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Wavefront-guided LASIK still outperforms SMILE, study shows
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Wavefront-guided LASIK showed better and more predictable outcomes, better aberrometric control and preservation of visual quality than SMILE in patients with low to moderate myopia and myopic astigmatism in a multicenter, prospective study.
A total of 110 patients with myopia or myopic astigmatism of less than 6 D were randomly assigned to wavefront-guided LASIK or Small incision lenticule extraction (SMILE). Only one eye for each patient was evaluated.
Wavefront-guided LASIK was performed using the M2 microkeratome (Moria) and the Star S4IR excimer laser combined with the iDesign system (Abbott Medical Optics), and SMILE was performed with the VisuMax platform (Carl Zeiss Meditec).
Although preoperative corrected distance visual acuity was better in the SMILE group, postoperative outcomes were significantly better in the LASIK group, the study showed.
Uncorrected distance visual acuity of 20/20 or better was achieved in 90.20% of eyes with LASIK and 77.97% of eyes with SMILE. More eyes lost lines in the SMILE group (6.8% vs. 0.0%).
Ninety-eight percent of eyes reached spherical equivalent within +0.50 D with LASIK, and 81.5% reached it with SMILE. A similar proportion was found with postoperative cylinder.
A significantly higher increase in higher-order aberrations and primary coma root mean square was observed in the SMILE group as compared with the LASIK group, leading to a significantly higher decrease of contrast sensitivity.
According to the authors, optimization in the algorithms used for the calculation of the lenticule size in relation to the refractive error is necessary to improve results.
In addition, “the development of a future wavefront-guided SMILE technique with automatic axial and torsional registration would allow better astigmatic correction and an optimization of the aberrometric changes induced with the surgery and consequently of the visual quality outcomes,” they wrote. – by Michela Cimberle
Disclosure: Khalifa received an unrestricted educational grant from AMO. The remaining authors have no relevant financial disclosures.
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