Small Incision Lenticule Extraction (SMILE) for Hyperopia: 12-Month Refractive and Visual Outcomes

To evaluate visual and refractive outcomes of small incision lenticule extraction (SMILE) for hyperopia.

This was a prospective study of vertex-centered hyperopic SMILE using the VisuMax femtosecond laser (Carl Zeiss Meditec, Jena, Germany). Inclusion criteria were maximum attempted hyperopic meridian of between +1.00 and +7.00 diopters (D). Lenticule parameters were 6.3- to 6.7-mm diameter, 2-mm transition zone, 30-µm minimum thickness, and 120-µm cap thickness. A standard outcomes and stability analysis was performed for the 12-month data, including contrast sensitivity using the Functional Vision Analyzer.

For the 93 eyes treated, last follow-up was 12 months for 72 eyes (77%) and 3 months for 11 eyes (12%), with 10 eyes (11%) lost to follow-up. Attempted spherical equivalent refraction (SEQ) was +5.61 ± 1.21 D (range: +1.00 to +6.90 D) and cylinder was -1.01 ± 0.64 D (range: 0.00 to -3.50 D). For eyes targeted for emmetropia (n = 37), uncorrected distance visual acuity was 20/40 or better in 95% of eyes. SEQ relative to target was -0.17 ± 0.85 D (range: -2.20 to +3.00 D) at 3 months and -0.19 ± 0.90 D (range: -2.07 to +3.50 D) at 12 months with 53% within ±0.50 D. For 70 eyes with data at 3 and 12 months, the mean change in SEQ was -0.06 ± 0.53 D (range: -2.00 to +1.75 D) and the mean change in keratometry was -0.22 ± 0.48 D (range: -1.00 to +1.00 D). There was one line loss of corrected distance visual acuity (CDVA) in 16% of eyes and no loss of two or more lines. There was no clinically significant change in contrast sensitivity.

Refractive and visual outcomes 12 months after SMILE for hyperopia were promising, given the high degree of hyperopia corrected and relatively reduced CDVA in this population. There was good refractive and topographic stability between 3 and 12 months. [J Refract Surg. 2019;35(7):442-450.].