Tear Film Stability In The First Month After Refractive Surgery: Smile Compared To Femto-Lasik — What Our Patients Told Us

To compare early postoperative tear film stability and patient-reported dry eye symptoms following SMILE and Femto-LASIK procedures, based on the first clinical experience in Armenia with SMILE.

This study was conducted at a private ophthalmology clinic in Yerevan, the only clinic currently performing SMILE in the country using the Carl Zeiss Meditec VisuMax platform. The center serves as a referral hub for refractive surgery, receiving patients from across Armenia.

This prospective observational study was conducted at the only center in Armenia currently performing SMILE. Patients undergoing either SMILE or Femto-LASIK for myopia and myopic astigmatism were included. Objective tear film parameters — Schirmer test, tear break-up time (TBUT), and fluorescein staining — were recorded preoperatively and at 1-month post-op. Subjective dry eye symptoms were evaluated using the Ocular Surface Disease Index (OSDI).

Preliminary results indicate that the SMILE group had better tear film preservation, with less reduction in TBUT and lower OSDI scores compared to the femto-LASIK group. While both groups experienced a mild decrease in Schirmer values, symptoms were generally milder in SMILE patients, who also reported faster recovery and reduced dependence on lubricants.

Our findings suggest that SMILE may offer better short-term ocular surface outcomes than Femto-LASIK. These early results are especially relevant in clinical settings where ocular surface preservation is a priority — such as in young, active patients or those with borderline tear function.