Home Lasik Topo-guided LASIK shows better visual performance than SMILE over long-term follow-up

Topo-guided LASIK shows better visual performance than SMILE over long-term follow-up


October 12, 2021

1 min read



Kanellopoulos J. Topography-guided LASIK vs. small incision lenticule extraction (SMILE) for myopia and myopic astigmatism: 4 year data of a randomized, prospective, contralateral eye study. Presented at: European Society of Cataract and Refractive Surgeons meeting; Oct. 8-11, 2021; Amsterdam.

Kanellopoulos reports consulting for Alcon, Avedro, i-Optics, ISP Surgical, KeraMed and Zeiss.

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Four-year results in a group of patients treated with topography-guided LASIK in one eye and SMILE in the contralateral eye showed that LASIK provides superior visual outcomes.

“This is likely due to the eye tracking, cyclorotation compensation and active centration control in the LASIK technology,” A. John Kanellopoulos, MD, said at the European Society of Cataract and Refractive Surgeons meeting.

Several data analyses were published since the beginning of the study. In a 2019 paper, anterior segment OCT epithelial mapping showed significant epithelial remodeling with both procedures, with more prominent inflammation in the LASIK eyes in the initial 3 months, corresponding to the peak of transient dry eye.

“Quite surprisingly, in the long term, the two procedures appear more similar. Curvature changes associated with both procedures may promote similar remodeling patterns, with a significantly higher mid-peripheral epithelial thickness increase,” Kanellopoulos said. “This was an eye-opener for us.”

A new study currently in press in the Journal of Cataract and Refractive Surgery used the Pentacam (Oculus) to look at the radial and angular displacement of the center ablation with respect to the corneal vertex and found a significant difference between LASIK and SMILE eyes.

“The LASIK eyes had a 130 µm deviation from the vertex, while the SMILE eyes had 313 µm, almost three times more,” Kanellopoulos said.

Over 4 years of follow-up, both procedures showed good visual and refractive outcomes, but topo-guided LASIK demonstrated superior visual performance and more accuracy, especially in highly myopic eyes. LASIK has the advantage of eye-tracking technology, providing cyclorotation compensation and active centration control, Kanellopoulos said.

“SMILE has some intrinsic advantages, but still a lot of work needs to be done in order to reach the level that excimer lasers have reached today,” he said.

The new Schwind ATOS femtosecond laser, which enables lenticule extraction, may represent the next step forward, he said.

  • References:
  • Kanellopoulos AJ. Cornea. 2019;doi:10.1097/ICO.0000000000001821.
  • Vingopoulos F, et al. J Cataract Refract Surg. 2021;doi:10.1097/j.jcrs.0000000000000687.

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