Quality of Vision and Ocular Higher Order Aberrations after SMILE for Myopia and Myopic Astigmatism

Abstract

efractive errors and consequent spectacles wear have always been cumbersome for many persons. Development of refractive surgeries in the last decades was established in response to patient’s needs. Corneal LASER refractive procedures are always the first choice, either for patients or surgeons. However, corneal refractive surgeries have their limitations, including Small incision lenticule extraction (SMILE) has been reported since 2011, for treatment of myopia and astigmatism. SMILE is a less invasive technique because only a small incision is required and without a flap. Therefore, avoiding the creation of a flap and preserving more corneal nerve fibers, SMILE is expected to remedy the shortcomings of laser-assisted in situ keratomileusis (LASIK) and femtosecond laser-assisted LASIK (FS-LASIK). Studies have reported that SMILE minimizes dry eye, and maintains higher corneal sensitivity. In addition, the postoperative corneal biomechanical strength is theoretically greater in comparison to LASIK and FS-LASIK. Recent studies suggested that the SMILE procedure provided excellent clinical outcomes, considering its safety, efficacy, predictability, and postoperative ocular surface health. Therefore, SMILE is considered to be a good selection mode for refractive surgery. There have been studies on SMILE techniques, but most reported results on visual acuity and refractive outcomes. It is known that high-order aberrations (HOAs) are always responsible for postoperative symptoms, including halos, glare, monocular diplopia, and decreased contrast sensitivity after successful refractive surgery corneal parameters or a high refractive error.