Refractive Surgery in Athletes: Safety, Visual Performance and Return-to-Sport Considerations - A Narrative Review

Background: Optimal vision is performance-critical in many sports, while spectacles and contact lenses may impair comfort, safety, and reliability during training and competition. Corneal refractive surgery (photorefractive keratectomy—PRK, laser in situ keratomileusis—LASIK, small-incision lenticule extraction—SMILE) is increasingly considered by athletes, but procedure selection must balance visual quality, ocular-surface stability, biomechanical safety, and sport-specific trauma risk [1,4–7,19,20]. Aim: To synthesize contemporary evidence on safety, visual performance, and return-to-sport considerations after PRK, LASIK, and SMILE in athletic and athletic-like populations [1–8,19,20]. Material and methods: A narrative review was conducted using PubMed as the primary database (supplemented by manual reference chasing) for English-language human studies (2018–2025) addressing refractive surgery outcomes relevant to athletes: visual acuity/quality, contrast sensitivity and low-contrast acuity, dry eye and symptoms, ectasia/biomechanics, traumatic flap events, and occupational return-to-duty in visually demanding cohorts [1–8,13–17,19,20]. Results: Modern PRK, femtosecond LASIK, and SMILE provide high efficacy and safety in most appropriately selected patients [1–3]. SMILE and PRK avoid a permanent flap and may be preferable in high-impact/contact sports [9–11]. Visual quality (including low-contrast performance) generally recovers rapidly after LASIK/SMILE and more gradually after PRK [1,14,16,17]; dry-eye metrics tend to worsen most after LASIK, with smaller or nonsignificant changes reported after PRK/SMILE in meta-analytic evidence [4,5]. Ectasia remains rare but is linked to preoperative risk factors; reported ectasia after SMILE is uncommon in large cohorts [6,7]. Return-to-sport timelines are primarily based on healing biology and trauma risk rather than randomized evidence [19–21]. Conclusions: For athletes, procedure choice should be individualized by sport exposure, ocular-surface status, corneal tomography/biomechanical risk, and performance demands under glare/low contrast [4–8,14,16,17]. Flapless approaches (PRK/SMILE) are generally favored for contact sports; structured, staged return-to-sport with protective eyewear is recommended [9–11,19–21].