Eyeworld

APRIL 2022 | EYEWORLD | 21 References 1. Ito M, et al. Picosecond laser in situ keratomileusis with a 1053- nm Nd:YLF laser. J Refract Surg. 1996;12:721–728. 2. Sekundo W, et al. First efficacy and safety study of femtosec- ond lenticule extraction for the correction of myopia: six-month results. J Cataract Refract Surg. 2008;34:1513–1520. 3. Shah R, et al. Results of small incision lenticule extraction: All-in-one femtosecond laser refractive surgery. J Cataract Refract Surg. 2011;37:127–137. 4. Sekundo W, et al. Small inci- sion corneal refractive surgery using the small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism: results of a 6 month prospective study. Br J Ophthalmol. 2011;95:335–339. 5. Hjortdal JO, et al. Predictors for the outcome of small-incision lenticule extraction for myopia. J Refract Surg. 2012;28:865–871. 6. FDA approves VisuMax Femtosecond Laser to surgically treat nearsightedness. FDA News Release. September 13, 2016. Ac- cessed February 8, 2022. www. fda.gov/news-events/press-an- nouncements/fda-approves-vi- sumax-femtosecond-laser-surgi- cally-treat-nearsightedness. 7. Sia RK, et al. Visual outcomes after SMILE from the first-year experience at a U.S. military refractive surgery center and comparison with PRK and LASIK outcomes. J Cataract Refract Surg. 2020;46:995–1002. Discussion Many prior studies have examined corneal refractive procedures including LASIK and PRK in the context of the unique occupational demands of a U.S. military service member. The authors of this study sought to perform a similar evaluation of SMILE to provide data on a refrac- tive surgical technique that could lead to faster visual recovery and faster return to duty. This study suggests that based on early postoperative visual outcomes, SMILE is safe, effective, and highly predictable with a high lev- el of patient satisfaction. The authors reported a low number of complications including diffi- cult lenticule dissection and cap tears, which improved with increased surgical experience and standardization of surgical techniques. Low contrast visual acuity and contrast sensitivity appeared to fluctuate in the early postoperative period, though the clinical significance is uncer- tain given the small but statistically significant results. These findings appeared transient and normalized or improved between the 1- and 3-month postoperative evaluations. Patient sat- isfaction with SMILE was very high in this study, addition to significant increases in coma, trefoil, and spherical aberration. LCVA was decreased in photopic (mean difference 0.03; 95% CI: 0.01, 0.06), night vision (mean difference 0.03; 95% CI: 0.00, 0.05), and mesopic conditions (mean difference 0.04; 95% CI: 0.02, 0.06) 1 month postoperatively when compared to the preoperative baseline. On average, LCVA improved at all contrast levels and conditions 3 months postoperatively (photopic [mean differ- ence –0.01; 95% CI: –0.04, 0.02], night vision [mean difference –0.02; 95% CI: –0.04, 0.00], and mesopic [mean difference –0.01; 95% CI: –0.03, 0.01]). Eighteen of 35 patients (51.4%) were noted to have clinically significant loss of contrast sensitivity at 1 month postoperatively defined as a change of greater than or equal to 0.30 log units from the preoperative baseline at two or more spatial frequencies. Loss of con- trast sensitivity was seen in seven (20.0%) of 35 patients 3 months postoperatively. A clini- cally significant gain of contrast sensitivity was reported in 16 of 35 patients (47.1%) at 1 and 3 months postoperatively. At the 3-month postop- erative evaluation, significant improvements in patient-reported double images and starburst were reported, but there were no changes in patient-reported glare or halo. Twenty-nine of 35 patients (82.9%) reported a higher level of satisfaction with current vision at 3 months, and the overall satisfaction rating with the proce- dure was high at 90.9 (95% CI, 85.3, 96.5). As measured by Work Productivity and Activity Im- pairment scores and National Eye Institute Re- fractive Error Quality of Life activity limitation scores, post-SMILE procedure work limitations were limited to immediate postoperative care, and no patients reported activity impairment at 3 months. There was no statistically signifi- cant difference in marksmanship performance reported postoperatively without correction when compared to preoperative testing with correction. continued on page 22 The authors of this study sought to perform a similar evaluation of SMILE to provide data on a refractive surgical technique that could lead to faster visual recovery and faster return to duty.

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