SMILE for Myopic Astigmatism: Early Experience in the USA and International Advances
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CATARACT AND REFRACTIVE SURGERY (CE STARR AND A BRISSETTE, SECTION EDITORS)
SMILE for Myopic Astigmatism: Early Experience in the USA and International Advances Jillian K. Chong 1 & D. Rex Hamilton 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review In this article, we review the early experience with small incision lenticule extraction (SMILE) in the USA as well as recent international data. We address long-term experience, new techniques, optimization of settings, corneal biomechanics, and comparison with other refractive surgical procedures. Recent Findings Despite promising early experience, US refractive surgeons have adopted the SMILE procedure slowly, owing in part to limitations on energy settings that have impacted early visual recovery. Outside of the USA, advances in parameters and techniques have driven improved early and long-term outcomes, with the result of increasing adoption. Although there remains debate, there is evidence for parity with FS-LASIK in visual outcomes, as well as advantages to SMILE in post-operative dry eye, spherical aberration induction, and biomechanical stability. Summary SMILE is a safe and effective procedure with promising advantages over other techniques and increasing usership worldwide. Continued improvements in energy optimization, nomogram development, and surgical technique allow for improved outcomes over early iterations of SMILE. Keywords SMILE . Small incision lenticule extraction . Femtosecond laser . Myopic astigmatism . Refractive surgery
Introduction The first report of small incision lenticule extraction (SMILE) in 2008 described a novel refractive surgery procedure using a single femtosecond laser for the treatment of myopia [1]. Since that time, SMILE has become increasingly popular throughout the world, with over 3 million procedures performed as of June 2020 and a current global marketshare of 17% [2]. Factors supporting its growth have been: its minimally-invasive Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40135-020-00250-0) contains supplementary material, which is available to authorized users. This article is part of the Topical Collection on Cataract & Refractive Surgery * D. Rex Hamilton [email protected] Jillian K. Chong [email protected] 1
Cornea and Refractive Surgery, Cleveland Clinic Cole Eye Institute, Cleveland, OH, USA
2
Hamilton Eye Institute, Los Angeles, CA, USA
approach, which appeals to refractive surgery patients; a reduced impact on the ocular surface compared with other laser refractive procedures [3]; and its potentially lower corneal biomechanical effects compared with other laser refractive procedures [4]. Factors limiting its growth are: the significant reliance of early post-operative visual acuities on energy setting optimization, which can vary between lasers; a steep initial learning curve; and the capital expenditure required to purchase the VisuMax FS laser (Carl Zeiss Meditec, Jena, Germany), which is currently the onl
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