Patients Prefer LASIK to SMILE, Despite Lack of Difference in Visual Symptoms

This prospective, randomized, contralateral-eye study compared patient-reported quality of vision and adverse visual symptoms following LASIK and SMILE procedures, with similar results regarding symptoms. However, more patients preferred the eye that underwent LASIK.

In patients who underwent laser in situ keratomileusis (LASIK) in 1 eye and small incision lenticule extraction (SMILE) in the other, more patients preferred vision from the LASIK eye, according to findings published in the Journal of Cataract and Refractive Surgery. However, researchers note that no patients reported no significant differences in visual symptoms between either eye.

Researchers conducted a prospective randomized contralateral-eye clinical trial to compare patient-reported quality of vision and visual symptoms in participants undergoing LASIK and SMILE. Participants with myopia were randomized to receive wavefront-guided femtosecond LASIK in 1 eye and SMILE in the fellow eye. The presence and severity of adverse visual symptoms were reported via the Patient-Reported Outcomes With Laser In Situ Keratomileusis (PROWL) questionnaire, as well as which eye had better vision at the preoperative and postoperative 1-, 3-, 6-, and 12-month visits. 

The study included 80 eyes of 40 participants. It found no differences in the presence or severity of double vision, glare, halo, or starbursts between eyes that underwent LASIK or SMILE at each visit (P ≥.85 for each comparison). From the preoperative visit to the postoperative month 12 visit for double vision, glare, halos, and starbursts, scaled scores for the presence of visual symptoms improved (P =.03, P =.02, P <.01, and P <.01, respectively). The researchers report that 46% of participants preferred the vision from the eye that underwent LASIK compared with 19% that underwent SMILE at the postoperative month 12 visit. The preferred eye was correlated with uncorrected visual acuity (P <.01). 

A greater number of participants preferred the eye that underwent LASIK compared to SMILE, in part due to better uncorrected visual acuity.

The researchers highlighted the study’s finding that, although participants who underwent wavefront-guided femtosecond LASIK and SMILE overall reported excellent results for quality of vision and adverse visual symptoms, a majority preferred LASIK, which is consistent with the existing literature. 

“A greater number of participants preferred the eye that underwent LASIK compared to SMILE, in part due to better uncorrected visual acuity,” the researchers explain.

Study limitations included the inability for the surgeon or participants to be masked to which eye received treatment, given that LASIK requires an additional excimer laser ablation step.

Disclosure: This research was supported by Johnson & Johnson Vision. Multiple study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Ma KK, Manche EE. Patient-reported quality of vision in a prospective randomized contralateral-eye trial comparing LASIK and SMILE. J Cataract Refract Surg. Published online December 20, 2022. doi:10.1097/j.jcrs.0000000000001127