Low Contrast Acuity Outcomes After SMILE and LASIK

Purpose: To compare early visual quality of small incision lenticule extraction (SMILE) versus laser in situ keratomileusis (LASIK) in terms of low contrast acuity. Methods: A secondary analysis was performed using a harmonized dataset derived from two completed prospective cohort studies on active-duty military service members undergoing either SMILE (n = 37), wavefront-guided (WFG) LASIK (n = 51), or wavefront-optimized (WFO) LASIK (n = 56). Night vision and photopic and mesopic low contrast visual acuity (LCVA) up to 3 months postoperatively were compared between groups. Results: Compared to SMILE-treated eyes, WFG LASIK–treated eyes had significantly better night vision and photopic LCVA at 1 month postoperatively (beta = −0.039, P = .016; beta = −0.043, P = .007, respectively). WFO LASIK–treated eyes had significantly better photopic LCVA at 1 month postoperatively (beta = −0.039, P = .012) but had worse mesopic LCVA at 3 months postoperatively (beta = 0.033, P = .015) versus SMILE-treated eyes. Conclusions: SMILE and LASIK, on either a WFG or WFO laser platform, yielded excellent outcomes, but LCVA seemed to recover quicker following LASIK compared to SMILE. [ J Refract Surg . 2024;40(9):e667–e671.]