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    What you should know about SMILE and wavefront guided LASIK

    Literature review finds potential pros and cons of each technique, but need for more comparative studies

    Take-home: Findings of a literature review highlight the need for more studies to compare SMILE and WFG LASIK for treatment of myopia and myopic astigmatism.

    David P. Piñero, PhDProponents of small incision lenticule extraction (SMILE) are advocating this all-femtosecond laser refractive surgery technique for having advantages compared with LASIK. However, examination of the peer review literature shows there is still a lack of high level scientific evidence to support many of the claims, said David P. Piñero, PhD.

    “Good clinical results have been reported for SMILE, and compared with wavefront guided (WFG) LASIK, SMILE appears to be associated with less postoperative dry eye and avoids flap-related complications. However, SMILE shares other complications in common with LASIK and published data do not show that SMILE is superior to WFG LASIK in terms of visual, aberrometric, or biomechanical outcomes,” he said.

    “Whereas the efficacy and safety of WFG LASIK and enhancement procedures are well established, experience with SMILE is still limited, available follow-up is relatively short-term, and information is needed about methods of retreatment and their efficacy. These issues need to be addressed through future research that ideally will include head-to-head comparison trials. Clearly, more data are needed before refractive surgeons should feel confident adopting SMILE into their practices.”

    Dr. Piñero is assistant professor, departments of optics, pharmacology, and anatomy, University of Alicante, Spain. Setting out to compare outcomes of the two refractive surgery procedures when performed with modern technology, he conducted a search of the published literature that was restricted to January 2012 to September 2015.

    Efficacy findings

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