Objective and Subjective Quality of Vision After SMILE for High Myopia and Astigmatism

THERAPEUTIC REFRACTIVE VITRECTOMY FOR THE MANAGEMENT OF VITREOUS FLOATERS AND OPACITIES ASSESSED BY THE STANDARDIZED AND KINETIC ANATOMICAL AND FUNCTIONAL TESTING OF VITREOUS FLOATERS AND OPACITIES

PURPOSE

Propose new terminology and evaluate the effectiveness of therapeutic refractive vitrectomy (TRV) for selective removal of vitreous floaters and opacities using Standardized Kinetic Anatomical Functional Testing of Vitreous Floaters and Opacities and new ultra widefield optical coherence tomography imaging techniques.

METHODS

Retrospective analysis. Twenty eyes underwent therapeutic refractive vitrectomy for symptomatic vitreous floaters and opacities. Pre-TRV assessments/post-TRV assessments: Standardized and Kinetic Anatomical and Functional Testing of Vitreous Floaters and Opacities, including straylight measurements (HD Analyzer, Light Disturbance Analyzer, C-Quant) alongside noncontact imaging including a new ultra widefield optical coherence tomography to evaluate changes in vitreous anatomical and optical properties.

RESULTS

Post-TRV evaluations indicated objective changes in vitreous optical properties and subjective measures. Reduced straylight measurements: HD Analyzer 22%, light disturbance analyzer 54.4% ( P = 0.013), and C-Quant 7.8% ( P = 0.034). Patient-reported outcomes statistically significantly improved ( P = 0.022). Corrected distance visual acuity changes were marginal. New ultra widefield 26 mm by 12 mm imaging window optical coherence tomography facilitated detailed vitreous imaging, confirming the status of posterior vitreous detachment (100%). Post-TRV ultra widefield and optical coherence tomography imaging demonstrated restoration of vitreous clarity, confirmed the presence of residual cortical vitreous and absence of new posterior vitreous detachments.

CONCLUSION

Therapeutic refractive vitrectomy is a significant contribution for therapeutic refractive surgery as a safe and effective approach to enhancing visual quality, correcting refractive and opaque vitreous anomalies. Improvement in corrected distance visual acuity was minimal, representing limited effectiveness as a measure of comprehensive visual function. Improvements in objective straylight measures and imaging are in alignment with subjective symptom improvements post-TRV. This underscores the utility and value of new holistic evaluation methods beyond traditional metrics to assess the impact of therapeutic refractive vitrectomy on visual function and quality of life.

Comparing femtosecond LASIK and small-incision lenticule extraction (SMILE)

PURPOSE OF REVIEW

This review compares two refractive surgery modalities, femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small-incision lenticule extraction (SMILE), focusing on their efficacy, safety, postoperative recovery, and patient-reported outcomes. The aim is to provide an updated review of recent findings and identify areas for additional research to further optimize surgical outcomes and patient selection.

RECENT FINDINGS

FS-LASIK and SMILE show excellent, comparable visual outcomes for the correction of myopia and astigmatism. SMILE may have a lower risk of dry eye and has no flap-related complications, while FS-LASIK provides quicker visual recovery. SMILE may offer superior long-term visual outcomes, particularly for high myopia. However, customized FS-LASIK (wavefront- and topography-guided) outperform SMILE in some visual metrics, including uncorrected visual acuity and reduction in higher-order aberrations.

SUMMARY

FS-LASIK remains the gold standard refractive procedure due to its rapid recovery and predictable results, but SMILE offers advantages in preserving corneal biomechanical stability and potentially minimizing dry eye symptoms. SMILE may also offer improved long-term stability for patients at risk of myopic regression. However, a growing body of evidence suggests that wavefront- and topography-guided LASIK yield superior visual outcomes compared to SMILE. Additional long-term comparative studies are needed for different refractive treatment requirements.

The influence of axial length on visual quality following SMILE surgery in patients with high myopia

PURPOSE

This retrospective study aimed to investigate the subjective and objective visual outcomes following Small Incision Lenticule Extraction (SMILE) surgery in high myopic patients with varying axial lengths (AL).

METHODS

The study enrolled 113 highly myopic patients (202 eyes) who underwent SMILE surgery at Shanghai's Tenth People's Hospital from July 2021 to September 2023. Patients were classified into three groups based on the axial length before surgery: Group A (AL < 26 mm, 62 eyes), Group B (26 mm ≤ AL < 27 mm, 88 eyes), and Group C (AL ≥ 27 mm, 52 eyes). Preoperative and postoperative evaluations included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), equivalent spherical error, and ocular higher-order aberrations. Subjective visual quality was assessed using the Quality of Vision (QoV) questionnaire.

