The Dynamic Changes and Influencing Factors of Visual Symptoms After Small Incision Lenticule Extraction

Overview

Journal BMC Ophthalmol

Publisher Biomed Central

Specialty Ophthalmology

Date 2023 May 19

PMID 37208645

Authors

Han Chen

Xiuyu Mao

Dongye Xu

Chenwen Guo

Jinhui Dai

Affiliations

Soon will be listed here.

Abstract

Background: To investigate the dynamic changes and influencing factors of visual symptoms after small incision lenticule extraction (SMILE).

Methods: This was a prospective observational study. Visual symptoms including glare, haloes, starbursts, hazy vision, fluctuation, blurred vision, double vision and focusing difficulties were evaluated before and 1, 3, 6 months after SMILE using a questionnaire. Generalized linear mixed models were used to assess the effects of preoperative characteristics and objective visual quality parameters on postoperative visual symptoms.

Results: 73 patients/146 eyes were enrolled. Preoperatively, the most common symptoms were glare (55% of eyes), haloes (48%), starbursts (44%) and blurred vision (37%). At 1 month postoperatively, the incidence and extent scores of glare, haloes, hazy vision and fluctuation rose significantly. At 3 months, the incidence and extent scores of glare, haloes and hazy vision restored to baseline. And at 6 months, the extent scores of fluctuation returned to baseline. Other symptoms (e.g., starbursts) did not change before and 1, 3, 6 months after SMILE. Preoperative visual symptoms were associated with postoperative symptoms, as patients with a symptom preoperatively had higher postoperative scores for that symptom. Age was related to postoperative extent of double vision (coefficient = 0.12, P = 0.046). There were no significant associations between postoperative visual symptoms and preoperative SE, scotopic pupil size, angle kappa (with intraoperative adjustment), postoperative HOAs or scattering indexes.

Conclusions: The incidence and extent scores of hazy vision, glare, haloes and fluctuation increased at the first month after SMILE, and recovered to baseline at 3 or 6 months. Preoperative visual symptoms were associated with the postoperative symptoms and should be fully considered before SMILE.

Citing Articles

Relationship of corneal percent tissue altered with visual outcome in small incision lenticule extraction surgery.

Wu X, Lin Y, Chen X, Li J Int Ophthalmol. 2025; 45(1):95.

PMID: 40085260 DOI: 10.1007/s10792-025-03483-9.

Posterior lenticule laser scan influence the ultra-early postoperative visual acuity and quality of SMILE.

Wan Q, Qian T, Wei R, Yin H, Tang J, Ma K Sci Rep. 2024; 14(1):27072.

PMID: 39511370 PMC: 11544260. DOI: 10.1038/s41598-024-78080-4.

Comparative Analysis of Visual Outcomes and Complications in Intraocular Collamer Lens, Small-Incision Lenticule Extraction, and Laser-Assisted In Situ Keratomileusis Surgeries: A Comprehensive Review.

Swaminathan U, Daigavane S Cureus. 2024; 16(4):e58718.

PMID: 38779265 PMC: 11110473. DOI: 10.7759/cureus.58718.

References

Miao H, Tian M, Xu Y, Chen Y, Zhou X . Visual Outcomes and Optical Quality After Femtosecond Laser Small Incision Lenticule Extraction: An 18-Month Prospective Study. J Refract Surg. 2015; 31(11):726-31. DOI: 10.3928/1081597X-20151021-01. View

Wei R, Li M, Zhang H, Aruma A, Miao H, Wang X . Comparison of objective and subjective visual quality early after implantable collamer lens V4c (ICL V4c) and small incision lenticule extraction (SMILE) for high myopia correction. Acta Ophthalmol. 2020; 98(8):e943-e950. DOI: 10.1111/aos.14459. View

Li M, Liu L, Shi Y, Sun L, Ma X, Zou J . Age-related differences in corneal nerve regeneration after SMILE and the mechanism revealed by metabolomics. Exp Eye Res. 2021; 209:108665. DOI: 10.1016/j.exer.2021.108665. View

Sekundo W, Kunert K, Blum M . Small incision corneal refractive surgery using the small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism: results of a 6 month prospective study. Br J Ophthalmol. 2010; 95(3):335-9. DOI: 10.1136/bjo.2009.174284. View

Kang E, Ryu I, Lee I, Kim J, Kim S, Ji Y . Comparison of Corneal Higher-Order Aberrations Following Topography-Guided LASIK and SMILE for Myopic Correction: A Propensity Score Matching Analysis. J Clin Med. 2022; 11(20). PMC: 9604777. DOI: 10.3390/jcm11206171. View

