Abstract
Hyperopia is a common refractive error, apparent in 25% of Europeans. Treatments include spectacles, contact lenses, laser interventions and surgery including implantable contact lenses and lens extraction. Laser treatment offers an expedient and reliable means of correcting ametropia. LASIK is well-established however SMILE (small-incision lenticule extraction) or lenticule implantation (derived from myopic laser-correction) are newer options. In this study we compared the outcomes of hyperopic LASIK, SMILE and lenticule re-implantation in a primate model at +2D/+4D treatment. While re-implantation showed the greatest regression, broadly comparable refractive results were seen at 3-months with SMILE and LASIK (<1.4D of intended), but a greater tendency to regression in +2D lenticule reimplantation. Central corneal thickness showed greater variation at +2D treatment, but central thickening during lenticule reimplantation at +4D treatment was seen (-17± 27μm LASIK, -45 ± 18μm SMILE and 28 ± 17μm Re-implantation; p <0.01) with expected paracentral thinning following SMILE. Although in vivo confocal microscopy appeared to show higher reflectivity in all +4D treatment groups, there were minimal and inconsistent changes in inflammatory responses between modalities. SMILE and lenticule re-implantation may represent a safe and viable method for treating hyperopia, but further optimization for lower hyperopic treatments is warranted.
Highlights
Clear vision depends on the cornea and lens focusing light from a distance object on to the retina and is termed emmetropia
Optimal Cutting Temperature (OCT) imaging demonstrated the effects of corneal steepening by Laser Assisted In Situ Keratomileusis (LASIK), small-incision lenticule extraction (SMILE) and lenticule re-implantation with representative OCT images derived from +4 treatment groups over the course of 3 months (Fig 2B)
Since the advent of femtosecond laser technology, SMILE has become increasingly popular for the correction of myopia and astigmatism [13, 18, 31, 32]
Summary
Clear vision depends on the cornea and lens focusing light from a distance object on to the retina and is termed emmetropia. Hyperopia correction by LASIK, SMILE or lenticule re-implantation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
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