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NEW ORLEANS -- Among patients who underwent LASIK surgery on one eye and SMILE (small incision lenticule extraction) surgery on the other, the LASIK eyes retained better vision on average, according to long-term results of a prospective study.

Among 21 patients, 92.4% of the LASIK eyes had an uncorrected distance visual acuity (UDVA) of 20/20 or better compared with 79.2% of the SMILE eyes after 4 years (P<0.002), reported A. John Kanellopoulos, MD, of LaserVision Clinical and Research Eye Institute in Athens, Greece, during a presentation here at the American Academy of Ophthalmology (AAO) annual meeting.

Additionally, 62.3% of LASIK eyes had a UDVA of 20/16 or better versus 34.5% of SMILE eyes (P<0.002), he noted.

Two SMILE eyes required photorefractive keratectomy retreatment, which Kanellopoulos described as a high number.

"Both [techniques] were safe and effective in correcting myopia and myopic astigmatism. All patients had a very rapid recovery," Kanellopoulos told MedPage Today.

However, research has suggested that there are differences to consider, he added. SMILE is very effective to improve vision in patients with myopia of -3.00 to -6.00 without astigmatism. "But if there's significant astigmatism, and/or myopia is of a higher refractive error, LASIK is far superior," he noted.

LASIK, which has been used for 30 years, is the grizzled elder of myopia-correcting eye surgeries. The FDA approved the SMILE procedure much more recently, in 2016.

In the study, 21 consecutive patients were assigned to have one eye treated with LASIK and the other with SMILE. Three-month data were and found that "topography-guided LASIK was superior in all visual performance parameters studied, both subjective and objective."

For example, spherical equivalent refraction at ±0.50 D was 95.5% for the LASIK eyes and 77.3% for the SMILE eyes (P<0.002). Residual refraction cylinder (≤0.25 D) was 81.8% and 50%, respectively (P<0.001).

"The main difference between the two techniques likely derives from the eye tracking, cyclorotation compensation, and active centration control in the LASIK technology studied in contrast to the current technology available with SMILE-like procedures," Kanellopoulos wrote.

Other research has suggested that the LASIK and SMILE techniques are more closely matched in terms of visual outcomes. Edward Manche, MD, of Stanford University School of Medicine in California, launched a similar study and earlier this year at the American Society of Cataract and Refractive Surgery annual meeting.

In this study, 40 consecutive patients were assigned to undergo wavefront-guided LASIK surgery in one eye and SMILE in the other. Among 25 patients, 90% and 85% of LASIK and SMILE eyes, respectively, reached a UDVA of 20/20 or better at 12 months; 70% and 75%, respectively, reached a UDVA of 20/16 or better.

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