Refractive and Visual Outcomes of SmartSight NOVA Refractive Lenticule Extraction for Myopia and Myopic Astigmatism at 3 Months: a Retrospective Case Series

INTRODUCTION: SmartSight NOVA using the ATOS platform (SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany) is a refractive lenticule extraction method with CenTrax-assisted centration. We hypothesized that SmartSight NOVA would provide safe, effective, and predictable 3-month outcomes for myopia and myopic astigmatism while maintaining favorable positional stability relative to the preoperative vertex-centered reference and acceptable higher-order aberration profiles. METHODS: This retrospective single-center case series included 84 eyes of 42 patients treated with SmartSight NOVA for myopia and myopic astigmatism. Standard refractive surgery outcome analyses were performed at 1 and 3 months, including visual acuity, manifest refraction, and stability. Higher-order aberrations, chord μ subgroup analyses, and postoperative center-coordinate stability relative to the preoperative position were also assessed. RESULTS: No clinically significant intraoperative or postoperative complications were observed during the 3-month follow-up. Preoperative manifest spherical equivalent was -3.70 ± 1.21 D. At 3 months, mean postoperative uncorrected distance visual acuity was 0.006 ± 0.020 logarithm of the minimum angle of resolution (logMAR), and postoperative manifest sphere, cylinder, and spherical equivalent were 0.021 ± 0.311 D, -0.327 ± 0.280 D, and -0.143 ± 0.336 D, respectively. Spherical equivalent was within ± 0.50 diopters (D) in 81.0% of eyes at 1 month and 89.3% at 3 months, and within ± 1.00 D in 100.0% of eyes at both visits. Postoperative refractive astigmatism was ≤ 0.50 D in 86% of eyes and ≤ 1.00 D in 100% of eyes at 3 months. No eyes lost two or more lines of corrected distance visual acuity. Induced higher-order aberrations did not differ significantly among preoperative chord μ groups. Mean displacement magnitude was 0.049 ± 0.028 mm, and 92.9% of eyes were within 0.10 mm of the preoperative position. CONCLUSIONS: SmartSight NOVA showed favorable early clinical outcomes at 3 months, with good visual and refractive performance, low residual astigmatism, limited higher-order aberration induction, and small postoperative displacement relative to the preoperative vertex-centered reference in most eyes.