Higher order aberrations and visual quality after refractive surgeries for myopia: a systematic review and network...

This network meta-analysis compared the impact of eight refractive surgery techniques on higher-order aberrations (HOAs) and visual quality in adults with myopia.

Bayesian network meta-analysis.

The review protocol was prospectively registered in PROSPERO (CRD420251069362). We systematically searched PubMed Embase Web of Science CochraneLibrary, and ClinicalTrials.gov from inception to August 22 2025, for studies comparing refractive surgeries. The primary outcomes were total HOAs, spherical aberration, coma, and trefoil. The secondary outcomes were vertical coma, horizontal coma, and vertical and horizontal trefoil. The risk of bias was assessed using the Cochrane and Newcastle-Ottawa tools. A Bayesian network meta-analysis was performed using random-effects models in the R software.

Fifty studies (encompassing 5,141 eyes) were included. The implantable collamer lens (ICL) showed superiority in lower total HOAs than other surgeries, including SMILE (MD 0.683, 95% CI 0.370-0.996), FS-LASIK (MD 0.759, 95% CI 0.401-1.118), LASIK (MD 0.799, 95% CI 0.460-1.138), PRK (MD 0.710, 95% CI 0.286-1.134), LASEK (MD 0.705, 95% CI 0.178-1.233), FLEx (MD 0.640, 95% CI 0.211-1.070), and T-PRK (MD 0.610, 95% CI 0.183-1.037). ICL also demonstrated superior efficacy in reducing both spherical aberration and coma compared to the other interventions(P < 0.05). The surface under the cumulative ranking (SUCRA) curve consistently positioned the ICL as the most effective intervention for minimizing total HOAs, spherical aberration, and coma.

ICL demonstrated superior clinical effects in reducing total HOAs, spherical aberration, and coma. ICL implantation may be considered in selected patients seeking refractive correction, particularly those with high myopia or large pupils, where optimal optical quality and minimization of higher-order aberrations are desired.