Wavefront-Guided LASIK Has Comparable Ocular and Corneal Aberrometric Outcomes but Better Visual Acuity Outcomes Than SMILE in Myopic Eyes

To compare ocular and corneal aberrometric outcomes of wavefront-guided (WFG) LASIK and small incision lenticule extraction (SMILE).This was a prospective, interventional study where 48 eyes (24 patients) underwent SMILE (Carl Zeiss Meditec, Jena, Germany) and 58 eyes (29 patients) underwent WFG LASIK (Abbott Medical Optics, Abbott Park, IL). Visual acuity and ocular surface disease index were assessed preoperatively and 1 and 3 months postoperatively. Corneal topography and anterior aberrations were assessed with the Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany) and iTrace (Tracey Technologies, Houston, TX), respectively. Ocular aberrations were also assessed with the iTrace.Safety and efficacy indexes of WFG LASIK (0.99 and 1.01, respectively) and SMILE (1.01 and 1.13, respectively) were comparable, although WFG LASIK was better (P < .0001). At 3 months postoperatively, all eyes in both groups achieved an uncorrected distance visual acuity of 20/20 or better. Further, 74.14% and 45.83% of the eyes in the WFG LASIK and SMILE groups, respectively, achieved uncorrected distance visual acuity of 20/16 (P = .003). The Pentacam reported an increase in root mean square of higher order aberrations (diameter of 4 mm and 6th order Zernike) and coma with a decrease in spherical aberration in both groups (P < .001). Corneal aberrations from the iTrace also did not yield any definitive differences between the treatments. However, changes in ocular aberrations were clinically insignificant at 3 months after both treatments. The ocular surface disease index increased mildly after WFG LASIK (P > .05) but was unchanged after SMILE.WFG LASIK and SMILE had similar aberrometric outcomes but WFG LASIK had better postoperative visual acuity. Surgeon experience, internal aberrations, small pupil size, and wound healing can enable similar outcomes in both procedures. [J Refract Surg. 2018;34(8):527-532.].