Li M, Zhang L, Song Y, Hao W, Zhao X, Zhang Y . Effect of Wavefront Aberrations on Night Vision Problems and Mesopic Contrast Threshold After SMILE. J Refract Surg. 2021; 37(7):446-452. DOI: 10.3928/1081597X-20210405-02. View

Kashima K, Trus B, Unser M, Edwards P, Datiles M . Aging studies on normal lens using the Scheimpflug slit-lamp camera. Invest Ophthalmol Vis Sci. 1993; 34(1):263-9. View

Liu Q, Yang X, Lin L, Liu M, Lin H, Liu F . Review on Centration, Astigmatic Axis Alignment, Pupil Size and Optical Zone in SMILE. Asia Pac J Ophthalmol (Phila). 2019; 8(5):385-390. PMC: 6784779. DOI: 10.1097/01.APO.0000580144.22353.46. View

Schmelter V, Dirisamer M, Siedlecki J, Shajari M, Kreutzer T, Mayer W . Determinants of subjective patient-reported quality of vision after small-incision lenticule extraction. J Cataract Refract Surg. 2019; 45(11):1575-1583. DOI: 10.1016/j.jcrs.2019.06.012. View

10.

Blum M, Taubig K, Gruhn C, Sekundo W, Kunert K . Five-year results of Small Incision Lenticule Extraction (ReLEx SMILE). Br J Ophthalmol. 2016; 100(9):1192-5. DOI: 10.1136/bjophthalmol-2015-306822. View

11.

Wang L, Li Y . [Regeneration of corneal nerve after SMILE, FS-LASIK and T-PRK surgery and study its relationship with subjective visual quality]. Zhonghua Yan Ke Za Zhi. 2018; 54(10):737-743. DOI: 10.3760/cma.j.issn.0412-4081.2018.10.004. View

12.

Bosem M, Sample P, Martinez G, Lusky M, Weinreb R . Age-related changes in the human lens: a comparison of Scheimpflug photography and lens density index. J Cataract Refract Surg. 1994; 20(1):70-3. DOI: 10.1016/s0886-3350(13)80047-8. View

13.

Han T, Zhao F, Chen X, Miao H, Chen Z, Zhou X . Evaluation of disk halo size after small incision lenticule extraction (SMILE). Graefes Arch Clin Exp Ophthalmol. 2019; 257(12):2789-2793. DOI: 10.1007/s00417-019-04481-1. View

14.

Gyldenkerne A, Ivarsen A, Hjortdal J . Optical and visual quality after small-incision lenticule extraction. J Cataract Refract Surg. 2018; 45(1):54-61. DOI: 10.1016/j.jcrs.2018.08.026. View

15.

Artal P, Chen L, Fernandez E, Singer B, Manzanera S, Williams D . Neural compensation for the eye's optical aberrations. J Vis. 2004; 4(4):281-7. DOI: 10.1167/4.4.4. View

16.

Pop M, Payette Y . Risk factors for night vision complaints after LASIK for myopia. Ophthalmology. 2004; 111(1):3-10. DOI: 10.1016/j.ophtha.2003.09.022. View

17.

Stulting R, Fant B, Bond W, Chotiner B, Durrie D, Gordon M . Results of topography-guided laser in situ keratomileusis custom ablation treatment with a refractive excimer laser. J Cataract Refract Surg. 2016; 42(1):11-8. DOI: 10.1016/j.jcrs.2015.08.016. View

18.

Chiang B, Valerio G, Manche E . Prospective, Randomized Contralateral Eye Comparison of Wavefront-Guided Laser In Situ Keratomileusis and Small Incision Lenticule Extraction Refractive Surgeries. Am J Ophthalmol. 2021; 237:211-220. DOI: 10.1016/j.ajo.2021.11.013. View

19.

Chalita M, Chavala S, Xu M, Krueger R . Wavefront analysis in post-LASIK eyes and its correlation with visual symptoms, refraction, and topography. Ophthalmology. 2004; 111(3):447-53. DOI: 10.1016/j.ophtha.2003.06.022. View

20.

Zhang F, Zhou Z, Yu F, Lu Z, Li T, Wang M . Comparison of age-related changes between corneal and ocular aberration in young and mid-age myopic patients. Int J Ophthalmol. 2012; 4(3):286-92. PMC: 3340808. DOI: 10.3980/j.issn.2222-3959.2011.03.16. View