Corneal Higher-Order Aberrations And Visual Outcomes 6 Months After Smartsight Lenticule Extraction For Myopic Astigmatism.

To assess 6-month corneal higher-order aberrations (HOAs) and visual outcomes after SmartSight lenticule extraction surgery for high myopic astigmatism with a new femtosecond laser platform.

Eye Center, Dong Do Hospital, Vietnam.

A total of 120 eyes from 60 patients with high myopic astigmatism (mean spherical equivalent -6.07 ± 2.32 D; mean cylinder 2.45 ± 0.31 D) underwent SmartSight. To optimize high cylinder correction, automated cyclotorsion compensation and a targeted nomogram adjustment for astigmatism > 2.00 D were applied. Preoperative and 6-month postoperative uncorrected and corrected distance visual acuities (UDVA, CDVA) and corneal HOAs (spherical aberration, coma, trefoil) were compared. A comprehensive assessment examined the association between induced HOAs and preoperative refractive severity.

At 6 months, mean astigmatism was effectively reduced to 0.22 ± 0.19 D. Vector analysis confirmed excellent astigmatism correction (Correction Index 0.97; Angle of Error -0.07 degrees). Mean UDVA was 0.05 ± 0.13 logMAR, and postoperative UDVA was +0.39 ± 0.67 lines better than preoperative CDVA (P < 0.05). Regarding the primary focus on optical quality, postoperative total HOAs, spherical aberration, coma, and trefoil 30° increased significantly compared with preoperative measurements. Pearson analysis indicated a statistically significant positive relationship between the preoperative severity of myopia/astigmatism and most HOAs (P < 0.05).

The 6-month evaluation confirms that SmartSight is a highly precise and efficient approach for managing high myopic astigmatism. While visual outcomes and astigmatism correction are excellent, the postoperative increase of corneal HOAs is directly related to the baseline severity of myopia and astigmatism.