A 3-month comparison study of subjective and objective visual quality of small incision lenticule extraction and transepithelial photorefractive keratectomy in patients with low and moderate myopia.

Aim: To compare the subjective and objective visual quality between small incision lenticule extraction (SMILE) and transepithelial photorefractive keratectomy (tPRK) in patients with low and moderate myopia.
Methods: Patients undertaking SMILE or tPRK for the correction of low and moderate myopia were consecutively recruited in this prospective cohort study with a 3-month follow-up period. Objective evaluation [visual acuity test, manifest refraction, wavefront aberrations, the total cut-off value of the total modulation transfer function (MTF _cut-off ), and Strehl ratio (SR)] and subjective evaluation of visual quality (quality-of-life questionnaire) were conducted before surgery and at days 1, 7, 30, and 90 after surgery.
Results: A total of 47 patients (94 eyes) with SMILE and 22 patients (22 eyes) with tPRK were enrolled. The uncorrected visual acuity (UCVA) was better in SMILE patients on day 7 after surgery (1.13±0.13 vs 0.99±0.17, t =4.85, P <0.001) but was comparable at days 30 and 90. At day 90, the SMILE group had a lower spherical equivalent (SE) than the tPRK group (0.04±0.31 vs 0.19±0.43, t =2.08, P =0.042). Total higher order aberrations (HOAs) were induced in both surgical types, which were more evident in the tPRK group with 3-mm pupil diameter (0.16±0.07 vs 0.11±0.05, t =4.27, P <0.001) and 5-mm pupil diameter (0.39±0.17 vs 0.36±0.11, t =2.33, P =0.022). The MTF _cut-off and SR showed a trend of improvement in both SMILE and tPRK patients but were statistically better in the SMILE group with both pupil diameters. There was a significant improvement of contrast sensitivity (CS) over baseline levels at the spatial frequency of 18 cycles/degree (c/d) in the SMILE group ( F =2.72, P =0.033) and at 3 c/d ( F =3.03, P =0.031), 12 c/d ( F =3.72, P =0.013), and 18 c/d ( F =4.62, P =0.004) in the tPRK group. The subjective quality of life questionnaire showed a steady improvement in the SMILE group ( F =8.31, P <0.001) but not the tPRK group.
Conclusion: SMILE and tPRK are both safe and effective ways to correct low and moderate myopia. A generally better and quicker recovery of visual quality favors the application of SMILE in qualified patients.
(International Journal of Ophthalmology Press.)