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Questionnaire-based results 6 months after treatment of high degrees of myopia with ReLEx FLEx and ReLEx SMILE

Poster Details

First Author: A.Vestergaard DENMARK

Co Author(s):    J. Grauslund   A. Ivarsen   J. Hjortdal        

Abstract Details


ReLEx flex (FLEX) and ReLEx smile (SMILE) are two relative new corneal refractive procedures, where a stromal lenticule is cut by a femtosecond laser and manually extracted. In FLEX, a LASIK-like flap is used to access the stromal lenticule. In SMILE, only a small incision is made, minimizing trauma to the corneal surface. The purpose of this study was to evaluate and compare questionnaire-based outcomes 6 months after surgery.


Department of Ophthalmology, Aarhus University Hospital, Denmark.


A prospective study of 34 patients treated with FLEX in one eye, and SMILE in the other at the Department of Ophthalmology, Aarhus University Hospital. Preoperative spherical equivalent refraction averaged -7.50 D (range -6.00 to -9.75 D) with a maximal astigmatism of -1.75 D in both groups. All patients had stable myopia for at least one year and no other ocular diseases. A VisuMax® femtosecond laser (Carl Zeiss Meditec, Jena, Germany) was used. Lenticule diameters were the same in both eyes and ranged from 6.00 to 6.50 mm. The patients completed a questionnaire after their final 6 month clinical examination. Questions were based on linear visual analogue scales from 0 to 10, anchored at each end by adjectival descriptors, and with the opportunity to answer separately for the FLEX and the SMILE treated eye. Mean scores were calculated. Also, responses for questions were divided into 1 of 4 categories: very negative (0 to 2.5), negative (>2.5 to 5), positive (>5 to 7.5) and very positive (>7.5 to 10). No neutral responses were allowed in this categorisation. Also, all patients were verbally asked if they felt any differences between the 2 eyes, and they were also verbally questioned about vision disturbances.


All patients completed the questionnaire. Results for FLEX and SMILE were identical: Six months after surgery, the mean satisfaction score was 9.15 ± 1.05 (range 4.50 to 10), and 97 % were satisfied or very satisfied with the surgery. Concerning change in quality of life, mean score was 8.41 ± 1.37 (range 3.50 to 10), and 97 % felt an improvement in quality of life after surgery. The remaining 3 % (1 patient) sometimes still needed distance visual correction. Nine percent had problems or many problems with backlight glare, and 12 % with nighttime glare. Three percent had problems or many problems with halos around light sources in daylight and 18 % in nighttime. Also, 24 % reported of problems or many problems with nighttime driving, but the majority reported of improvement when using glasses or contact lenses. When asked verbally: before surgery 3 % (1 patient) reported of slight daytime glare and 18 % (6 patients) had slight night vision disturbances (glare, reduced peripheral vision, unsafe nighttime driving). Six months after surgery, 12 % (4 patients) had slightly more night vision disturbances (halos and/or glare) in both eyes than before surgery.


For both the FLEX and the SMILE procedure, patient satisfaction was high despite some vision disturbances post surgery. However, especially night vision disturbances were already partially present before surgery. As expected, patient satisfaction was related to spectacle independence. For all types of refractive eye surgery, thorough preoperative patient education is important to establish realistic expectations and satisfaction concerning overall outcome. FINANCIAL INTEREST: One of more of the authors... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

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