RESULTS

One year postoperatively, there were no notable differences found in safety, efficacy, or stability among the groups (P > 0.05). Postoperative spherical aberration, horizontal, and vertical coma increased compared to preoperative values and showed a positive association with axial length (P < 0.05). Horizontal and vertical trefoil remained stable at all follow-up points without any significant inter-group variances (P > 0.05). Postoperative QoV scores were obviously higher in Groups A (45.45 ± 5.49) and B (46.34 ± 3.25) compared to Group C (49.15 ± 7.89). There was no correlation between QoV scores and axial length observed. The induced horizontal trefoil showed a positive correlation with changes in lens thickness (LT) one year after SMILE (r = 0.22, p = 0.03).

CONCLUSIONS

SMILE surgery is a safe and effective approach for correcting high myopia, exhibiting a significant correlation observed between ocular high-order aberrations and axial length.

Effects of effective optical zone and decentration on visual quality after smile for different astigmatism types

PURPOSE

To compare the refractive outcomes and visual quality among different types of astigmatism following SMILE and evaluate effective optical zone (EOZ) features, decentration and their potential effects on visual quality.

METHODS

This study included 101 left eyes of 101 patients who underwent SMILE. Patients were grouped according to astigmatism types (with-the-rule [WTR], against-the-rule [ATR] and oblique astigmatism) and decentered displacement (major axis > minor axis and major axis < minor axis). We compared the refractive outcomes, visual quality, EOZ and decentration 3 months postoperatively and analyzed correlations between corneal aberrations and EOZ parameters.

RESULTS

The visual and refractive outcomes were favorable in different types of astigmatism. The induced corneal aberrations, EOZ and total decentration were comparable among three groups (all p >.05). There was a strong positive correlation (r =.828, p <.001) between preoperative cylinder axis and the angle of EOZ. The postoperative induced changes in spherical aberration (0.02 ± 0.15 vs. 0.08 ± 0.13, p =.037), coma (0.22 ± 0.27 vs. 0.36 ± 0.25, p =.010), total HOAs (0.28 ± 0.24 vs. 0.42 ± 0.31, p =.009) and LOAs (0.16 ± 0.62 vs. 0.49 ± 0.84, p =.023) were fewer in group with greater decentered displacement along the major axis than the minor axis.

CONCLUSIONS

Favorable outcomes were observed in different types of astigmatism. Postoperative refractive errors, visual acuity, and induced corneal aberrations showed no significant differences between groups with WTR, ATR, and oblique astigmatism. The angle of EOZ was closely associated with cylinder axis. EOZ provided greater tolerance to decentration, with fewer induced corneal aberrations along the major axis compared to the minor axis. The combined impacts of EOZ and decentration on visual quality should be noted.

The Efficiency, Predictability and Safety Between Custom-Q Femotsecond Laser In Situ Keratomileusis and Second (Visumax 800) Generation Keratorefractive Lenticule Extraction Surgery

Background/Objectives: To evaluate the postoperative outcomes between the second-generation keratorefractive lenticule extraction (KLEx) surgery and femtosecond laser in situ keratomileusis (FS-LASIK). Methods: A retrospective cohort study was conducted and subjects received second-generation KLEx and FS-LASIK surgeries were enrolled. A total of 124 and 102 eyes were selected into the second-generation KLEx and FS-LASIK groups after exclusion. The primary outcomes were the postoperative uncorrected distance visual acuity (UDVA), spherical equivalent (SE), amount of astigmatism, and best-correct visual acuity (BCVA). The independent t-test was applied to compare the primary outcomes between groups. Results: The mean UDVA three months postoperatively showed insignificant differences between the two groups (p = 0.999). At the final visit, there were 113 (91.12%) and 96 (94.12%) subjects who reached UDVA 20/20 in the FS-LASIK and second-generation KLEx groups and the difference was statistically insignificant (p = 0.455), and the second-generation KLEx group illustrated a higher UDVA improvement (p = 0.046). The SE three months postoperatively showed insignificant difference between groups, whether the absolute value or the ratio of SE within ±0.50 D or ±1.00 D (all p > 0.05). The vector analysis indicated that the difference vector (DV) was significantly lower in the second-generation KLEx group (p = 0.033). The ratio of loss of more than 1 line BCVA showed insignificant differences between the two groups (all p > 0.05). In addition, the risk of postoperative dry eye disease (DED) was significantly higher in the FS-LASIK group (p = 0.031). Conclusions: The efficiency and predictability between second-generation KLEx and FS-LASIK surgeries are similar, while more DED occurred after FS-LASIK surgery.

