visit to the postoperative month 12 visit for double vision (88 vs 97, P = .03), glare (77 vs 92, P = .02), halos (68 vs 87, P < .01), and starbursts (60 vs 86, P < .01). At the postoperative month 12 visit, 17 (46%) of 37 participants preferred the vision from the eye that underwent LASIK compared with 7 (19%) of 37 who underwent SMILE. The preferred eye was correlated with uncorrected distance visual acuity ( r = 0.52, P < .01). CONCLUSIONS Rates of visual symptoms were similar for LASIK and SMILE, and visual symptoms improved with time. More patients preferred vision from the eye that underwent LASIK compared with SMILE.
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Affiliation(s)
- Kevin K Ma
- From the Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
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Corneal Higher-Order Aberrations Measurements: Precision of SD-OCT/Placido Topography and Comparison with a Scheimpflug/Placido Topography in Eyes After Small-Incision Lenticule Extraction. Ophthalmol Ther 2023; 12:1595-1610. [PMID: 36862309 PMCID: PMC10164219 DOI: 10.1007/s40123-023-00693-1] [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: 12/09/2022] [Accepted: 02/14/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the measurements of corneal higher-order aberrations (HOAs) obtained by a new anterior segment optical coherence tomography (OCT) technique combined with a Placido topographer (the MS-39 device) in eyes with prior small-incision lenticule extraction (SMILE) and compare them to the measurements obtained by a Scheimpflug camera combined with a Placido topographer (the Sirius device). METHODS A total of 56 eyes (56 patients) were included in this prospective study. Corneal aberrations were analyzed for the anterior, posterior, and total cornea surfaces. Within-subject standard deviation (Sw), test-retest repeatability (TRT), and intraclass correlation coefficient (ICC) were used to assess the intraobserver repeatability and interobserver reproducibility. The differences were evaluated by paired t-test. Bland-Altman plots and 95% limits of agreement (95% LoA) were used to evaluate the agreement. RESULTS High repeatability was observed for anterior and total corneal parameters, with Sw value < 0.07, TRT ≤ 0.16, and ICCs > 0.893, but not trefoil. For the posterior corneal parameters, ICCs varied from 0.088 to 0.966. Regarding interobserver reproducibility, all Sw values were ≤ 0.04 and TRT ≤ 0.11. ICCs ranged from 0.846 to 0.989, from 0.432 to 0.972, and from 0.798 to 0.985 for the anterior, total, and posterior corneal aberrations parameters, respectively. The mean difference in all aberrations was ≤ 0.05 μm. All parameters showed a narrow 95% LoA. CONCLUSION The MS-39 device achieved high precision in both anterior and total corneal measurements; the precision of posterior corneal higher-order RMS, astigmatism II, coma, and trefoil was lower. The two technologies used by the MS-39 and Sirius devices can be used interchangeably for measuring corneal HOAs after SMILE.
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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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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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7
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Chang JY, Lin PY, Hsu CC, Liu CJL. Comparison of clinical outcomes of LASIK, Trans-PRK, and SMILE for correction of myopia. J Chin Med Assoc 2022; 85:145-151. [PMID: 34861667 DOI: 10.1097/jcma.0000000000000674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Transepithelial photorefractive keratectomy (Trans-PRK), laser-assisted in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE) are three mainstay refractive surgeries worldwide. The applicability, efficacy, safety, and predictability of these different techniques are quite similar. Trans-PRK has the strongest biostability, earliest return to normal corneal sensitivity but the longest recovery time, most uncomfortable postoperative experience, and possibility of corneal haze. LASIK possesses the fastest visual rehabilitation but the slowest corneal nerve reinnervation, and flap displacement is possibly lifelong. SMILE incurs no flap-related complications and has intermediate vision recovery time and biomechanics compared with Trans-PRK and LASIK. However, it lacks the cyclotorsion-compensation system, eye-tracking system, and customized treatment profile for high astigmatism or irregular corneal surface. This review aims to introduce the mechanisms, pros, and cons of these three types of refractive surgery. With full understanding, practitioners could advise patients on the most suitable treatment of choice.
