One To Six Month Outcomes Of Corneal Lenticular Extraction For Advanced Refractive Correction (Clear): A Large-Scale Retrospective Study Of 1013 Eyes

Corneal Lenticular Extraction for Advanced Refractive Correction (CLEAR) is a novel, flapless approach to treating myopia and astigmatism. As the first and only Malaysian center offering this technique, we aimed to evaluate its early to mid-term clinical performance by examining visual acuity, refractive stability, safety, and potential benefits—particularly minimal induced astigmatism and accelerated recovery. The findings of this large-scale retrospective analysis may guide further adoption of CLEAR and enhance surgical decision-making in refractive practice.

This single-center study was conducted at a dedicated refractive surgery facility in Malaysia. Four operating theaters and 14 ophthalmic surgeons participated, each following a standardized protocol using a low-energy femtosecond laser for lenticular extraction.

A total of 1013 eyes from 514 patients (aged 18–45) who underwent CLEAR from November 2023 to December 2024 were retrospectively reviewed. Inclusion criteria included stable refraction, spherical error of –3.00D to –7.00D, cylindrical error up to –2.00D, absence of deep-set eyes, and a predicted residual corneal thickness ≥280 µm. Comprehensive examinations were performed preoperatively and postoperatively at Day 1, Week 1, and Months 1, 3, and 6. Main outcome measures included uncorrected distance visual acuity (UDVA), spherical equivalent (SE), and astigmatism.

Day 1 postoperatively, 90% of eyes achieved UDVA of 6/6 or better, increasing to 95% by Week 1 and 97% at Month 1. By Months 3 and 6, 98% maintained 6/6 or better. Mean SE improved from –5.00±1.20D preoperatively to –0.25±0.40D at Month 1 and stabilized thereafter. At Month 1, 92% of eyes were within ±0.50D of the targeted correction, rising to 95% by Month 3. Fewer than 1% of eyes exhibited residual astigmatism ≥–1.00D beyond one month. No significant intraoperative or serious postoperative complications were reported.

CLEAR demonstrated excellent efficacy, predictability, and safety through six months of follow-up, with rapid visual recovery and minimal or no induced astigmatism. Its flapless design may help reduce postoperative dry eye and improve patient comfort compared to traditional refractive surgeries. These encouraging early- to mid-term outcomes suggest CLEAR is a viable option for myopic and astigmatic correction, warranting further research into long-term stability and broader clinical applications.