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Small incision lenticule extraction (SMILE) vs femtosecond laser in situ keratomileusis (FS-LASIK) for treatment of myopia

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Session Details

Session Title: Presented Poster Session 16: Small Incision Lenticule Extraction

Session Date/Time: Monday 15/09/2014 | 15:00-17:00

Paper Time: 16:15

Venue: Pod 1 (Poster Village)

First Author: : R.Hansen DENMARK

Co Author(s): :    N. Lyhne   B. Justesen   J. Grauslund   A. Vestergaard     

Abstract Details


LASIK has been the dominating corneal refractive procedure for almost two decades, but the new flap-free SMILE procedure has shown promising results. The aim of this study was to evaluate and compare refractive predictability, uncorrected and corrected distance visual acuity (UDVA and CDVA), and safety at 1 day, 1 week and 3 months after SMILE and FS-LASIK for all degrees of myopia, but in particular high myopia.


Department of Ophthalmology, Odense University Hospital, Odense, Denmark.


Retrospective study of results after SMILE and FS-LASIK for all degrees of myopia. All treatments were performed at the Department of Ophthalmology, Odense University Hospital from April 2011 to December 2013. Inclusion criteria: CDVA ≤ 0.10 (logMAR) before surgery and no other ocular conditions than myopia with or without astigmatism of maximum 3 D. Exclusion criteria: Eyes having undergone re-treatment. The SMILE treatments and FS-LASIK flaps were performed with a VisuMax® femtosecond laser (Carl Zeiss-Meditec, Jena, Germany). The FS-LASIK photoablation was performed with a MEL-80 flying-spot excimer laser with eye-tracker (Carl Zeiss-Meditec, Jena, Germany). In SMILE, lenticule diameter ranged from 6.00 to 6.60 mm, whereas the FS-LASIK optical zone ranged from 6.00 to 6.25 mm. Maximum attempted spherical correction was -10.00 D in both procedures. Clinical examinations were performed pre-operatively and at 1 day, 1 week and 3 months post-operatively. For analysis, high myopia was defined as a spherical equivalent (SE) refraction of -6.00 D or worse.


In total, 612 SMILE eyes and 306 FS-LASIK eyes were included and analyzed. Before surgery, 88% of SMILE eyes and 85% of FS-LASIK eyes were highly myopic and SE refraction averaged -7.26±1.75 D (range: -0.88 to -14.75) for SMILE and -7.16±2.38 D (range: -0.88 to -16.50) for FS-LASIK (P=0.42). After 3 months, 81% of SMILE eyes and 76% of FS-LASIK eyes (P=0.56) were within ±0.5 D of intended refraction, whilst 96% of SMILE eyes and 91% of FS-LASIK eyes (P=0.61) were within ±1.0 D. The mean difference between attempted and achieved SE refraction 3 months after surgery was 0.15±0.49 D in SMILE eyes and -0.13±0.60 D in LASIK eyes (P<0.05). Emmetropia was the target refraction in 233 eyes; At day 1 after surgery, 33% of SMILE eyes and 48% of FS-LASIK eyes (P=0.24) had an UDVA ≤ 0.00 (logMAR). After 3 months, the results were 86% of SMILE eyes and 68% of FS-LASIK eyes (P=0.48). After 3 months, 5 SMILE eyes (0.8%) and no FS-LASIK eyes (P=0.18) had lost 2 or more lines of CDVA. All eyes had CDVA ≤ 0.15 (logMAR) 3 months after surgery.


Both FS-LASIK and SMILE were efficient in treating all degrees of myopia and low degrees of astigmatism, and results were overall comparable 3 months after surgery.

Financial Interest:


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