Retrospective observational study of micro-monovision small incision lenticule extraction (SMILE) for the correction of presbyopia and myopia

Abstract

This study was aimed to evaluate refractive and visual outcomes after micro-monovision small incision lenticule extraction (SMILE) in patients with presbyopia and myopia. In total, 72 patients (144 eyes) with a mean age of 46.0 ± 4.9 years were included in this study. The dominant eye was treated for distance vision and the nondominant eye for near vision by targeting between −0.50 and −1.75 diopters (D). Treatment efficacy, safety, and refractive stability were calculated from postoperative data including refraction, binocular uncorrected distance visual acuity (UDVA), binocular uncorrected near visual acuity, monocular uncorrected distance visual acuity, and monocular corrected distance visual acuity (CDVA). Six months post-surgery, binocular UDVA was better than or equal to 20/20 in 88% of patients. No loss in 2 or more lines was observed in the Snellen lines of corrected distance visual acuity. Mean spherical equivalent (SE) for the distance eye was −0.18 ± 0.37 D, whereas the attempted and achieved SE in the near eye were −0.90 ± 0.44 and −0.99 ± 0.54 D, respectively. In total, 79% of eyes were within ±0.50 D, and 98% within ±1.00 D, of the intended refraction. A UDVA of 0.0 logMAR (20/20) or better, and an uncorrected near visual acuity of Jaeger (J) of 3 (20/32) or better, were observed in 83% of patients. Micromonovision refractive surgery using SMILE enhanced functional near vision in presbyopic patients.

Long-term follow-up for monovision surgery by Implantable Collamer Lens V4c implantation for myopia correction in early presbyopia

“…Studies on conventional refractive surgery using LASIK have demonstrated that 84.7% of eyes had UDVA ≥ 20/20 (Snellen lines) at 3 months postoperatively, 90.7% VA ≥ 20/40 at 0.4 m, and 86.7% overall satisfaction rate [ 12 ]. And such figures were 100% ≥ 20/32, 100% ≥ 20/40 at 0.33 m, and 86.7% of the overall satisfaction rate 1 year postoperatively using SMILE with 1.03 of the SI and 1.04 of the EI [ 13 ]. It was observed that the distant VA of the patients at the last follow-up in this study was slightly lower than that at 3 months postoperatively, as shown by the significant decrease in SE and EI.…”

Comparison of intraocular lens power calculation formulas with and without total keratometry and ray tracing in patients with previous myopic SMILE

“…On the basis of this technique, many other applications, such as the correction of presbyopia and hyperopia, are currently in development. 3–8…”

“…On the basis of this technique, many other applications, such as the correction of presbyopia and hyperopia, are currently in development. [3][4][5][6][7][8] As corneal refractive surgery is mostly performed in younger patients with SMILE being performed for less than 15 years now, little is known about the accuracy of intraocular lens (IOL) power calculation in eyes with previous SMILE. Regarding IOL calculation in eyes with previous SMILE, the literature is very sparse, and only single case reports can be found in the literature.…”

Effectiveness of SMILE Combined with Micro-Monovision in Presbyopic Patients: A Pilot Study

“…In this pilot study, the efficacy of micro-monovision with SMILE was evaluated and binocular summation using CSDC was reported for the first time. The efficacy of micro-monovision with SMILE has been published in previous studies [ 6 , 7 , 8 ]. Unfortunately, none of these studies reported standardized VA measured in logMAR with an ETDRS chart; therefore, the efficacy of our study cannot be easily compared with previous micro-monovision studies with SMILE reporting results using non-standard methods for reporting VA, such as Jaeger notation or reading charts.…”

“…Although micro-monovision studies have been conducted with older LRS techniques such as LASIK or photorefractive keratectomy (PRK) [ 2 ], few studies have been conducted with the combination of SMILE and micro-monovision, mainly because it is a more recent technique [ 6 , 7 , 8 ]. In addition, although the usual clinical practice procedure involves the correction of distance vision in the dominant eye and near vision in the non-dominant eye [ 6 , 7 , 8 ], recent laboratory research suggests that the vision of a patient undergoing a monovision procedure may vary according to different patterns of accommodative response [ 9 ], as presbyopic patients in their 40s and 50s still retain some accommodative capabilities. Thus, depending on the accommodative response, the patient may achieve a different range of clear vision.…”