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    Exploring laser vision correction for myopia with/without astigmatism

    Comparative study documents superiority of wavefront-guided LASIK versus SMILE

    Take-home:  A prospective masked study enrolling eyes with low to moderate myopia with or without astigmatism found significantly better efficacy, safety, and predictability with wavefront-guided LASIK compared with small incision lenticule extraction (SMILE). 


    Results of a prospective, masked study show significant differences favoring wavefront-guided (WFG) LASIK compared with small-incision lenticule extraction (SMILE) for the treatment of low to moderate myopia with or without astigmatism.

    The study, which was conducted by Dr Mounir A Khalifa and colleagues in Egypt, included 110 eyes with spherical equivalent (SE) up to -6 D who were followed for six months after their refractive procedure. All patients but one underwent bilateral surgery.

    WFG LASIK was performed in 51 eyes of 51 patients with the Star S4 IR excimer laser (Abbott) using a high-resolution wavefront aberrometer (iDesign system, Abbott), mechanical microkeratome (M2, Moria), 6.0 mm optical zone, and 8.0 mm treatment zone. Fifty-nine eyes of 59 patients underwent SMILE using the VisuMax femtosecond laser (Carl Zeiss Meditec) to create a 6.5 mm lenticule.

    Visual and refractive outcomes were good with both procedures. WFG LASIK, however, was associated with faster visual recovery compared with SMILE as well as significantly better efficacy, safety, predictability, and preservation of visual quality with less induction of higher-order aberrations (HOAs) and less contrast sensitivity loss.

    The recovery of UDVA in relation to preoperative CDVA (efficacy index with time) was slower in the SMILE group than in the WFG LASIK-treated eyes, and the difference between groups was more prominent in eyes with low myopia versus those with moderate myopia because of a virtually flat efficacy index curve in the WFG LASIK group (see Figure on Page 24).

    “Previously published studies comparing SMILE and LASIK primarily included eyes treated with conventional LASIK and found visual and refractive outcomes were similar for the two procedures whereas results for visual quality and aberrometry were more variable,” said Dr Khalifa, professor of ophthalmology, Tanta University, and chairman, Horus Vision Correction Center, Alexandria, Egypt.

    “SMILE offers some advantages compared with LASIK because there is no flap, and we found it to be an efficacious and safe procedure for correction of myopia with or without astigmatism,” he said.

    “However, WFG LASIK remains the state-of-the-art laser vision correction technique,” Dr Khalifa added. “It offers more predictable outcomes and better aberrometric control and delivers rapid visual recovery and better UCVA outcomes, which are important factors influencing overall satisfaction of refractive surgery patients.”

    Dr Khalifa performed all of the LASIK procedures at the Horus Vision Correction Center. The SMILE procedures were done by Dr Ahmed Ghoneim, professor of ophthalmology, Tanta University, Tanta, Egypt.

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