A recent small study of 22 myopic patients found both topography-guided LASIK and small-incision lenticule extraction (SMILE) are safe and effective procedures to correct myopia or astigmatism. The results also found topography-guided LASIK provided some better visual performance outcomes for study participants.
In this prospective, randomized study, researchers randomly assigned one eye of each patient to the topography-guided LASIK group and the fellow eye to the SMILE group. LASIK procedures achieved greater than 20/20 vision about twice as often as SMILE. Rates of 20 20/16 uncorrected distance acuity in LASIK eyes were 59.1% at three months and 71.4% at one year. For the SMILE eyes, rates were 31.8% at three months and 38.1% at one year. However, SMILE fared better than LASIK in preventing residual astigmatism. Rates of refractive cylinder less than or equal to 0.25D were 81.0% for the LASIK group at both time points, compared to 50% at three months and 66.7% at 12 months for the SMILE group.
When measuring residual manifest spherical equivalent of 0.0±0.5D between three and 12 months post-op, the researchers found it to be between 95.5% and 100% for LASIK eyes, while SMILE eyes decreased from 77.3% to 66.7%. The eyes that underwent SMILE did achieve a more impressive low-contrast sensitivity improvement, according to the researchers, because “there may be a lapse of postoperative scatter or healing because this procedure is different than LASIK.”
Researchers found both procedures are effective and safe in refractive error correction, with comparable results throughout the first year. “The difference between the two techniques in astigmatic correction and in visual performance in regard to corrected and uncorrected distance visual acuity, objective scatter index, and low contrast sensitivity may derive from the fact that the topography-guided LASIK eyes did have the privilege of having topography-guided customization, cyclorotation compensation, and active tracking during the excimer ablation,” the researchers wrote.
“As SMILE-like techniques and technology evolve," the report notes, " refractive outcomes are bound to improve further, so it is impressive that this procedure, even in our early clinical experience, renders results far superior than the Food and Drug Administration requirements.”
|Anastasios JK. Topography-guided LASIK versus small incision lenticule extraction: long-term refractive and quality of vision outcomes. Ophthalmol. May 2018. [Epub ahead of print].|