Contralateral Evaluation Of Ocular Surface Stability: Lenticule Extraction (Smartsight) Versus Flap-Based Presbyopic Correction (Femto-Lasik Presbymax)

To compare early postoperative ocular surface dryness and tear film stability between lenticule extraction (SmartSight) and flap-based excimer laser ablation (Femto-LASIK PresbyMAX) using a contralateral eye study design in a presbyopic population.

Private Refractive Surgery Center.

This prospective observational study included patients (age 45+) undergoing refractive surgery for presbyopia. A contralateral treatment protocol was applied: the dominant eye received SmartSight lenticule extraction (Schwind Atos) for distance correction, and the non-dominant eye received Femto-LASIK with the PresbyMAX profile (Schwind Amaris) for near-vision enhancement. Ocular surface assessment was performed using Non-Invasive Fluorescein Break-Up Time (NIF-BUT) and Average NIAvg-BUT at baseline and 1 month postoperatively.

Preliminary analysis at the 1-month follow-up demonstrates a clear trend toward superior tear film stability in the SmartSight group compared to the Femto-LASIK group. While the flap-based eyes (PresbyMAX) showed a more significant reduction in NIF-BUT from baseline values, the lenticule extraction eyes (SmartSight) exhibited greater stability, with some cases showing nearly unchanged or even improved NIAvg-BUT values. The data suggest that the smaller peripheral incision and preservation of the anterior corneal stroma in the SmartSight procedure result in less disruption to the corneal subbasal nerve plexus than the creation of a standard LASIK flap.

In patients over 45, where the ocular surface is more vulnerable, SmartSight lenticule extraction appears to offer better preservation of tear film stability at 1 month postoperatively compared to Femto-LASIK PresbyMAX. This suggests a clinical advantage for lenticule-based procedures in minimizing postoperative dry eye symptoms in the presbyopic demographic.