18 EyeWorld Asia-Pacific | December 2024 References 1. Sandoval HP, Donnenfeld ED, Kohnen T, Lindstrom RL, Potvin R, Tremblay DM, Solomon KD. Modern laser in situ keratomileusis outcomes. J Cataract Refract Surg. 2016 Aug;42(8):1224-34. doi: 10.1016/j.jcrs.2016.07.012. PMID: 27531300. 2. Taneri S, Knepper J, Rost A, Dick HB. PRK, LASIK, SMILE im Langzeitverlauf [Long-term outcomes of PRK, LASIK and SMILE]. Ophthalmologe. 2022 Feb;119(2):163-169. German. doi: 10.1007/s00347-021-01449-7. Epub 2021 Jul 9. PMID: 34241701. 3. Chang JY, Lin PY, Hsu CC, Liu CJ. Comparison of clinical outcomes of LASIK, Trans-PRK, and SMILE for correction of myopia. J Chin Med Assoc. 2022 Feb 1;85(2):145-151. doi: 10.1097/JCMA.0000000000000674. PMID: 34861667. 4. Ferrer-Blasco T, Montés-Micó R, Peixoto-de-Matos SC, González-Méijome JM, Cerviño A. Prevalence of corneal astigmatism before cataract surgery. J Cataract Refract Surg. 2009 Jan;35(1):70-5. doi: 10.1016/j.jcrs.2008.09.027. PMID: 19101427. 5. Song J, Cao H, Chen X, Zhao X, Zhang J, Wu G, Wang Y. Small Incision Lenticule Extraction (SMILE) Versus Laser Assisted Stromal In Situ Keratomileusis (LASIK) for Astigmatism Corrections: A Systematic Review and Meta-analysis. Am J Ophthalmol. 2023 Mar;247:181-199. doi: 10.1016/j.ajo.2022.11.013. Epub 2022 Nov 19. PMID: 36410469. 6. Yoon H, Magnago T, Yeom DJ. Three-Month Clinical Outcomes to Correct Myopia or Myopic Astigmatism Using a Femtosecond Laser for Lenticule Creation With Automated Centration and Cyclotorsion Compensation. J Refract Surg. 2024 Jan;40(1):e30-e41. doi: 10.3928/1081597X-20231212-03. Epub 2024 Jan 1. PMID: 38190561. About the Physicians William F. Wiley, MD | Private practice, Cleveland Eye Clinic, Ohio | drwiley@clevelandeyeclinic.com Thomas Kohnen, MD | University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt, Germany Relevant Disclosures Wiley: Carl Zeiss Meditec Kohnen: Allergan, Avedro, Bausch & Lomb, Geuder, LensGen, Med Update, Nevakar, Santen, Staar, Stadapharm, Thieme, and Ziemer Particular attention should be given to astigmatism correction when comparing the two techniques. Studies highlight the high prevalence of clinically significant astigmatism in the population, emphasizing the importance of addressing this issue4. A systematic review of this topic, which included 17 studies and 1,985 eyes, revealed that for low-to-moderate astigmatism, the SMILE procedure tends to result in greater undercorrection and more residual astigmatism compared to LASIK. However, when treating high myopia, SMILE can be just as effective as LASIK. It has been shown that issues with axis alignment, partly due to the absence of automated cyclotorsion control and eye-tracking, were a key factor contributing to residual astigmatism of current KLex procedures5. However, new KLex-based systems featuring automated cyclorotation are now clinically established, and early data indicate promising results, particularly concerning astigmatism correction6. In summary, both techniques show convincing refractive and safety-related outcomes. LASIK benefits from more extensive experience due to its longer history of use, provides a shorter rehabilitation time, and offers more possibilities for secondary surgery. Both LASIK and KLex provide effective correction of astigmatism, and the current slight disadvantages of KLex are quickly being addressed by new technologies and a rapidly growing base of experience. Eye tracking including cyclorotation of modern corneal laser treatments. Source: Schwind eye-tech-solutions CATARACT
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