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Preoperative Suboptimal Correction and Early Visual Recovery After SMILE: How Full vs Under/Over-Correction Shapes
Lu Ma1, Yingting Huang1, Weijin Nan1
1Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People's Republic of China.
Background:
Preoperative suboptimal correction (under/over-correction) is prevalent among myopic SMILE candidates. Existing studies lack data on its impact on early visual recovery and binocular function. This study aims to investigate the impact of preoperative suboptimal correction on early visual recovery in myopes undergoing SMILE and to compare these outcomes to normal values.
Methods:
Visual results of 148 eyes with preoperative suboptimal correction were compared with 72 full-corrected eyes after SMILE. Assessments included uncorrected distance visual acuity (UDVA), refraction, visual quality parameters (strehl ratio (SR), the modulation transfer function (MTF) curves), and binocular visual function (perceptual eye position, vergence-divergence dynamic and stereovision) at baseline and 1 week, 1 month and 3 months postoperatively.
Results:
UDVA improved significantly faster in the full-correction group (1-week follow-up) versus the suboptimal group (1-month follow-up). The full-correction group exhibited superior SR (P = 0.02) and MTF performance at 4-mm pupil (P < 0.05 at 5 and 10 cycles/degree) at 1 month. Horizontal perceptual deviation transiently increased at 1 month but normalized by 3 months in the suboptimal group. Convergence function decreased at 1 month but returned to baseline at 3 months in the suboptimal correction group, while improved at both 1-month and 3-month visits in the full-correction group. Divergence function improved in both groups with no intergroup differences (all P > 0.05).
Conclusion:
Myopic subjects with preoperative suboptimal correction exhibit delayed visual recovery (notably UDVA and binocular function) compared to fully corrected peers after SMILE. These findings confirm SMILE's safety and efficacy even in eyes with suboptimal presenting visual acuity (PVA), while indicating the need for preoperative counseling to align patient expectations and targeted postoperative visual training to accelerate recovery-strategies that may enhance patient satisfaction.
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