Patient-reported quality of vision in a prospective randomized contralateral-eye trial comparing LASIK and small-incision lenticule extraction

Abstract Purpose: To compare patient-reported quality of vision and visual symptoms in participants undergoing laser in situ keratomileusis (LASIK) and small incision lenticule extraction (SMILE). Setting: Byers Eye Institute at Stanford University Design: Prospective randomized contralateral-eye clinical trial Methods: Subjects with myopia were randomized to receive wavefront-guided femtosecond LASIK in one eye and SMILE in the fellow eye. Participants reported the presence and severity of adverse visual symptoms via the Patient-Reported Outcomes With Laser In Situ Keratomileusis (PROWL) questionnaire and reported which eye had better vision at the preoperative and the postoperative 1-, 3-, 6-, and 12-month visits. Results: 80 eyes of 40 participants were treated. There was no difference in the presence or severity of double vision, glare, halo, or starbursts between eyes that underwent LASIK or SMILE at each visit (P ≥ 0.85 for each comparison). Scaled scores for the presence of visual symptoms improved from the preoperative visit to the postoperative month 12 visit for double vision (88 vs 97, P=0.03), glare (77 vs 92, P=0.02), halos (68 vs 87, P<0.01), and starbursts (60 vs 86, P<0.01). At the postoperative month 12 visit, 17/37 (46%) of participants preferred the vision from the eye that underwent LASIK compared to 7/37 (19%) that underwent SMILE. The preferred eye was correlated with uncorrected visual acuity (r=0.52, P<0.01). Conclusions: Rates of visual symptoms were similar for LASIK and SMILE, and visual symptoms improved with time. More patients preferred vision from the eye that underwent LASIK compared to SMILE.