SMILE With Low Energy Levels: Assessment of Early Visual and Optical Quality Recovery

Donate, David; Thaëron, Rozenn

doi:10.3928/1081597x-20190416-01

Cited by 12 publications

(6 citation statements)

References 24 publications

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“…Since the density of the cornea decreases progressively towards the deeper layer of the stroma [25], photodisruption becomes more irregular, giving rise to a higher straylight value in eyes with larger ablation ratio. Using double-pass aberrometry, several studies also reported that the increase in postoperative objective scatter index (OSI) was correlated with the preoperative spherical equivalent [26,27].…”

Section: Discussionmentioning

confidence: 99%

Fluctuation in straylight measurements during the visual recovery phase after small incision lenticule extraction

Wan

Tsui

Chan

2019

Eye

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Purpose To investigate the postoperative straylight changes during the visual recovery phase after small incision lenticule extraction (SMILE) and their association. Methods Seventy consecutive eyes from 37 patients with a mean age of 30.92 ± 7.26 years and a mean preoperative spherical equivalent of −5.24 ± 1.90 dioptres undergoing myopic or myopic astigmatism SMILE correction were included in this prospective study. Patients were followed up at days 1, 3, 7, 14, 21 and 28 after standard SMILE. Straylight was measured using the C-Quant straylight meter (Oculus GmbH, Germany) preoperatively and at each postoperative visit. Results Preoperatively, the mean straylight measurement was 1.16 ± 0.16. After SMILE, the mean straylight values were 1.12 ± 0.14 and 1.13 ± 0.13 at days 7 and 14, which were significantly reduced compared to preoperative values (p ≤ 0.028). Straylight returned to baseline by week 3 (p = 0.160) and remained stable onwards (p = 0.651). A lower ablation ratio was associated with less straylight level at days 1, 3, 14 and 21 (p ≤ 0.0497) in the multivariable regression model. Likewise, better visual acuity was associated with lower straylight at days 7, 14 and 28 postoperatively (p ≤ 0.038). A small proportion of eyes (range: 0-12.86%) had ≥0.30 log(s) increase in postoperative straylight within the first month after SMILE. Conclusions SMILE induced a temporary decrease in straylight. It gradually returned to the preoperative level, which could be related to a number of dynamic processes during corneal healing. In the small proportion of patients with an increase in straylight postoperatively, this can affect their visual recovery during the early postoperative period.

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Section: Discussionmentioning

confidence: 99%

Fluctuation in straylight measurements during the visual recovery phase after small incision lenticule extraction

Wan

Tsui

Chan

2019

Eye

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“…The optical quality refers to the evaluation of the optical beam from the cornea to the retina. The global point spread function analysis are objective measurements of this optical quality [7]. In order to correct vision after cataract surgery, it is important to evaluate not only visual acuity but also optical quality.…”

Section: Introductionmentioning

confidence: 99%

Comparison of optical quality and distinct macular thickness in femtosecond laser-assisted versus phacoemulsification cataract surgery

et al. 2020

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Background: Optical quality and macular thickness changing optical quality is rarely reported after femtosecond laser-assisted cataract surgery (FLACS). In current research, we evaluated optical quality recovery and distinct macular thickness changes after FLACS and phacoemulsification cataract surgery (PCS). Methods: A total of 100 cataract patients (100 eyes) were included (50 eyes for the FLACS group and 50 eyes for the PCS group). Modulation transfer function (MTF), point spread function (PSF) and dysfunctional lens index (DLI) were measured by a ray-tracing aberrometer (iTrace). Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were also assessed pre-operation,1 week and 1 month after surgery. The MTF values at spatial frequencies of 5, 10, 15, 20, 25 and 30 cycles/degree (c/d) were selected. We used optical coherence tomography (OCT) to assess the macular thickness of different regions pre-operatively and1month after the surgery. Results: In PCS group, we found the statistically significant differences between pre-operation and post-operation in DLI (p < 0.0001), PSF (strehl ratio, SR) (p = 0.027) and MTF (p = 0.028), but not intraocular pressure (IOP) (p = 0.857). The differences between pre-operation and post-operation for DLI (p = 0.031), SR (p = 0.01) and IOP (p = 0.03), but not MTF (p = 0.128) were also found in FLACS group. The differences were statistically significant when the spatial frequencies were at 5, 10 and 25 (p = 0.013, 0.031 and 0.048) between pre-operation and post-operation in PCS group but not FLACS group at 1 month. In PCS group, we found the differences between pre-operation and postoperation in nasal inter macular ring thickness (NIMRT) (p = 0.03), foveal volume (FV) (p = 0.034) and average retinal thickness (ART) (p = 0.025) but not FLACS group at 1 month. Conclusion: FLACS is safe that did not cause significant increase of macular thickness in current study. However, it also cannot produce better optical quality. In contrast, PCS can produce macular thickness changes, but better optical quality recovery. The slightly retinal change may not affect optical quality.

