Uncorrected visual acuity, postoperative astigmatism, and dry eye symptoms are major determinants of patient satisfaction: a comparative, real-life study of femtosecond laser in situ keratomileusis and small incision lenticule extraction for myopia

Pietilä, Juhani; Huhtala, Anne; Mäkinen, Petri; Nättinen, Janika; Rajala, Teppo; Salmenhaara, Kalle; Uusitalo, Hannu

doi:10.2147/opth.s172894

Cited by 18 publications

(7 citation statements)

References 22 publications

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“…Again, no statistically significant differences in CDVA were found between the two procedures at 3 months postoperatively, and the mean safety and efficacy indices for those in the SMILE group (1.1060.14; 1.0260.17) were similar to those in the LASIK group (1.1260.15; 1.0760.20) as well [10]. The study found that the refractive error was within ± 0.5 D of target refraction in 93% of treated eyes in both groups 3 months after surgery [10], in agreement with the findings of other studies comparing the two procedures, which demonstrated high refractive accuracy and clinical efficacy for both treatments [11–13]. Furthermore, the two techniques were found to be equally safe, as no patient had a loss of more than two lines of best-corrected visual acuity (BCVA) throughout the 6-month follow-up period or suffered from significant postoperative complications such as epithelial defect, lamellar keratitis or epithelial implantation.…”

Section: Resultssupporting

confidence: 87%

“…In terms of surgically induced astigmatism (SIA), one study in India including 30 eyes with low to moderate myopic astigmatism reported that there was no statistically significant difference between the two techniques (LASIK: 1.21 ± 0.85; SMILE: 1.02 ± 0.43; P > 0.05) [19]. However, a study in Finland found that the SMILE group (100 eyes with preoperative SE ranging from −1.38 to −8.25 D) had more postoperative astigmatism than the FS-LASIK-treated group (200 eyes with preoperative SE ranging from −0.63 to −11.63 D) [11]. Thus the results are inconclusive with regard to which technique is more likely to induce astigmatism, and additional evidence from prospective studies and randomized controlled trials is needed.…”

Section: Resultsmentioning

confidence: 99%

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Comparison of Visual, Refractive and Ocular Surface Outcomes Between Small Incision Lenticule Extraction and Laser-Assisted In Situ Keratomileusis for Myopia and Myopic Astigmatism

et al. 2019

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Laser-assisted in situ keratomileusis (LASIK) is the most commonly performed laser refractive surgical technique worldwide for the treatment of myopia and myopic astigmatism. In recent years, small incision lenticule extraction (SMILE) has emerged as a promising alternative to LASIK, requiring only a single femtosecond laser to create an intrastromal lenticule, which is then removed via a small incision. The technique obviates the need for a corneal flap. A number of published studies have compared the two techniques in terms of visual, refractive and ocular surface outcomes. This review compares the clinical outcomes between LASIK and SMILE in treating myopia and myopic astigmatism based on studies published in the last 5 years. Twenty-two studies were included, all of which were observational in nature. Results suggest that the two techniques have comparable visual outcomes in terms of safety, efficacy and predictability, although recovery in visual acuity may be slower in SMILE-treated than LASIK-treated eyes. SMILE is found to result in less severe postoperative dry eye symptoms and faster recovery of corneal sensitivity than LASIK. It is important to note, however, that the SMILE technique is limited by the lack of a cyclotorsion-compensation system and option for customized treatment profile. The heterogeneity of results in this review may be attributable to the use of different LASIK platforms in different studies. Few studies compared the outcomes regarding severity of myopia. Future prospective randomized controlled trials with a larger sample size and longer follow-up period will be highly beneficial for progress in this field.

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Section: Resultssupporting

confidence: 87%

Section: Resultsmentioning

confidence: 99%

Comparison of Visual, Refractive and Ocular Surface Outcomes Between Small Incision Lenticule Extraction and Laser-Assisted In Situ Keratomileusis for Myopia and Myopic Astigmatism

et al. 2019

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“…This study appears to highlight that SMILE surgery is safe to perform in patients with a low FTBUT. This is supported by a previous which suggests that SMILE surgery can result in a decrease in dry eye symptoms postoperatively [ 26 ].…”