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Affiliation(s)
- Jin-Yu Chang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pei-Yu Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Catherine Jui-Ling Liu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Kwak JJ, Jun I, Kim EK, Seo KY, Kim TI. Clinical Outcomes of Small Incision Lenticule Extraction in Myopia: Study of Vector Parameters and Corneal Aberrations. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 34:76-84. [PMID: 32037752 PMCID: PMC7010474 DOI: 10.3341/kjo.2019.0109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/05/2019] [Accepted: 10/17/2019] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To investigate clinical outcomes of small incision lenticule extraction (SMILE) including vector parameters and corneal aberrations in myopic patients. METHODS This retrospective, observational case series included 57 eyes (29 patients) that received treatment for myopia using SMILE. Visual acuity measurement, manifest refraction, slit-lamp examination, autokeratometry, corneal topography, and evaluation of corneal wavefront aberration were performed preoperatively and at 1 and 3 months after surgery. We analyzed the safety, efficacy, vector parameters, and corneal aberrations at 3 months after surgery. RESULTS Preoperatively, mean manifest refraction spherical equivalent refraction was -4.94 ± 1.94 D (range, -8.25 to 0 diopters [D]), and the cylinder was -1.14 ± 0.82 D (range, -3 to 0 D). Mean manifest refraction spherical equivalent improved to -0.10 ± 0.23 D at 3 months postoperatively, when uncorrected distance visual acuity was 20 / 20 or better in 55 (96%) eyes. The linear regression model of target induced astigmatism vector versus surgically induced astigmatism vector exhibited slopes and coefficients (R²) of 0.9618 and 0.9748, respectively (y = 0.9618x + 0.0006, R² = 0.9748). While total corneal root mean square higher order aberrations, coma and trefoil showed statistically significant increase, spherical aberration did not show statistically significant change after SMILE. CONCLUSIONS SMILE has proven to be effective and safe for correcting myopia and astigmatism. We showed that SMILE did not induce spherical aberrations. A small increase in postoperative corneal higher order aberration may be associated with increase in coma and trefoil.
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Affiliation(s)
- Jay Jiyong Kwak
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Ikhyun Jun
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Kweon Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.,Corneal Dystrophy Research Institute, Severance Biomedical Science Institute, and Brain Korea 21 Project for Medical Science, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Yul Seo
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Im Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.,Corneal Dystrophy Research Institute, Severance Biomedical Science Institute, and Brain Korea 21 Project for Medical Science, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
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Zhao X, Zhang L, Ma J, Li M, Zhang J, Zhao X, Wang Y. Comparison of Wavefront-Guided Femtosecond LASIK and Optimized SMILE for Correction of Moderate-to-High Astigmatism. J Refract Surg 2021; 37:166-173. [PMID: 34038300 DOI: 10.3928/1081597x-20201230-01] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare refractive outcomes, higher order aberrations (HOAs), and the changes in contrast sensitivity after wavefront-guided femtosecond laser-assisted in situ keratomileusis (WFG LASIK) and optimized small incision lenticule extraction (SMILE) for moderate-to-high astigmatism correction. METHODS This prospective, randomized study included 87 eyes: 40 eyes in the WFG LASIK group and 47 eyes in the SMILE group. Manual cyclotorsion compensation by marking the horizontal axis before SMILE surgery was used for optimized SMILE. Refractive diopter, aberrations, and contrast sensitivity were assessed 3 months postoperatively. The Alpins vector analysis method was used to analyze the astigmatic changes after surgery. RESULTS There were no significant differences in the corrected distance visual acuity and refraction between the two groups after surgery. The fitted curve of surgically induced astigmatism versus target induced astigmatism was described as y = 0.9905 x + 0.0009 in the WFG LASIK group and y = 0.9672 x + 0.0026 in the SMILE group. The percentage of corneal astigmatism axis change within 5 degrees was statistically significant (chi-square test: 10.632, P = .001). HOAs increased in both the WFG LASIK and SMILE groups after surgery (t = -3.655, P = .001, t = -3.784, P = .001, respectively). However, comparison of the changes of HOAs between both groups was not significant (t = -0.565, P = .575). The improvement in contrast sensitivity in the WFG LASIK group was significantly higher than that in the SMILE group. CONCLUSIONS WFG LASIK and optimized SMILE can achieve similar outcomes for astigmatism correction. Optimized SMILE with marking could achieve good astigmatism correction, even without an eye tracking system. [J Refract Surg. 2021;37(3):166-173.].
