LAUSR

PURPOSE Wave-front guided laser in situ keratomileusis (WFG-LASIK) and small incision lenticule extraction (SMILE) are keratorefractive surgeries that can improve uncorrected visual acuity in myopic patients. Comparison of visual outcomes in myopic patients treated with LASIK and SMILE are needed. DESIGN Prospective, randomized contralateral eye-controlled trial METHODS: We performed a single-center prospective, randomized, contralateral eye comparison of WFG-LASIK and SMILE (NCT03067077). Myopic patients with low levels of astigmatism were treated with WFG-LASIK in one eye and SMILE in the fellow eye from March 2017 to March 2021. Treatments were randomized by ocular dominance. WFG-LASIK and SMILE were performed. Postoperative evaluation at 1 day consisted of UDVA, wavefront aberrometry, and a slit lamp examination. On subsequent postoperative visits at 1-mo, 3-mo, 6-mo, and 12-mo, UDVA, manifest refraction, 5% and 25% low-contrast visual acuity, wavefront aberrometry, and slit lamp examination were performed. MAIN OUTCOME MEASURE The primary outcome measure was uncorrected distance visual acuity at twelve months RESULTS: Eighty-eight (88) eyes of 44 patients with myopia were enrolled in the study. Seventy-four eyes of 37 patients had successful treatments and ccompleted 12 months of follow-up. At postoperative month 12, there was significantly higher proportion of WFG-LASIK eyes who had >= 20/20 uncorrected distance visual acuity compared with SMILE eyes (94% vs 83%, p<0.05). There was no difference between spherical equivalent between WFG-LASIK eyes and SMILE eyes (-0.17±0.25 vs -0.29±0.38, p>0.05); there was no difference in higher order aberrations, including coma, trefoil, and spherical aberrations (p>0.05); and there was significantly higher proportion of WFG-LASIK eyes who had improved 5% and 25% low contrast visual acuity compared with SMILE eyes (p<0.05) CONCLUSIONS: WFG-LASIK and SMILE both offered significant improvements in corrected distance visual acuity and excellent predictability in both eyes. Compared with SMILE, WFG-LASIK resulted in faster visual recovery, better low contrast visual acuity, and greater gains in uncorrected visual acuity.