Five-Year Clinical Outcomes Of Hyperopic Smile: A Prospective Multicenter Study
Published 2026 - 44th Congress of the ESCRS
Reference: FP11.08 | Type: Free paper | DOI: 10.82333/m5qv-ee72
Authors: Mr Pavel Stodulka* 1 , Dr Anke Messerschmidt-Roth 2 , A/Prof. Drahomira Barakova 3 , Dr Martin Slovak 4 , Prof. Dr Walter Sekundo 2
1Gemini Eye Clinic,Zlin,Czech Republic;Third Faculty of Medicine,Charles University,Prague,Czech Republic, 2Department of Ophthalmology,Phillips University of Marburg,Marburg,Germany, 3Gemini Eye Clinic,Prague,Czech Republic, 4Gemini Eye Clinic,Zlin,Czech Republic
Purpose
To evaluate visual acuity, refractive outcomes, and long-term stability five years after hyperopic SMILE in a multicenter cohort from Germany and the Czech Republic.
Setting
Gemini Eye Clinic in Zlin in Czech Republic, Gemini Eye Clinic in Prague in Czech Republic, Department of Ophthalmology, Phillips University of Marburg, Germany
Methods
This prospective study recruited 66 patients (128 eyes) who had undergone hyperopic SMILE as part of the original safety and efficacy study. The same study methods were adopted to allow comparison between baseline, 1 year (1Y), and > 5 years (>5Y) outcomes. Assessed parameters included spherical equivalent manifest refraction (MRSE), cycloplegic refraction (CRSE), uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA). Visual acuity is presented as mean±SD in logMAR.
Results
Mean UDVA improved from 0.31±0.26 logMAR at baseline to 0.04±0.12 at 1Y and remained stable at 0.03±0.13 at 5Y (p<0.001), with a mean change of -0.01 between 1 and 5 years (p=0.301). At 5 years, 92.6% achieved ≥20/32 and 64.8% ≥20/20. CDVA remained stable (−0.03±0.07 baseline; −0.03±0.11 at 5 years); ≥2-line loss occurred in 1.7%. CRSE changed from +3.95±1.63 D to +0.89±0.93 D at 1Y and +1.39±1.08 D at >5Y, with a regression of +0.49 D between 1–5 years (p<0.001). Similarly, MRSE changed from +3.39±1.51 D to −0.07±0.57 D at 1 year and +0.65±0.80 D >5Y, with a +0.70 D shift from 1 to 5 years (p<0.001).
Conclusions
Hyperopic SMILE demonstrated sustained visual acuity and safety at five years, with stable CDVA and UDVA. However, a measurable hyperopic refractive shift occurred between 1 and 5 years, indicating partial regression despite preserved functional visual outcomes.