Comparison of visual quality after Q value-guided FS-LASIK and SMILE for correction of myopia with age-related accommodation deficiency

Purpose

To investigate differences in objective and subjective visual quality 12 months following Q value-guided (Custom-Q) femtosecond laser‐assisted laser in situ keratomileusis (FS-LASIK) versus small incision lenticule extraction (SMILE) for correction of low-to-moderate myopia and compensate for age-related accommodation deficiency.

Methods

Clinical data of 45 patients were analyzed, of whom 23 were treated with FS-LASIK and 22 with SMILE. At the 12-month follow-up, the distance, intermediate, and near visual acuities; objective and subjective refractions; Q factor; corneal higher-order aberrations (HOAs); defocus curve; contrast sensitivity; stereopsis and a subjective visual quality questionnaire were evaluated.

Results

At 12 months postoperatively, the two groups had comparable binocular uncorrected distance and intermediate visual acuities (UDVA, UINA). A slightly better uncorrected near visual acuity (UNVA) was observed in the FS-LASIK group (P < 0.05), but patients reported equivalent near vision satisfaction and spectacle independence. Total HOAs and coma increased significantly in all treated eyes (P < 0.05). The Q value and spherical aberration (SA) became more positive, but the shifts were significant only in the SMILE group and the dominant eyes of the FS-LASIK group (P < 0.05). Binocular contrast sensitivity was better in the FS-LASIK group. No significant differences in visual disturbances were found between groups.

Conclusion

For myopic patients with mild age-related accommodation deficiency, both FS-LASIK with Custom-Q protocol and SMILE could provide good efficacy, safety, predictability, and high patient satisfaction. The Custom-Q protocol could better preserve the original prolate shape of the cornea and achieve superior visual quality compared to SMILE.

Key messages

What is known

Both femtosecond laser‐assisted laser in situ keratomileusis (FS-LASIK) and small-incision lenticule extraction (SMILE) have been widely applied in young myopic patients, with comparable efficacy and safety.

Studies evaluating the clinical outcomes of FS-LASIK and SMILE in treating myopia with age-related accommodation insufficiency are lacking.

What is new

For myopic patients with mild age-related accommodation deficiency, both FS-LASIK with Custom-Q protocol and SMILE could provide good efficacy, safety, predictability, and high patient satisfaction.

The Custom-Q protocol could better preserve the original prolate shape of the cornea and achieve superior visual quality compared to SMILE.