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10
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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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11
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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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Effect of flap homogeneity on higher-order aberrations induction after femtosecond LASIK for myopia. J Cataract Refract Surg 2020; 46:1278-1283. [PMID: 32898096 DOI: 10.1097/j.jcrs.0000000000000255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the relevance of the homogeneity of femtosecond laser flap thickness regarding induction of higher-order aberrations (HOAs). SETTING Clínica Rementería & Clínica Novovisión, Madrid, Spain. DESIGN Prospective observational study. METHODS Two hundred thirty-one patients underwent in situ keratomileusis using 5 different femtosecond lasers. The flap thicknesses were measured using anterior segment optical coherence tomography 3 months postoperatively. The same masked observer measured 6 symmetrical points nasally and temporally 1.0 mm, 2.0 mm, and 3.0 mm from the center of the flap in each case. HOAs induced in the cornea were measured using tomography. RESULTS Positive and significant correlations were found between HOA induction and the flap thickness heterogeneity 3.0 mm from the center of the flap. Pearson correlation coefficients for the induction of HOAs were third-order 0.17112 (P = .0224), fourth-order 0.22474 (P = .0026), fifth-order 0.16449 (P = .0282), coma-like 0.17370 (P = .0204), and total HOAs 0.18182 (P = .0151). CONCLUSIONS The amount of flap-thickness heterogeneity at 3.0 mm from the center of the flap created using femtosecond lasers was correlated with the magnitude of the HOAs induced.
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13
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Five-year outcomes of small-incision lenticule extraction vs femtosecond laser–assisted laser in situ keratomileusis: a contralateral eye study. J Cataract Refract Surg 2020; 46:403-409. [DOI: 10.1097/j.jcrs.0000000000000067] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Kayhan B, Coskunseven E, Sahin O, Pallikaris I. The effects of implantable collamer lens implantation on higher order aberrations. Int J Ophthalmol 2019; 12:1848-1852. [PMID: 31850167 DOI: 10.18240/ijo.2019.12.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/30/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the changes in higher order aberrations (HOAs) after implantable collamer lens (ICL; Staar Surgical, Nidau, Switzerland) implantation. METHODS Totally 30 eyes of 18 patients with myopia were included in this study with an average age of 25.77y (min: 21, max: 40). Refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), HOAs (entire, corneal and internal) were evaluated preoperatively and three months postoperatively. Ocular aberrations were measured by using iTrace (Tracey Technology, Houston, Texas, USA). SPSS (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp) was used for the statistical analysis and the interpretation of the data. P values of less than 0.05 were considered statistically significant. RESULTS The preoperative mean spherical power was -9.01 D (min: -5.00, max: -13.00) and the mean cylindrical error was -2.40 D (min: -0.50, max: -4.75). The postoperative mean residual spherical power was -0.73 D (min: -0.20, max: -1.75) and the mean cylindrical error was -0.89 D (min: -0.18, max: -2.09). Analyses were made on root mean square (RMS) values of total HOAs (tHOAs), spherical aberration, coma and trefoil as entire, corneal and internal components. The differences in entire tHOAs and in internal tHOAs were significant. There was no significant change found in spherical aberrations. The differences in entire coma and in internal coma were significant. There was no significant change found in corneal coma. With respect to trefoil, the only significant difference was in internal trefoil. CONCLUSION The ICL implantation corrects the refractive error successfully and changes entire and internal HOAs of the eye.
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Affiliation(s)
- Belma Kayhan
- Dunyagoz Hospital Group, Istanbul 34337, Turkey.,Department of Ophthalmology, Sultan Abdulhamid Han Training and Research Hospital, the University of Saglik Bilimleri, Istanbul 34668, Turkey
| | | | - Onurcan Sahin
- Dunyagoz Hospital Group, Istanbul 34337, Turkey.,Institute of Vision and Optics, University of Crete, Heraklion 70013, Greece
| | - Ioannis Pallikaris
- Dunyagoz Hospital Group, Istanbul 34337, Turkey.,Institute of Vision and Optics, University of Crete, Heraklion 70013, Greece
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Schmelter V, Dirisamer M, Siedlecki J, Shajari M, Kreutzer TC, Mayer WJ, Priglinger SG, Luft N. Determinants of subjective patient-reported quality of vision after small-incision lenticule extraction. J Cataract Refract Surg 2019; 45:1575-1583. [PMID: 31585852 DOI: 10.1016/j.jcrs.2019.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/22/2019] [Accepted: 06/17/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE To characterize patient-reported long-term quality of vision (QoV) after small-incision lenticule extraction (SMILE), and to identify potential clinical parameters that might predispose to experiencing deteriorated visual quality. SETTING University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany. DESIGN Prospective cross-sectional study. METHODS For the assessment and scoring of visual symptoms, the Quality of Vision questionnaire was employed, which constitutes a clinically validated, linear-scaled 30-item instrument providing a QoV score on three scales (symptom frequency, severity, and bothersome). Subgroup analyses were performed for patient subgroups stratified by baseline characteristics (eg, age) and treatment parameters (eg, surgical refractive correction) as well as refractive outcomes (eg, residual refraction) and visual outcomes (eg, uncorrected distance visual acuity [UDVA]). RESULTS The study comprised 394 eyes of 197 patients (117 women [59.4%], 80 men [40.6%]) were included with a mean postoperative follow-up of 24.4 months ± 14.1 (SD). The QoV scores for symptom frequency, severity, and bothersome were 34.63 ± 13.69, 29.60 ± 12.38, and 24.56 ± 16.00, respectively. Patients with a preoperative binocular corrected distance visual acuity (CDVA) of 20/12.5 or better, patients who lost 1 or more lines of UDVA as compared with preoperative CDVA, patients older than the age of 40, and patients with inadvertent anisometropia more than 0.375 diopters reported worse QoV scores. CONCLUSION The relationship between objective clinical parameters and patient-reported subjective QoV after SMILE seems complex. Defined prognostic factors that convey a higher risk for experiencing visual disturbances were identifiable and should be discussed with patients seeking SMILE treatment during preoperative counseling.
