Clinical Outcomes Of Q-Value Customized Lenticule Extraction Surgery In Moderate Myopia

To compare short-term visual and refractive outcomes, higher-order aberrations (HOAs) including spherical aberration (SA), Q value, and effective optical zone (EOZ) changes after CLEAR with FlowSuite (FEMTO LDV Z8) with those after SMILE (VisuMax 500) and SMILE Pro (VisuMax 800).

Nunemiso Eye Center, Seoul, Korea

Retrospective review of moderate myopic patients who underwent KLEX in Nunemiso Eye Center were included. Patients were devided into three subgroups and analyzed: CLEAR (Z8), SMILE (VisuMax 500) and SMILE Pro (VisuMax 800). For CLEAR group automated centration and cyclotorsion compensation was assisted with FlowSuite software program based on pre-operative Galilei exam. Uncorrected distance visual acuity (UDVA) was evaluated at postoperative day 1, week 1, month 1, and month 3. Manifest refraction (MR) was assessed at months 1 and 3. Corneal HOAs and Q value were measured using the Galilei G4 and Pentacam HR systems at months 1 and 3. EOZ change was analyzed at months 1 and 3 with Pentacam HR.

At 3 months, 74–86 eyes per group remained for analysis. At 3 months, no statistically significant differences in visual acuity were observed among the three groups, and refractive accuracy was within ±0.5 D in more than 95% of eyes in all groups. Spherical aberration (SA) at 3 months was significantly lower in the Q-value customized CLEAR group (ΔSA +0.05 ± 0.05 µm) compared with the other platforms (+0.11 to +0.13 µm; p < 0.01). EOZ reduction was also smaller in the CLEAR group but did not reach statistical significance (−0.60 ± 0.36 mm vs −0.68 to −0.69 mm; p > 0.05). Q value demonstrated a smaller shift in the CLEAR group, consistent with the lower induction of SA.

Q-value customized lenticule extraction surgery by FEMTO LDV Z8 demonstrated lower induction of SA and potential of preserving EOZ in moderate myopic patients with comparable visual and refractive outcomes with VisuMax systems. Q-value customization may contribute to improved postoperative optical quality, potentially enhanced by the FlowSuite upgrade, which provides fully automated centration and cyclotorsion compensation.