Section: Discussionsupporting

confidence: 76%

Assessment of the correlation of the tear breakup time with quality of vision and dry eye symptoms after SMILE surgery

et al. 2021

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Purpose It is well reported that dry eye symptoms can increase after many refractive surgery procedures. This study aims to provide a clinical understanding of the correlation of fluorescein tear film breakup time (FTBUT) with quality of vision (QoV) and dry eye symptoms following small incision lenticule extraction surgery (SMILE). Methods Patients electing to have SMILE surgery were subdivided into 2 groups: Group 1 included short preoperative FTBUTs of 3 to 6 seconds (s); Group 2 included long FTBUTs of ≥ 8 s. Uncorrected distance visual acuity, corrected distance visual acuity, manifest refraction, FTBUT, QoV and Ocular Surface Disease Index (OSDI) questionnaires were recorded 1 and 6 months postoperatively. Results Thirty-nine subjects were included in each group. There was no significant difference in visual outcomes between the 2 groups at both the 1- and 6-month postoperative assessments. FTBUT remained significantly lower in group 1. Oxford staining was initially higher for group 1 at 1 month (P = 0.007), but there was no significant difference at 6 months (P = 0.180). There was no significant difference in QoV or OSDI scores between the 2 groups at both postoperative visits. Conclusions Low preoperative FTBUT (3–6 s) does not appear to negatively affect postoperative visual outcomes or results in a greater likelihood of dry eye symptoms and poor ocular surface compared to eyes with a longer preoperative FTBUT. These results suggest that a low preoperative FTBUT does not necessarily increase the likelihood of poor visual acuity, dry eyes symptoms, or poor ocular surface outcomes following SMILE surgery.

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“…In our previous studies, we compared FS-LASIK and SMILE for myopic treatment 38. In the comparison, myopic patients treated with FS-LASIK had no change in self-reported dry eye symptoms, but patients treated with SMILE reported fewer dry eye symptoms after 1-month follow-up than preoperatively.…”

Section: Discussionmentioning

confidence: 99%

<p>Patient satisfaction and self-reported dry eye symptoms in hyperopic patients treated with femtosecond laser in situ keratomileusis</p>

Mäkinen¹,

Huhtala²,

Pietilä³

et al. 2019

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Purpose To study self-reported patient satisfaction and dry eye symptoms in hyperopic correction with femtosecond laser-assisted in situ keratomileusis (FS-LASIK). Patients and methods Ninety-eight eyes (53 patients) were treated with FS-LASIK for hyperopia. Patients’ self-reported dry eye symptoms and satisfaction with near and far vision were graded on the visual analog scale (VAS) preoperatively and 1 month postoperatively. Results Ninety-one percent of the eyes with the plano target (54 eyes) achieved an uncorrected distance visual acuity of 20/20 or better. Predictability, defined as spherical equivalent refraction within ±0.5 D of target, was 88% of all eyes. None of the eyes lost two or more Snellen lines of corrected distance visual acuity. There was no significant change in the self-reported dry eye sensation (VAS score from 2.7±2.0 to 2.8±2.0; P =0.66). In 44 monovision patients, satisfaction with both far vision (from 71.2±19.8 to 89.2±8.7; P <0.0001) and near vision (from 51.7±26.2 to 89.3±13.2; P <0.0001) increased significantly. In nine emmetropic patients, satisfaction with neither far vision nor near vision was significantly improved, although there was a clear tendency (from 73.7±23.7 to 86.9±15.3; P =0.22, and from 58.9±29.1 to 81.6±17.4; P =0.11, respectively). In the monovision patient group, far vision satisfaction decreased when dry eye symptoms increased. Monovision patients, as predicted, were more satisfied with their near vision, when postoperative spherical equivalent from target was on the myopic side. Conclusion FS-LASIK correction of hyperopia significantly improved patient satisfaction with both near and far vision in monovision patients. Hyperopic patients had no significant changes in postoperative dry eye symptoms compared to preoperative values.

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Uncorrected visual acuity, postoperative astigmatism, and dry eye symptoms are major determinants of patient satisfaction: a comparative, real-life study of femtosecond laser in situ keratomileusis and small incision lenticule extraction for myopia

Cited by 18 publications

References 22 publications

Comparison of Visual, Refractive and Ocular Surface Outcomes Between Small Incision Lenticule Extraction and Laser-Assisted In Situ Keratomileusis for Myopia and Myopic Astigmatism

Comparison of Visual, Refractive and Ocular Surface Outcomes Between Small Incision Lenticule Extraction and Laser-Assisted In Situ Keratomileusis for Myopia and Myopic Astigmatism

Assessment of the correlation of the tear breakup time with quality of vision and dry eye symptoms after SMILE surgery

<p>Patient satisfaction and self-reported dry eye symptoms in hyperopic patients treated with femtosecond laser in situ keratomileusis</p>

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