Dr. David Robinson is a well-trained, qualified and experienced corneal and cataract surgeon; not just a standard eye surgeon doing cataracts. He has skill and experience in his field. He uses latest technology and equipment’s in their treatment procedure.

1. A Comparison of
LASIK Vs SMILE
Dr. David Robinson
M.B. B.S. B.Sc. (MED) F.R.A.N.Z.C.O. F.R.A.C.S
david@sydneyvision.com.au
www.sydneyvision.com.au

2. Techniques Being Compared
SMILE – Small-incision Lenticule Extraction
LASIK – Wavefront Guided Femtosecond Laser-
assisted Laser in Situ Keratomileusis

3. Literature Reviews:
LASIK articles published between 2008 and
2015 containing clinical outcomes were
reviewed and graded. (Sandoval et al.)
All studies of SMILE, and wavefront guided
femtosecond laser-assisted LASIK published
from January 2012 to September 2015 were
reviewed. (Pinero et al.)

4. LASIK Articles Reviewed (Sandoval et al.)
 LASIK articles published between 2008 and 2015
containing clinical outcomes were reviewed and
graded.
 There were 97 relevant articles (67,893 eyes)
 Conventional (standard) treatment, and Advanced
treatment (wavefront-guided, wavefront-optimized, or
topography-guided) were catagorized

5. LASIK History
 LASIK is one of the most commonly performed
elective procedures
 More than 16 million LASIK procedures performed
globally
 LASIK was introduced by Pallikaris et al. in 1990.
 Excimer laser approved by FDA in 1995
 LASIK approved by FDA in 1999

6. LASIK Visual Outcomes
 In aggregate, more than twice as many eyes gained
2 or more lines of CDVA (1.45%) as lost 2 or more
lines of CDVA (0.61%)
 The percentage of eyes with a loss of 2 or more lines
was statistically significantly lower in advanced group
(0.6%), than in the conventional group (0.94%)
 The percentage of eyes with a loss of 2 or more lines
was statistically significantly higher in eyes treated for
hyperopia (2.13%), than myopia (0.95%)
Loss or gain of CDVA:

7. LASIK Visual Outcomes
 90.8% of eyes had UDVA 20/20 or better p/op
 99.5% of eyes had UDVA 20/40 or better p/op
 Postoperative UDVA statistically significantly better in
advanced treatment results (-0.04 logMAR), than
conventional treatment results (+0.05 logMAR) – the
difference being almost 1 line
UDVA Results:

8. LASIK Visual Outcomes
 No difference in results between wavefront-guided,
wavefront-optimized, or topography-guided
treatments in the advanced treatment group
UDVA Results (cont):

9. LASIK Visual Outcomes
UDVA Results (cont):

10. LASIK Visual Outcomes
UDVA Results (cont):

11. LASIK Visual Outcomes
 90.9% within +0.50D
 98.6% within +1.0D
 In 95% eyes, the mean SE was within +0.25D
Residual SE Refrative Error:

12. LASIK Outcomes
 Multiple studies have shown that corneal sensation
returns to normal in almost all cases at 6 months p/op
 0.8% incidence of dry eye 1 year p/op (Bower et al.)
 Preoperative dry eye predictive of postoperative dry
eye
Corneal Sensation & Dry Eye:

13. LASIK Outcomes
 98.7% of all patients were satisfied or very satisfied
after LASIK surgery
 97% of patients (in response to a survey) said they
felt they were better off having had the surgery
(Kezirian et al.)
Patient Satisfaction:

14. LASIK Outcomes
 Mean UDVA for conventional LASIK was within a half
a line of 20/20
 UDVA in advanced treatment group was nearly 1 line
better than in the conventional group
Advanced LASIK vs Standard LASIK:

15. LASIK Outcomes
The aggregate data from a large number of recent
articles demonstrates the outcomes of modern LASIK
are significantly better than when the technology was
first introduced.
Some reasons for this are likely to be:
 Improved diagnostic and laser technology and patient
selection,
 better refinement of nomograms,
 more sophisticated ablation patterns
 Introduction of new technology (femtosecond laser
for flap creation etc)
Advanced LASIK vs Standard LASIK (cont):

16. SMILE and LASIK Articles Reviewed
(Pinero et al.)
All studies of SMILE and wavefront-guided femtosecond
laser-assited LASIK published from January 2012 to
September 2015 were reviewed