Comparison Between Topographic-Based and Manifest-Based Astigmatism Corrections in the Second (Visumax 800)-Generation Keratorefractive Lenticule Extraction Surgery: A Real-World Study

Objectives: To evaluate the effectiveness of astigmatism correction between topographic- and manifest-based methods in individuals who underwent second-generation keratorefractive lenticule extraction (KLEx) surgery. Methods: This study was conducted with participants who underwent second-generation KLEx surgery. After exclusion, there were 46 and 43 participants in the manifest and topographic groups, respectively. The main outcomes were postoperative uncorrected distance visual acuity (UDVA), spherical equivalent (SE), and residual astigmatism. The independent T-test and generalized estimate equation were used to investigate differences between the two groups. Results: Three months postoperatively, UDVA was 0.02 ± 0.04 in the manifest group and 0.00 ± 0.06 in the topographic group which also revealed no significant difference (p = 0.155). Also, the SE value in the two groups three months postoperatively was statistically similar (-0.57 ± 0.48D versus -0.63 ± 0.62D, p = 0.574). The final residual astigmatism was -0.26 ± 0.27 in the topographic group which was significantly lower than the -0.51 ± 0.40 in the manifest group (p < 0.001). Moreover, the amplitude of astigmatism change was significantly lower in the topographic group (p = 0.002). In the subgroup analysis, UDVA and residual astigmatism were significantly better in the topographic group than in the manifest group (both p < 0.05). Conclusions: The topographic-based method represents a better astigmatism correction than the manifest-based method in second-generation KLEx surgery, especially in the low astigmatism population.

Comparison of Visual and Refractive Outcomes Between Refractive Lens Exchange and Keratorefractive Lenticule Extraction Surgery in Moderate to High Myopia

Background/Objectives: To evaluate the visual and refractive outcomes of keratorefractive lenticule extraction (KLEx) surgery and refractive lens exchange (RLE) surgery in moderate to high myopia patients. Methods: A retrospective cohort study was performed, and patients receiving KLEx or RLE surgeries with myopia within -3.00 to -10.00 diopter (D) were enrolled. A total of 19 and 35 patients were put into the RLE and KLEx groups after exclusion. The main outcomes are postoperative uncorrected visual acuity (UDVA), the spherical equivalent (SE), and residual astigmatism via vector analysis. Fisher's exact test and the Mann-Whitney U test were utilized for the statistical analysis. Results: The percentages of patients who reached UDVA results of more than 20/25 and 20/20 were statistically similar between groups (both p > 0.05), and the percentages of patients who reached SE results within ±0.50 D and ±1.00 D were statistically similar between groups (both p > 0.05). The change in SE in the KLEx group was lesser compared to that in the RLE group (p = 0.021). The vector analysis showed a lower DV and ME and a higher CoI in the KLEx group than in the RLE group (all p < 0.05). The percentage of patients who reached specific UDVA and SE thresholds were statistically similar between groups with different myopia degrees (all p > 0.05). Conclusions: The postoperative visual and refractive outcomes between RLE and KLEx surgeries are grossly comparable, while the KLEx may have a slight advantage in astigmatism correction.

Comparison of Visual and Refractive Outcomes of Keratorefractive Lenticule Extraction for Compound Myopic Astigmatism Between VisuMax and VISUMAX 800

Purpose

To evaluate the visual outcomes of keratorefractive lenticule extraction using a new version of a femtosecond laser platform with semi-automated cyclotorsion compensation in comparison to the previous generation without cyclotorsion control.

Methods

This was an ambispective study of consecutive eyes treated by SMILE with the VisuMax and VISUMAX 800 femtosecond lasers at the Uma Eye clinic, Chennai, India between June 2022 and July 2023. Inclusion criteria were myopia up to -10 D and astigmatism between 1.5 D and 5 D. Data was retrospectively collected from patients that underwent SMILE using the VisuMax without cyclotorsion compensation and prospectively collected from patients undergoing SMILE using the VISUMAX 800 with Oculign and Centralign software aids.

