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Laser refractive surgical techniques: SMILE and LASIK, which provides the best outcome?

Poster Details

First Author: M. Johnson UK

Co Author(s):    E. Ansari                    

Abstract Details


Within the last 20 years, laser surgical treatment options offer correction of refractive error without the need for lenses. This comprehensive literature review will look at one of the more recent techniques, small incision lenticule extraction (SMILE), compared to one of the more popular techniques, laser-assisted in-situ keratomileusis (LASIK) to assess which technique is most effective at improving visual acuity.


Systematic Literature Review


A systematic literature review was conducted using PubMED, Cochrane Library, and databases. A PICO search strategy was used selecting for a population of adults 18 years and over with myopia. The intervention was small incision lenticule extraction (SMILE), and the comparison group was laser assisted in-situ keratomileusis (LASIK). The outcome measure used to assess for effectiveness of the procedure was percentage of population with uncorrected visual acuity of 20/20 at termination of follow up.


The literature search returned a total of 131 articles. Articles were screened and 17 full-text of articles were analysed, 5 were found to be adequate for synthesis in this review. Laser refractive treatment across both groups showed high success at achieving emmetropia. in the range of 88-98% however three of the studies failed to show any statistically significant difference between the techniques. Two studies alternately favoured either SMILE or LASIK. The SMILE technique was associated with less adverse events. Furthermore, SMILE was not associated with flap complications, which whilst rare are a potential adverse occurrence of LASIK techniques.


Whilst there is no appreciable evidence to support one technique over the other currently, the current literature comes from poor quality data sets, with highly variable follow-up. Comparable rates of emmetropic outcome combined with lower reported complications, and lack of flap-related problems, favours the preference of the SMILE technique over LASIK, assuming costs remain largely comparable. Future research should focus more broadly on long term regression rates between the techniques, as well as outcomes across a broader age group since these are likely to impact on future recommendations for surgery.

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