The Economic Value And Learning Curves Associated With Laser Vision Correction

Refractive surgeries are used to correct refractive errors by reshaping the cornea. Surgical technologies include laser-assisted in situ keratomileusis (LASIK) and small incision lenticule extraction (SMILE). A targeted literature review was conducted to examine the costs, time, and/or healthcare resource utilization (HCRU) and learning curves associated with the LASIK and SMILE technologies. 

Global literature review

Searches were performed in MEDLINE with terms including “LASIK”, “small lenticule extraction”, “costs”, and “learning curve”. English-language studies published between 1/1/2002 and 9/1/2022 were included if they reported either the costs, time, and/or healthcare resource utilization associated with laser vision correction, or the learning curve associated with LASIK and/or SMILE. 

SMILE was associated with a steep learning curve for inexperienced ophthalmic surgeons with significantly worse UDVA and efficacy index (p<0.043), safety index (p<0.045), longer duration of docking/suction engagement (p=0.0.34) and duration for lenticule extraction (p<0.001) for their first 100 procedures. Outcomes associated with LASIK were found to be consistent between attending/resident groups compared to non-resident surgeons. LASIK was associated with time and cost savings for patients when compared to CL and glasses over 30 years. These savings were driven by fewer optometrist visits (4.7 vs. 12.2), optical center visits (41 vs. 117 compared to CL and 18 vs. 50 compared to glasses) and CL care hours (1,090 hours saved). 

While laser vision correction provides patients with long-term time and cost savings, there is a significant learning curve associated with the SMILE technology.