Results

Data was collected from a total of 220 eyes that underwent routine SMILE; 115 eyes with VisuMax (VM500 group) and 105 eyes with VISUMAX 800 (VM800 group). The mean attempted spherical equivalent was -4.82±2.16 D in the VM500 group and -4.80±2.24 in the VM800 group. At the 3-month postoperative visit, 94% of eyes in the VM500 group and 98% of eyes in the VM800 group had an UDVA of 20/20 or better. Accuracy of the SEQ showed that 71% of eyes were within ±0.50 D and 100% were within ±1.00 D of target in the VM500 group and 96% of eyes were within ±0.50 D and 100% were within ±1.00 D of target in the VM800 group. There were no reported cases of suction loss or any other intraoperative complication in either group.

Conclusion

SMILE with the VisuMax and VISUMAX 800 provided excellent visual and refractive outcomes for subjects with myopic astigmatism. The VISUMAX 800, using Oculign and Centralign aids, demonstrated better accuracy when correcting cylinder greater than 2 D compared to the VisuMax without using manual cyclotorsion compensation.

The outcomes of first-generation (visumax 500) and second-generation (Visumax 800) keratorefractive lenticule extraction surgeries for astigmatism

To evaluate the efficiency, predictability, and residual astigmatism between first- and second-generation keratorefractive lenticule extraction (KLEx) surgeries in a prominent astigmatism population. A retrospective cohort study was conducted, and individuals who underwent first- and second-generation KLEx surgeries were enrolled. A total of 31 and 35 eyes were categorized into first and second KLEx groups, respectively. Visual acuity, refraction, topographic parameters, and surgical indices were recorded. Independent t tests were used to compare the postoperative uncorrected distance visual acuity (UDVA), spherical equivalent (SE), and residual astigmatism between the two groups. The difference in UDVA was not significant three months after KLEx surgery (P = 0.509), and the SEs three months after surgery also presented similar values between the two groups (P = 0.552). The first KLEx group demonstrated greater residual astigmatism than did the second KLEx group throughout the three-month follow-up period (all P < 0.05). The values of surgically induced astigmatism (SIA), difference vector (DV), magnitude of error (ME) and correction index (CoI) were significantly better in the second KLEx group via vector analysis (all P < 0.05). Old age, high steep keratometry (K), high topographic cylinder, large angle kappa, and a small optic zone were correlated with greater residual astigmatism in the first KLEx group (all P < 0.05), whereas only a small optic zone was significantly correlated with greater residual astigmatism in the second KLEx group (P = 0.047). The second-generation KLEx is correlated with a lower risk of residual astigmatism.

The Risk Factors for Myopia Undercorrection in Second-Generation (Visumax 800) Keratorefractive Lenticule Extraction Surgery: A Retrospective Case-Control Study

In this study, we aim to evaluate the risk factors of myopia undercorrection in recipients of second-generation keratorefractive lenticule extraction (KLEx) surgery. A retrospective case-control study was performed, and patients who received second-generation KLEx surgery were enrolled. The cases with myopia undercorrection were matched to non-myopia undercorrection cases with a 1:4 ratio according to age, and a total of 22 and 88 eyes were categorized into the undercorrection and control groups, respectively. Demographic, refractive, topographic, and surgical data were collected preoperatively. A generalized linear model was operated to evaluate the potential risk factors for myopia undercorrection. The uncorrected distance visual acuity (UDVA) at three months postoperation was significantly better in the control group (p = 0.006), and residual myopia and SE were significantly higher in the undercorrection group during the whole follow-up period (all p < 0.001). The UDVA value showed a trend of improvement in the control group (p < 0.001), and the changes to SE and residual myopia were significantly lower in the control group (both p < 0.001). Regarding the risk factors for myopia undercorrection in the whole population and the high-myopia population, a higher manifest sphere power, higher steep keratometry (K), higher topographic cylinder, lower central corneal thickness (CCT) at apex, higher CCT difference and lower residual stromal thickness (RST) correlated to myopia undercorrection (all p < 0.05). In the low-myopia population, only higher myopia and lower RST correlated to myopia undercorrection (both p < 0.05). In conclusion, a high-sphere power and irregular topographic pattern correlated to myopia undercorrection after the second KLEx surgery, especially for individuals with high myopia.

