Optical and visual quality after small-incision lenticule extraction.

Area of Science:

• Ophthalmology
• Refractive Surgery
• Corneal Physiology

Background:

• Small-incision lenticule extraction (SMILE) is a popular refractive surgery for myopia and astigmatism.
• Understanding the impact of corneal higher-order aberrations (HOAs) and scatter on visual outcomes is crucial for patient satisfaction.

Purpose of the Study:

• To investigate the relationship between corneal HOAs, scatter, residual refraction, and visual symptoms/acuity post-SMILE.
• To determine predictors of visual outcomes following SMILE surgery.

Main Methods:

• Prospective case series involving patients undergoing SMILE for myopia or myopic astigmatism.
• Pre- and postoperative assessments included visual acuity, refraction, Pentacam HR, scatter measurements (objective scatter index [OSI]), and visual quality questionnaires.

Main Results:

• Postoperatively, visual symptoms decreased, while scatter and coma increased significantly. Spherical aberration showed no significant change.
• Residual refractive error was a significant predictor of uncorrected distance visual acuity (UDVA) at 1 day and 3 months.
• Corneal HOAs and scatter were not correlated with visual symptoms or postoperative UDVA.

Conclusions:

• SMILE surgery leads to improved visual symptoms despite induced changes in corneal scatter and HOAs.
• Residual refractive error is a key determinant of visual acuity after SMILE.
• Corneal scatter and HOAs do not significantly impact postoperative visual acuity in SMILE procedures.