Myopic LASIK or SMILE?

Comparative study explores patient-reported differences.

Cheryl Guttman Krader

Posted: Friday, January 19, 2018

SMILE patients may be happier than LASIK patients, primarily because of less postoperative dry eye problems, a prospective, nonrandomised study provide suggests.

Juhani Pietilä MD, PhD, reported data from the study of 100 eyes (51 patients) treated with SMILE and 200 eyes (102 patients) who underwent LASIK with a femtosecond laser-created flap, at the XXXV Congress of the ESCRS in Lisbon.

The results showed that efficacy, predictability and safety outcomes were similar for the two procedures. However, SMILE was associated with less dry eye than LASIK, and while patient satisfaction with vision was high for both groups, for near vision, it was slightly better after LASIK.

“Corneal refractive surgeons report dry eye is the most common complication of LASIK and it is also the main reason why patients are dissatisfied with LASIK. We were interested in conducting this study to further compare dry eye symptoms and patient satisfaction associated with these two procedures,” said Dr Pietilä, University of Tampere, Finland.

The two-centre study was performed at hospitals in Tampere and Helsinki. All LASIK ablations were done with the Wavelight EX500 laser (Alcon). The VisuMax laser (Carl Zeiss Meditec) was used for SMILE. Preoperatively, the two groups were similar with respect to mean age and refractive values.

At one month after surgery, uncorrected distance visual acuity was 20/20 or better in 80% of SMILE eyes and 83% of the LASIK eyes. Achieved SE was ±0.5 D of target in 91% of SMILE eyes sand 94% of LASIK eyes. BCVA loss of one line affected two SMILE patients.

Patients completed a questionnaire for rating dry eye sensation (0 [no dryness] to 10 [extremely dry]) and satisfaction with vision (0% [not at all] to 100% [very]). Preoperatively, patients in the SMILE group had slightly worse mean scores for dry eye than the LASIK group (3.78 vs. 2.75) but better satisfaction with their far (80.69 vs. 73.10) and near vision (88.04 vs. 82.36).

“These differences are because SMILE patients were more often wearing contact lenses, while more LASIK patients were wearing glasses,” Dr Pietilä said.

Postoperative data were collected four-to-six weeks after LASIK and six-to-eight weeks after SMILE, allowing for the slower recovery after SMILE. Mean scores showed sensation of dryness was reduced in the SMILE group (2.80), but increased after LASIK (3.35). Mean scores for satisfaction with near and far sight for SMILE were 88.92 and 89.84, respectively, and 91.20 and 90.18, respectively for LASIK.

Juhani Pietilä, MD, PhD


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