The Efficiency, Predictability, and Safety of First-Generation (Visumax 500) and Second-Generation (Visumax 800) Keratorefractive Lenticule Extraction Surgeries: Real-World Experiences

We aimed to evaluate the postoperative visual and refractive outcomes between the first- and second-generation keratorefractive lenticule extraction (KLEx) surgeries. A retrospective cohort study was conducted and patients who had received first- and second-generation KLEx surgeries were enrolled. A total of 80 and 80 eyes were categorized into the first and second KLEx groups after exclusion, respectively. The primary outcomes were the postoperative uncorrected distance visual acuity (UDVA), spherical equivalent (SE), and safety indexes. An independent t-test and generalized estimate equation were implemented to compare the primary outcomes between the two groups. After the KLEx surgery, the UDVA showed no significant difference between the two groups throughout the study period (all p > 0.05), and the postoperative SE and safety index were also statistically identical between the two groups during the follow-up interval (all p > 0.05). There was a similar trend of visual recovery between the two groups (aOR: 0.967; 95% CI: 0.892-1.143; p = 0.844), while the amplitude of the SE change was significantly lower in the second KLEx group (aOR: 0.760; 95% CI: 0.615-0.837; p = 0.005). Nine and two unintended initial dissection of the posterior plane (UIDPP) occurred intraoperatively in the first and second KLEx groups, respectively, and the second group showed a lower risk of UIDPP (p = 0.032). In conclusion, the efficiency, predictability, and safety are similar between first- and second-generation KLEx surgeries.

Effective optical zone following small incision lenticule extraction: a review

Small incision lenticule extraction (SMILE) is a "flapless" keratorefractive surgery with excellent safety, efficacy, stability, and predictability for myopia correction. A recent global multicenter study also reported good refractive outcomes for hyperopic SMILE. SMILE has shown advantages including improved biomechanical strength, fewer dry eye symptoms, less corneal denervation, and fewer surgery-induced higher-order aberrations over laser in situ keratomileusis (LASIK). However, night vision complaints, including glare, halos, and starbursts, could still occur after SMILE. These symptoms have been proven to be closely related to the effective optical zone (EOZ), which is defined as the achieved area of corneal ablation. A larger postoperative EOZ may indicate better visual quality, making EOZ an important safety parameter for keratorefractive surgeries. As SMILE has gained wider application globally, the EOZ following SMILE has also been increasingly studied in the field of refractive surgery. This review provides an update on topics related to the EOZ after SMILE, including its measurement and influencing factors, aiming to benefit the personalization of the surgical algorithm and ultimately improve the visual quality after the SMILE procedure.

Three-Month Clinical Outcomes to Correct Myopia or Myopic Astigmatism Using a Femtosecond Laser for Lenticule Creation With Automated Centration and Cyclotorsion Compensation

PURPOSE

To individually evaluate the clinical outcomes for right and left eyes in the first 3 months after laser-assisted lenticule extraction for myopia and myopic astigmatism with the use of the new ATOS femtosecond laser system (Smart-Sight; SCHWIND eye-tech-solutions).

METHODS

A total of 331 eyes from 168 patients (166 right eyes and 165 left eyes) consecutively treated with SmartSight lenticule extraction were retrospective analyzed after a 3-month follow-up period. Patients' mean age was 26 ± 6 years (range: 18 to 47 years) and mean preoperative spherical equivalent (SEQ) was -5.07 ± 1.92 diopters [D] (range: -1.50 to -11.25 D) with a mean astigmatism of -1.04 ± 0.85 D (range: 0.00 to -4.00 D). At 3 months of follow-up, visual acuity, SEQ and cylinder, safety index, efficacy index, corneal higher order aberrations, and intraocular pressure (IOP) were analyzed. Furthermore, refractive and visual outcomes were also analyzed for the right and left eyes individually. All lenticule extraction treatments were performed with the SmartSight treatment method of the SCHWIND ATOS femtosecond laser.

RESULTS

At 3 months after surgery, mean SEQ was -0.12 ± 0.19 D and 98% of eyes were within ±0.50 D of the SEQ. All eyes were within ±1.00 D of the SEQ. Astigmatism of 0.50 D or less was achieved in 99% of eyes. The change in Snellen lines (difference between preoperative corrected distance visual acuity and postoperative uncorrected distance visual acuity) showed a gain of one or more lines in 13% and in 85% of the eyes the same was achieved. There was a loss of one or more lines at 3 months of follow-up in 1.6%. The safety index was 1.03 and efficacy index was 1.02. No significant difference between the right and left eyes was found.

CONCLUSIONS

The 3-month follow-up data show that SmartSight treatment for correction of myopia and myopic astigmatism with the SCHWIND ATOS is a safe, efficient, and accurate procedure. It provided excellent results in terms of visual recovery, predictability, and higher order aberrations. [J Refract Surg. 2024;40(1):e30-e41.].

