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  • Refractive Mgmt/Intervention

    This prospective randomized study compared visual outcomes following wavefront-guided LASIK (WFG-LASIK) performed in one eye and small incision lenticule extraction (SMILE) performed in the other eye.

    Study design

    Thirty-seven patients with myopia with low levels of astigmatism (74 eyes) seen at a single center in the United States were enrolled in the study. The primary outcome measure was uncorrected distance visual acuity (VA) at 12 months following surgery.


    At the 12-month visit, there was a significantly higher proportion of WFG-LASIK–treated eyes with ≥20/20 UCVA compared with SMILE-treated eyes (59% vs. 19%, respectively). More eyes treated with WFG-LASIK also had improved 5% and 25% low-contrast VA. No differences in spherical-equivalent or higher-order aberrations were seen.


    Although this study had a small sample size, results were similar to those previously noted. In addition, this study was conducted in contralateral eyes; one can argue that both eyes with the same technology may lead to different results. Last, while SMILE currently is unable to correct for lower astigmatism levels, technology continues to improve and newer-generation SMILE lasers are now available outside the United States.

    Clinical significance

    When a surgeon is weighing whether to add SMILE to WFG-LASIK or replace WFG-LASIK entirely, outcomes should be considered and discussed with the patient. It is likely that SMILE will have a significant role in refractive surgery, and hopefully the technology will continue to improve to match outcomes observed with WFG-LASIK.