Introducing “Smart Sight” Among Other Lenticule Extraction Techniques Into Our Clinical Practice- Learnings And Results

“Smart sight” is a comparatively new intrastromal lenticular extraction technique provided by Schwind´s Atos system (Schwind eye tec solutions, Kleinostheim, Germany). The system is outfitted with the centrax® System allowing for active cyclotorsion control. Does this active cyclotorsion control help to minimize residual astigmatism in lenticule surgery? How does the surgeon, previously used to “SmilePro” lenticule extraction technique using the Visumax 800 System (Zeiss, Jena, Germany), adopt to this different lenticule size and design? What are new clinical possibilities and potential drawbacks of these two techniques?

Patients were seen in a private practice specialized on refractive surgery in northern germany.Treatments relevant for this study where carried out in the city of Bremen and Walsrode following a profound ophthalmologic workup as well as an informed consent process. Patients where reffered to Visumax 800 "Smile Pro" or Atos "Smart Sight" treatment at the discretion of a senior ophthalmologist. All treatments were carried out by the first author.

We report on clinical results, surgical findings and the learning curve we noticed during treatment of our first 30 patients (59 eyes) undergoing “Smart sight” and compared the clinical outcomes with those of our last 30 “SmilePro” patients (60 eyes treated). Clinical records, video documentation of the surgery and slit lamp photography findings were evaluated.

Patients’ visits were scheduled one day, three days and 12 weeks following surgery.

Few of the patients had more appointments where additional data was collected. A structured survey helped to objectify subjective patients reporting.

Surgical adaptation from “Smile Pro” to “Smart Sight” went well although different forms of docking showed almost complementary pros and cons. Preparation of the “Smart Sight” lenticule seemed more challenging at the beginning due to its very thin lenticule edge and the bigger lenticule size.

Cyclotorsion control worked in all patients in the ATOS group.

The time needed for the laser application itself was significantly shorter in the Visumax group. One Suction loss was reported in the Atos group vs none in the Vismax group.

Clinical Analysis of the 3 month post OP refractive results showed significant differences in the correction of the astigmatism. Visual recovery at day 1 was significantly faster in Atos patients compared to control.

Both intrastromal lenticular technologies deliver outstanding clinical results. The surgical approach, time factor of the surgery and the docking process feels somewhat easier and yet slightly more controllable in the Visumax 800 group. This compares to the possibility to produce much bigger lenticules with greater optical zones in “Smart Sight” which is an important argument for patients with wider pupils or significant astigmatic error.

Fast visual recovery and perfect astigmatic correction are important issues for patient satisfaction and patients´ Post OP confidence into their treatment decision.

We are looking forward to see further development in lenticule surgery over the next years.