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Affiliation(s)
- Valerie Schmelter
- University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Martin Dirisamer
- University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany; SMILE Eyes Clinic, Linz, Austria
| | - Jakob Siedlecki
- University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany; SMILE Eyes Clinic, Linz, Austria
| | - Mehdi Shajari
- University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Thomas C Kreutzer
- University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - 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
| | - Nikolaus Luft
- University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany; SMILE Eyes Clinic, Linz, Austria.
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Piccinini AL, Golan O, Hafezi F, Randleman JB. Higher-order aberration measurements: Comparison between Scheimpflug and dual Scheimpflug-Placido technology in normal eyes. J Cataract Refract Surg 2019; 45:490-494. [PMID: 30713018 DOI: 10.1016/j.jcrs.2018.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/25/2018] [Accepted: 11/19/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare higher order aberrations (HOAs) in normal eyes between a Scheimpflug imaging system (Pentacam HR) and dual Scheimpflug-Placido imaging system (Galilei G4). SETTING Emory University, Atlanta, Georgia, and the University of Southern California, Los Angeles, USA. DESIGN Retrospective case series. METHODS Eyes screened for refractive surgery were evaluated sequentially using a Scheimpflug device and a dual Scheimpflug-Placido device. Differences, correlations, and agreement between values for total root mean square (RMS), trefoil, coma, and spherical aberration were analyzed, and Bland-Altman plots were generated. RESULTS One hundred five eyes of 105 patients (44 men, 61 women) were evaluated. Total RMS, coma, and trefoil were significantly different between groups (all P < .001), while spherical aberration values were not. There was moderate correlation between devices for trefoil (r = 0.475 to 0.652), coma (r = 0.574 to 0.651), and spherical aberration (r = 0.483) and a strong correlation for total cornea RMS (r = 0.817). There was no directional bias between groups. The 95% limits of agreement for absolute values was 0.039 μm for trefoil at 30 degrees, 0.405 μm for trefoil at 0 degree, 0.553 μm for horizontal coma, 0.545 μm for vertical coma, 0.318 μm for spherical aberration, and 0.617 μm for RMS. CONCLUSIONS A Scheimpflug imaging device and dual Scheimpflug-Placido imaging device generated statistically different values for total cornea HOAs; however, the correlation between devices was moderate to strong and there was reasonable agreement in all measures for normal eyes. Based on these findings, the devices appear functionally equivalent for clinical use, although caution is warranted for outcomes-based research protocols that report HOAs.
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Affiliation(s)
- Andre L Piccinini
- Keck School of Medicine, University of Southern California, Los Angeles, USA; Sadalla Amin Ghanem Eye Hospital, Joinville, SC, Brazil
| | - Oren Golan
- Keck School of Medicine, University of Southern California, Los Angeles, USA; Department of Ophthalmology, Tel Aviv Souraski Medical Center, Tel Aviv, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Farhad Hafezi
- Keck School of Medicine, University of Southern California, Los Angeles, USA; USC Roski Eye Institute, Los Angeles, USA; ELZA Institute, Dietikon/Zurich, Switzerland; Ocular Cell Biology Group, University of Zurich, Zurich, Switzerland; University of Wenzhou, Wenzhou, China
| | - J Bradley Randleman
- Keck School of Medicine, University of Southern California, Los Angeles, USA; USC Roski Eye Institute, Los Angeles, USA.
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