Comparison of Clinical Outcomes and Patient Satisfaction Following SMILE Performed With the VisuMax 800 in One Eye and VisuMax 500 in the Contralateral Eye

Purpose To compare the clinical outcomes, surgical workflow, and patient satisfaction following small incision lenticule extraction (SMILE) performed with the VisuMax 800 in one eye and the VisuMax 500 in the contralateral eye (both Carl Zeiss Meditec). Methods This was a prospective, single-site clinical study of patients undergoing SMILE for myopia and myopic astigmatism between February 2022 and August 2023. Each patient underwent bilateral treatment using the VisuMax 800 (VM800 group) in one eye and the VisuMax 500 (VM500 group) in the contralateral eye. Intraoperative docking time, suction time, laser time, and surgical time were noted. Patient satisfaction and laser preference was evaluated immediately after treatment. Visual and refractive outcomes, contrast sensitivity, and quality of vision were assessed at the 3-month postoperative visit. Results A total of 30 patients undergoing bilateral SMILE were included. The mean docking time and surgical time were significantly lower in the VM800 group (46.53 ± 11 sec and 4.52 ± 2.33 min, respectively) compared to the VM500 group (68.25 ± 15 sec and 6.22 ± 2.04 min, respectively) ( P < .001). No significant differences were observed at the 1-day or 3-month visit for uncorrected distance visual acuity, corrected distance visual acuity, spherical equivalent, higher order aberrations, Objective Scatter Index, modulation transfer function, and contrast sensitivity. Patient scores regarding subjective symptoms were comparable. However, overall satisfaction with the surgical experience was rated significantly better in the VM800 group, with 80% of patients preferring the VM800 eye. No complications occurred for eyes in either group. Conclusions No significant differences were observed in clinical outcomes between the two laser systems. However, the surgical workflow and patient-reported intraoperative experience favored the VisuMax 800. [ J Refract Surg . 2025;41(1):e14–e21.]