17 EyeWorld Asia-Pacific | December 2024 FEATURE Pathways to Precision and Perfection – SMILE vs. LASIK by Thomas Kohnen, MD LASIK The LASIK technique is among the most advanced, safe, and personalized procedures for correcting myopia, hyperopia, and astigmatism. Recently, keratorefractive lenticule extraction (KLex) methods, such as SMILE, have emerged as an alternative option for treating these conditions. The Kommission Refraktive Chirurgie (KRC), the official scientific body for establishing guidelines on the indications of refractive surgery in Germany, recommends correcting myopia up to -8 diopters and astigmatism up to -5 diopters for both techniques. However, for hyperopia, a correction of up to +3 diopters is only advised using LASIK. Scientific reviews on the efficacy and safety of LASIK present compelling results, with 98.6% of eyes studied achieving a spherical equivalent refraction within ±1.0 diopter (D) of the target refraction, alongside high levels of predictability, efficiency, and patient satisfaction.1 When comparing LASIK, PRK, and SMILE procedures, none of them shows a distinct advantage in terms of these outcomes2. However, long-term data (up to 10 years) is currently only available for the PRK and LASIK procedures. Therefore, the long-term outcomes of the KLex procedure remain to be determined. Regarding rehabilitation time among the three procedures, another review found that LASIK has the shortest recovery period, while applicability, efficacy, safety, and predictability were largely comparable across all procedures3. When it comes to the potential for secondary surgery (touch-up) to correct residual refractive errors, LASIK offers several options: Re-lifting the flap for Re-LASIK, performing PRK on the existing flap, or, depending on the condition of the original flap, creating a new one. Correspondingly, KLex procedures only allow secondary PRK or a conversion to LASIK (circle). Topography of astigmatism. Source: University eye clinic Frankfurt
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