Intraoperative patient experience and postoperative visual quality after SMILE and LASIK in a randomized, paired-eye, controlled study

Abstract

PURPOSE: To compare intraoperative and postoperative subjective patient experience after small incision lenticule extraction (SMILE) and femtosecond laser–assisted LASIK. METHODS: In a prospective, randomized, paired-eye, single-masked clinical trial at Singapore National Eye Centre, 70 patients were randomly treated with SMILE and LASIK in each eye. The intraoperative questionnaire was completed immediately after surgery and included light perception and levels of anxiety, fear, and discomfort. The postoperative 1- and 3-month questionnaires evaluated severity of light sensitivity, eye discomfort, eye dryness, excessive tearing, gritty sensation, glare, halos, blurring, and fluctuations in vision. RESULTS: Average discomfort scores were higher during tissue manipulation in SMILE (1.9 ± 0.9) than flap lifting in LASIK (1.59 ± 0.8) (P = .020) but comparable during docking and laser application (P > .249). Fear scores were lower in SMILE than LASIK during docking (2.6 ± 1.6 vs 3.4 ± 1.9, P = .024) but similar during occasional blackout, laser application, and lenticule/flap manipulation (P > .364). Fear scores were generally higher in patients with intraoperative suction loss (n = 3). For SMILE, light sensitivity, eye discomfort, blurring, and fluctuations in vision improved from 1 to 3 months (P < .039). For LASIK, improvements were reported for light sensitivity, eye discomfort, eye dryness, gritty sensation, and fluctuations in vision from 1 to 3 months (P < .046). At 1 month, patients experienced more blurring after SMILE than LASIK (2.1 ± 0.8 vs 1.8 ± 0.7, P = .025), but with no differences in any of the visual symptoms at 3 months. CONCLUSIONS: Tissue manipulation may be more uncomfortable during SMILE than LASIK, but not more frightening. Subjective visual symptoms were comparable after 3 months.