Visual outcomes after SMILE from the first-year experience at a U.S. military refractive surgery center and comparison with PRK and LASIK outcomes

PURPOSE: To assess the visual outcomes of small-incision lenticule extraction (SMILE) after the first year of treatments at a military refractive surgery center and compare with photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) outcomes during the same period. SETTING: Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir, VA. DESIGN: Retrospective study. METHODS: Records of service members who underwent SMILE, PRK, or LASIK for myopia from March 2017 to February 2018 were reviewed. Preoperative and up to 6-month postoperative data were collected. Visual outcomes were compared between treatments. RESULTS: Of 563 treated eyes, 173 (30.7%) underwent SMILE, 304 (54.0%) PRK, and 86 (15.3%) LASIK. In comparing SMILE with PRK 1 month postoperatively, SMILE (145 eyes 87.9%) attained uncorrected distance visual acuity (UDVA) ≥20/20 more vs PRK (214 eyes 73.8%; P < .01). Similarly, SMILE (152 eyes 94.4%) achieved more eyes with manifest spherical equivalent (MSE) within ±0.50 diopters (D) from intended target vs PRK (250 eyes 85.9%; P = .01). None lost ≥1 line of corrected distance visual acuity in SMILE vs PRK (16 eyes 5.5%; P < .01). Thereafter, there were no other significant differences except SMILE had 117 eyes (95.1%) vs PRK with 224 eyes (99.6%) achieving UDVA ≥20/20 at 3 months postoperatively (P = .01). In assessing SMILE vs LASIK, all parameters were comparable; however, 77 SMILE eyes (96.3%) had MSE within ±0.50 D from target vs 31 LASIK eyes (83.8%) at 6 months postoperatively (P = .02). CONCLUSIONS: The first year after SMILE treatments in a U.S. military center demonstrated early postoperative outcomes superior to PRK. SMILE seemed more predictable compared with LASIK.