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Three-year outcomes of small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for myopia and myopic astigmatism
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  • Published on:
    Authors' response: Three-year outcomes of small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for myopia and myopic astigmatism
    • Tian Han, ophthalmologist The Eye and ENT Hospital of Fudan University
    • Other Contributors:
      • Ye Xu, ophthalmologist
      • Xingtao Zhou, ophthalmologist

    We thank Dr. Montserrat for the letter regarding our article “Three-year outcomes of small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for myopia and myopic astigmatism.”1
    Their first concern is that the predictability of the FS-LASIK group was 65% of eyes within ±0.5 diopter (D), which is also different from our experience. Of note, 95% of eyes were within ±1.25 D in the FS-LASIK group. This may be due to the long-term follow-up of 3 years leading to variability in the manifest refraction over time. In fact, our predictability results were similar to that of other long-term studies, as shown in Table 1.1-5 Moreover, it is likely a reflection of selection bias in our retrospective analysis i.e. patients with visual complaints were more willing to participate in the follow-up at 3 years – and we had acknowledged this as a limitation in our discussion. However, the probability of this bias may be the same for both surgical procedures and therefore did not significantly affect the final conclusion in our analysis.

    Table1 Summary of Long-term Predictability Results for LASIK
    Study Eyes (patients) Preoperative MRSE (D) Follow-up ± 0.50 of Emmetropia (%)
    Han T 41(41) −7.15±1.92 3 years 65
    Kobashi H 30(30) −3.81±1.40 2 years 73
    Alio JL 97(70) −7.15±1.92 10 years 49
    Zalentein WN 38(21) spere of -6.55±1.74 2 years 63
    O'Doherty M 94(49) −4.85±2.35 5 years 60

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    Conflict of Interest:
    None declared.
  • Published on:
    • Montserrat Garcia-Gonzalez, Cataract and Refractive Surgeon Clínica Rementería, Madrid, Spain . Clínica Novovisión, Madrid, Spain
    • Other Contributors:
      • Juan Gros-Otero, Cataract and Refractive Surgeon
      • Miguel Teus, Cataract and Refractive Surgeon

    We have read with interest the article by Han et al.,1 in which the authors compare the outcomes of myopia correction using small incision lenticule extraction (SMILE) versus laser in situ keratomileusis (LASIK) using the VisuMax® femtosecond laser (FS) to cut the corneal flap, and we have some concerns regarding this study we would like to share with the authors.
    It is noteworthy that the authors found that only 65% of eyes were within ± 0.50 diopters of the attempted spherical equivalent correction after FS-LASIK, these results are clearly worse that those generally obtained with LASIK. It is accepted that the results obtained with excimer laser ablation, either using a surface ablation approach, or LASIK performed with mechanical microkeratome (MK) or using the Intralase® FS platform to correct myopia are quite similar.2,3 Indeed, our group has that 95% of unselected eyes with myopia of -3.9±1.5D3 and 80% of eyes with high myopia (-8.7±1.2D)4 were within ± 0.5D of emmetropia after LASIK. For this reason, we believe that the main conclusion of the article by Han et al.1 that “long-term outcomes of both SMILE and FS-LASIK are safe and equally effective for myopic and astigmatic correction” is clearly biased. In other words, the results of SMILE should have not been compared with a FS laser platform that does not seem to achieve the benchmark results clearly established for LASIK when correcting myopia.
    It should be highlighted that different FS platforms appr...

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    Conflict of Interest:
    None declared.