Comparison of the Visual Results After SMILE and Femtosecond Laser-Assisted LASIK for Myopia

PURPOSE: To perform a comparative clinical analysis of the safety, efficacy, and predictability of two surgical procedures (ie, small incision lenticule extraction SMILE and femtosecond laser-assisted LASIK FS-LASIK) to correct myopia. METHODS: Sixty eyes of 31 patients with a mean spherical equivalent of −5.13 ± 1.75 diopters underwent myopia correction with the SMILE procedure. Fifty-one eyes of 27 patients with a mean spherical equivalent of −5.58 ± 2.41 diopters were treated with the FS-LASIK procedure. Postoperative uncorrected and corrected distance visual acuity, manifest refraction, and higher-order aberrations were analyzed statistically at 1 and 3 months postoperatively. RESULTS: No statistically significant differences were found at 1 and 3 months in parameters that included the percentage of eyes with an uncorrected distance visual acuity of 20/20 or better ( P = .556, .920) and mean spherical equivalent refraction ( P = .055, .335). At 1 month, 4 SMILE-treated eyes and 1 FS-LASIK–treated eye lost one or more line of visual acuity ( P = .214, chi-square test). At 3 months, 2 SMILE-treated eyes lost one or more line of visual acuity, whereas all FS-LASIK–treated eyes had an unchanged or corrected distance visual acuity. Higher-order aberrations and spherical aberration were significantly lower in the SMILE group than the FS-LASIK group at 1 ( P = .007, .000) and 3 ( P = .006, .000) months of follow-up. CONCLUSIONS: SMILE and FS-LASIK are safe, effective, and predictable surgical procedures to treat myopia. SMILE has a lower induction rate of higher-order aberrations and spherical aberration than the FS-LASIK procedure. J Refract Surg. 2014;30(4):248–254.