Quality of vision after myopic refractive surgeries: SMILE, FS-LASIK, and ICL

BACKGROUND

To characterize the quality of vision after SMILE, FS-LASIK, and ICL implantation and evaluate the related factors.

METHODS

131 eyes of 131 myopic patients (90 female, 41 male) who underwent refractive surgeries including SMILE (35 patients), FS-LASIK (73 patients), and ICL implantation (23 patients) were analyzed. The Quality of Vision questionnaires were completed 3 months after surgery, and the results were characterized and analyzed with baseline characteristics, treatment parameters, and postoperative refractive outcomes using logistic regression analysis to find out predicted factors.

RESULTS

Mean age was 26.5 ± 4.6 years (range: 18 to 39 years) and mean preoperative spherical equivalent was - 4.95 ± 2.04 diopters (D) (range: -1.5 to -13.5). Safety and efficacy index was comparable between different techniques: the safety index was 1.21 ± 0.18, 1.22 ± 0.18, and 1.22 ± 0.16 and the efficacy index were 1.18 ± 0.20, 1.15 ± 0.17, 1.17 ± 0.15 for SMILE, FS-LASIK and ICL respectively. The mean overall QoV score was 13.40 ± 9.11, with mean frequency, severity, and bothersome score of 5.40 ± 3.29, 4.53 ± 3.04, and 3.48 ± 3.18 respectively, and there was no significant difference between different techniques. Overall, the symptom with the highest scores was glare, following fluctuation in vision and halos. Only the scores of halos were significantly different among different techniques (P < 0.000). Using ordinal regression analysis, mesopic pupil size was identified as a risk factor (OR = 1.63, P = 0.037), while postoperative UDVA was a protective factor (OR = 0.036, P = 0.037) for overall QoV scores. Using binary logistic regression analysis, we found that patients with larger mesopic pupil size had an increased risk to experience glare postoperatively; compared to ICL, patients who underwent SMILE or FS-LASIK tended to report fewer halos; patients with better postoperative UDVA were less likely to report blurred vision and focusing difficulty; with larger residual myopic sphere postoperatively, patients experienced focusing difficulties and difficulty judging distance or depth perception more frequently.

CONCLUSIONS

SMILE, FS-LASIK, and ICL had comparable visual outcomes. Overall, glare, fluctuation in vision, and halos were the most frequently experienced visual symptoms 3 months postoperatively. Patients with ICL implanted tended to report halos more frequently compared with SMILE and FS-LASIK. Mesopic pupil size, postoperative UDVA, and postoperative residual myopic sphere were predicted factors for reported visual symptoms.

The dynamic changes and influencing factors of visual symptoms after small incision lenticule extraction

BACKGROUND

To investigate the dynamic changes and influencing factors of visual symptoms after small incision lenticule extraction (SMILE).

METHODS

This was a prospective observational study. Visual symptoms including glare, haloes, starbursts, hazy vision, fluctuation, blurred vision, double vision and focusing difficulties were evaluated before and 1, 3, 6 months after SMILE using a questionnaire. Generalized linear mixed models were used to assess the effects of preoperative characteristics and objective visual quality parameters on postoperative visual symptoms.

RESULTS

73 patients/146 eyes were enrolled. Preoperatively, the most common symptoms were glare (55% of eyes), haloes (48%), starbursts (44%) and blurred vision (37%). At 1 month postoperatively, the incidence and extent scores of glare, haloes, hazy vision and fluctuation rose significantly. At 3 months, the incidence and extent scores of glare, haloes and hazy vision restored to baseline. And at 6 months, the extent scores of fluctuation returned to baseline. Other symptoms (e.g., starbursts) did not change before and 1, 3, 6 months after SMILE. Preoperative visual symptoms were associated with postoperative symptoms, as patients with a symptom preoperatively had higher postoperative scores for that symptom. Age was related to postoperative extent of double vision (coefficient = 0.12, P = 0.046). There were no significant associations between postoperative visual symptoms and preoperative SE, scotopic pupil size, angle kappa (with intraoperative adjustment), postoperative HOAs or scattering indexes.

CONCLUSIONS

The incidence and extent scores of hazy vision, glare, haloes and fluctuation increased at the first month after SMILE, and recovered to baseline at 3 or 6 months. Preoperative visual symptoms were associated with the postoperative symptoms and should be fully considered before SMILE.