Comparison of postoperative day-one uncorrected visual acuities for low-energy vs high-energy SMILE for myopic astigmatism

Session Details

Session Title: Small Lenticule Extraction I

Session Date/Time: Sunday 15/09/2019 | 08:00-10:00

Paper Time: 08:24

Venue: Free Paper Forum: Podium 1

First Author: : J.Chong USA

Co Author(s): :    M. Nutkiewicz   M. Nejad   D. Hamilton                       

Abstract Details

Purpose:

Adoption rates of the small incision lenticule extraction (SMILE) procedure in the United States have been slow, primarily because of relatively poor uncorrected early post-operative visual acuities. This study aims to determine if the lower-energy settings recently made available in the United States speed up uncorrected visual acuity (UCVA) recovery following SMILE for myopic astigmatism.

Setting:

Santa Monica Eye Medical Group, Santa Monica, California, United States of America.

Methods:

This was a retrospective review of results from myopic astigmatic SMILE surgeries performed by a single surgeon experienced with the SMILE surgical technique (DRH). Subjects were divided into high-energy (130 nJ-150 nJ, 4.5 µm spot spacing) and low-energy groups (125nJ, 4.5 µm spot spacing) based on laser settings used during surgery. Monocular uncorrected visual acuities on post-operative day one were measured and analyzed.

Results:

Twenty low-energy and 20 conventional-energy eyes were evaluated. Mean pre-operative manifest refraction spherical equivalent (MRSE) was -5.36D in the low energy group and -4.73 in the high energy group (p = 0.116). The difference in UCVA at day 1 (-0.01 +/- 0.04 low versus 0.13 +/- 0.13 high; p < 0.001) was highly statistically significant in favor of the low energy group (20/19.4 vs 20/26.3). In addition, 100% of low-energy eyes versus 39% of conventional-energy eyes achieved UCVA of 20/20 or better on the first post-operative day.

Conclusions:

Lower-energy laser settings for the SMILE procedure (lower energy per spot and wider spot spacing) recently became available in the United States. These settings are associated with a dramatic improvement in uncorrected visual acuity one day after surgery with patients reliably achieving 20/20 or better. This finding represents a marked improvement over the uncorrected visual acuities achieved with the older, high-energy laser settings. This improvement may render the SMILE procedure more attractive to patients and to refractive surgeons in the United States and increase the adoption rate of this procedure.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented