Page 91 - JSOM Winter 2024

TABLE 3 Preoperative and Postoperative Quality of Vison Questionnaire Scales by Type of Treatment
Treatment, mean (SD)* P value †
LASIK PRK SMILE Overall LASIK vs. PRK LASIK vs. SMILE PRK vs. SMILE
Far vision (total 30; higher score is better)
Preoperative 25.79 (6.14) 26.40 (4.32) 27.25 (2.91) .119 1 .358 .808
Postoperative 28.19 (3.17) 27.57 (4.05) 27.35 (3.56) .292 .815 .875 1
Postop vs. preop ‡ P=.009 P<.001 P=.384
Night vision (total 13, higher score is better)
Preoperative 8.04 (2.22) 8.03 (2.38) 8.22 (1.86) .804 1 1 1
Postoperative 10.02 (1.59) 9.74 (1.77) 9.76 (1.96) .482 .682 1 1
Postop vs. preop ‡ P<.001 P<.001 P<.001
Glare (total 32, lower score is better)
Preoperative 13.64 (4.67) 15.21 (4.96) 14.88 (5.20) .220 .087 .659 1
Postoperative 14.35 (4.85) 14.92 (4.84) 15.51 (4.07) .258 1 .775 1
Postop vs. preop ‡ P=.384 P=.749 P=.661
Driving difficulty (total 12, lower score is better)
Preoperative 3.88 (1.27) 4.43 (2.20) 4.32 (2.49) .311 .223 .932 1
Postoperative 3.45 (0.90) 3.54 (1.16) 3.98 (1.31) .025 1 .075 .074
Postop vs. preop ‡ P=.009 P<.001 P=.716
Symptoms (total 28, lower score is better)
Preoperative 8.41 (2.68) 9.43 (3.08) 8.78 (2.67) .556 .058 1 .592
Postoperative 8.44 (1.94) 9.19 (2.53) 8.33 (1.93) .823 .104 1 .103
Postop vs. preop ‡ P=.869 P=.266 P=.384
Bothered by (total 16, lower score is better)
Preoperative 6.17 (2.32) 6.93 (2.59) 6.13 (2.16) .083 .115 1 .179
Postoperative 6.00 (2.11) 6.16 (1.95) 6.61 (1.88) .131 1 .393 .521
Postop vs. Preop ‡ P=.641 P<.001 P=.386
Activity limitations (total 12, lower score is better)
Preoperative 5.67 (2.39) 6.06 (2.74) 6.54 (2.73) .115 .967 .346 .859
Postoperative 3.11 (0.42) 3.22 (0.98) 3.44 (1.23) .093 1 .278 .488
Postop vs. preop ‡ P<.001 P<.001 P<.001
*Unless otherwise specified.
†P values for overall tests are based on one-way ANOVA test. P values for pairwise comparisons are based on the post-hoc Bonferroni method
for the ANOVA.
‡P values for paired pre-post paired comparisons are based on the t test.
LASIK = laser in situ keratomileusis; PRK = photorefractive keratectomy; SMILE = small incision lenticule extraction.
Numerous studies have reported the clinical gains of LASIK, .85 to indicate success, as the .85 cut-off indicates less than
PRK, and SMILE. A literature review by Taneri et al. on the two CDVA lines lost. Out of the 8,775 eyes they studied, all
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long-term efficacy and safety of LASIK, PRK, and SMILE were above the cut-off level. Gomel et al. reported safety was
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found the procedures to be safe and effective, with rare late higher in PRK, while efficacy was higher in LASIK. Similar to
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complications. Similarly, Sia et al. found that early post- our findings, Ang et al. reported no significant differences
operative outcomes of SMILE were superior to PRK and more between LASIK vs. SMILE in terms of safety or efficacy three
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predictable than LASIK. Moshirfar et al. reviewed the litera- months postoperatively.
ture, which revealed SMILE as an effective vision correction
procedure but recommended adjustments to optimize cylinder While uncorrected visual acuity is a driving factor for visual
correction. Ultimately, studies have shown visual outcomes to satisfaction, satisfaction can be optimized by minimizing dis-
be predictable, safe, and well-received by patients undergoing ruption to visual quality. As a complement to clinical findings,
LASIK, PRK, or SMILE. qualitative patient reporting is gaining recognition for demon-
strating patient satisfaction and optimizing patient counseling.
This LASIK group required significantly higher cylinder cor- For preoperative assessment, our respondents were asked to
rection than PRK and SMILE. Regardless, the present study consider their vision with correction, wearing either glasses or
found UDVA 20/20 or better at six months postoperatively in contact lenses. Postoperatively, respondents were asked about
95% LASIK, 94% PRK, and 94% SMILE-treated eyes. There their unaided vision.
were no significant differences between groups in the efficacy
index or the safety index. While there were no significant dif- When asked about their quality of vision, patient responses
ferences between LASIK versus PRK or LASIK versus SMILE, to questions on ‘Far vision’ and ‘Night vision’ were compara-
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the safety index for PRK-treated eyes was higher than SMILE. ble between groups pre- and postoperatively. While Li et al.
found higher myopes experienced more glare three months
This work compares favorably to the literature. Gomel et al. after SMILE surgery, this study found no significant differ-
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used the proportion of patients with a safety index higher than ences six months postoperatively with glare in any procedure
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