Comparison of Visual Quality After SMILE and LASEK for Mild to Moderate Myopia.

Abstract

To compare the objective and subjective quality of vision after femtosecond laser-assisted small incision lenticule extraction (SMILE) and laser-assisted subepithelial keratomileusis (LASEK) for mild to moderate myopia. This prospective, comparative study included 65 eyes of 33 patients in the SMILE group, with a mean spherical equivalent (SE) of -4.16 ± 0.82 diopters, and 50 eyes of 25 patients in the LASEK group, with a mean SE of -3.81 ± 0.97 diopters. Visual acuity, corneal topography, contrast sensitivity, and wavefront aberrations were recorded preoperatively and compared with postoperative measurements. A quality of vision questionnaire was scored and analyzed 3 months postoperatively. Three months postoperatively, the SMILE group had fewer (P < .05) higher-order aberrations (HOAs) (0.390 ± 0.175 µm), including spherical aberration (SA) (0.262 ± 0.242 µm), than the LASEK group (HOAs = 0.479 ± 0.148 µm, SA = 0.576 ± 0.287 µm, trefoil = 0.465 ± 0.248 µm). There was no significant difference in the amount of coma and trefoil between the two groups after surgery. Analysis of the scores of glare and halos in the quality of vision questionnaire revealed that SMILE (night glare = 1.25 ± 1.22, halos = 0.97 ± 1.12) provided a better quality of vision (P < .05) than LASEK (night glare = 2.32 ± 1.99, halos = 1.96 ± 1.77). The two groups demonstrated no significant difference in contrast sensitivity 3 months postoperatively. No vision-threatening complications were noted at any stage in either group. Both SMILE and LASEK are safe and effective surgical procedures in the correction of myopia. SMILE has a lower induction rate of HOAs and a higher degree of patient satisfaction than LASEK at 3 months postoperatively.