17. Visual Outcomes (cont):
 SMILE – 66.7% of studies reported 80% or
more eyes achieving 20/20 or better UDVA
 LASIK – all studies reported 80% or more
eyes achieving 20/20 or better UDVA
(Figure 2)
Comparison of studies:

18. Visual Outcomes (cont):
 SMILE – 40% of studies reported 90% or
more eyes achieving 20/20 or better UDVA
 LASIK – 75% of studies reported 90% or
more eyes achieving 20/20 or better UDVA
(Figure 2)
Comparison of studies:

19. Visual Outcomes (cont):
Figure 2

20. Visual Outcomes (cont):
 No clear difference in loss of lines of CDVA
 Higher percentage of eyes gained lines of
CDVA with LASIK than SMILE (possibly due
to less corneal backscatter present early post
LASIK)
CDVA:

21. Refractive Outcomes:
 SMILE – Mean P/OP SE of -0.01D to -0.33D
 LASIK – Mean P/OP SE of -0.02D to -0.17D
(figure 5)
Spherical Equivalent:

22. Refractive Outcomes:
 SMILE – 67.6% - 100% within + 0.50D of target SE
 LASIK – 80% - 100% within + 0.50D of target SE
 SMILE – 95% - 100% within +1.0D of target SE
 LASIK – 96% - 100% within +1.0D of target SE
(figure 5)
Spherical Equivalent (Cont):

23. Refractive Outcomes (SE):
Figure 5

24. Refractive Outcomes:
 Suggests a slight trend toward myopic
residual SE in SMILE which would explain the
lower UDVA
Spherical Equivalent (Cont):

25. Refractive Outcomes:
 SMILE: -0.40D +0.32D (Gyldenkerne et al.)
 SMILE: -0.36D +0.38D (Qian et al.)
 LASIK: -0.28D +0.30D (He et al.)
 LASIK: -0.09D +0.13D (Prakash et al.)
Mean P/OP Astigmatism at 12 months:

26. Refractive Outcomes:
 SMILE: 95% eyes 0.5D cyl or less (Reinstein et al.)
 SMILE: 92% eyes 0.5D cyl or less (Sekundo et al.)
 SMILE: 79.1% eyes 0.5D cyl or less (Yao et al.)
 LASIK: 87% eyes 0.5D cyl or less (He et al.)
 LASIK: 95% eyes 0.5D cyl or less (Yu and Manche)
 LASIK: 94% eyes 0.25D cyl or less (Prakash et al.)
Further P/OP Astigmatism results:

27. Ocular & Corneal Aberrometric
Outcomes
 SMILE: 0.24um to 0.706um
 LASIK: 0.15um to 0.28um
Higher levels of coma seem to be related to mild levels of
treatment decentration
Mean Coma RMS:

28. Corneal Sensation and Dry Eye
Outcomes
 Corneal sensitivity: Significantly less decrease in
corneal sensitivity in SMILE than LASIK in early
postoperative measures (1 week, 1 month, 3 months)
 No significant difference in corneal sensitivity at 6
months post op.
 TBUT: Less decrease in SMILE in the early
postoperative period
 Schirmers Test: Less decrease in SMILE in the early
postoperative period

29. Re-treatment Comparisons:
 Limited evidence of the outcomes of SMILE re-
treatments
 Results of surface ablation re-treatments in SMILE
eyes are poor
 Successful re-treatments have been reported post
LASIK

30. Other Comparisons of note:
 Increase in backscattered light intensity early
postoperatively after SMILE compared with LASIK
which may be the cause of the limitations in early
postoperative SMILE outcomes
 Biomechanical changes occur after both procedures
with no evidence supporting the superiority of one
technique over the other
 Scientific evidence supporting the stability of results
exists for LASIK, but does not yet exist for SMILE

31. References
 Sandoval H.P, Donnenfeld E.D, Kohnen T, Lindstrom R.L, Potvin R,
Tremblay D.M, Solomon K.D. Modern Laser in situ keratomileusis
outcomes. J Cataract Refract Surg 2016; 42:1224-1234
 Pinero D.P, Teus M.A. Clinical outcomes of small-incision lenticule
extraction and femtosecond laser-assisted wavefront-guided laser in situ
keratomileusis. J Cataract Refract Surg 2016; 42:1078-1093

32. Thank You!
Dr. David Robinson
M.B., B.S., B.Sc. (MED), F.R.A.N.Z.C.O., F.R.A.C.S.
david@sydneyvision.com.au
www.sydneyvision.com.au