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“…Early approaches by Donate and Thaëron [19] introduced the concept of low energy levels to facilitate swift visual recovery following lenticule extraction. In their pioneering study, they maintained symmetric spot and track distances at 4.5µm each, while lowering pulse energy from 180nJ to 100nJ for the study group, resulting in improved early recovery.…”

Section: Discussionmentioning

confidence: 99%

Visual Acuity Improvement (Supernormal Vision) after SmartSight lenticule extraction procedures: A Machine Learning Assisted Approach.

Mosquera,

Darzi,

Pradhan

2024

Preprint

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Objectives To anticipate improvements in lenticule extraction, with the potential to enhance visual acuity, by employing SmartSight from SCHWIND eye-tech-solutions. This involves utilizing the advanced femtosecond laser system, SCHWIND ATOS, through a comprehensive analysis of patient data and specific details related to the surgical device. Methods This retrospective, observational case series includes 1262 eyes who underwent SmartSight with 86 features (sources of information). Procedures were performed with a SCHWIND ATOS femtosecond laser. Selection of those features that carry a high relevance in the change of Corrected Distance Visual Acuity (CDVA) was performed with Analysis of Variance (ANOVA) and Principal Components (PC) Analysis (PCA), whereas predicting the success probability (gain of CDVA) with various regression and classification methods. The full cohort was randomly split into training cohort (883 treatments) and test cohort (379 treatments). Results The initial 86 features reduced to 38 uncorrelated ones using a cross-correlation matrix. Subsequent refinement led to the identification of 3 PCs explaining 80% of the variance. PC1 was primarily associated with system settings, whereas PC2 and PC3 were correlated with gender and age at treatment. A successful dichotomous classifier (gain vs no-gain of CDVA) developed, showing consistent predictions in both training and test cohorts. Notably, lower pulse energy, larger spot distance, tighter track distance, higher spot to track distance ratio, lower dose, and lower average laser power were linked to a higher chance of CDVA gain. Conclusions Our findings demonstrate that employing the low-energy asymmetric spacing with the SmartSight instrument yields a notably safe and effective lenticule extraction process. This methodology significantly contributes to the improvement of visual outcomes in patients with myopic astigmatism undergoing SmartSight treatment. Introduction: Corneal refractive surgery, aiming to correct optical and visual imperfections, entails altering the corneal structure by surgically removing tissue that functions akin to a lens. SmartSight treatment (SCHWIND eye-tech solutions GmbH, Kleinostheim, Germany) is a lenticule creation and extraction implemented in the SCHWIND ATOS femtosecond system [1].

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SMILE With Low Energy Levels: Assessment of Early Visual and Optical Quality Recovery

Cited by 12 publications

References 24 publications

Fluctuation in straylight measurements during the visual recovery phase after small incision lenticule extraction

Fluctuation in straylight measurements during the visual recovery phase after small incision lenticule extraction

Comparison of optical quality and distinct macular thickness in femtosecond laser-assisted versus phacoemulsification cataract surgery

Visual Acuity Improvement (Supernormal Vision) after SmartSight lenticule extraction procedures: A Machine Learning Assisted Approach.

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