Page 92 - JSOM Winter 2024

(preoperative vs. postoperative), and scores were comparable nature and shorter follow-up. A long-term prospective study
between groups postoperatively. However, this study did not of the quality of vision after the range of laser treatment op-
differentiate between levels of correction. tions would be beneficial in developing algorithms for patient
selection.
This study found patients who underwent both LASIK and
PRK (but not the SMILE group) felt significantly less diffi- Conclusion
culty driving postoperatively compared with preoperatively.
This result bore out when comparing postoperative driving Practices not limited by technological availability can best serve
difficulty, as the LASIK and PRK groups had less difficulty patients by offering a tailored approach to help patients achieve
than the SMILE group. The PRK group alone noted significant their vision goals. Patient complaints after conventional LASIK
improvement in being bothered by symptoms from before to and PRK were mitigated by advances in laser technology and
after operation. When comparing treatment groups, however, lens options, achieving better visual quality and patient satis-
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the postoperative responses were comparable for being both- faction. PROs should be considered a part of the refractive
ered by glare, halos, and lack of vision sharpness. pre- and postoperative evaluation standard. As this was a retro-
spective study, procedures were based on prescriptive and per-
A consideration of patients undergoing laser refractive sur- sonal needs rather than randomization, thus emphasizing the
gery is improving their ability to perform daily activities and importance of appropriate procedure selection for a patient’s
giving themselves time to appreciate and adapt to their post- individual goals. This study added a comparative perspective of
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operative vision. Klokova et al. suggested patients require the QOV of SMILE to the vast LASIK and PRK literature.
adequate time to adjust to their new visual function. Numer-
ous studies 8,14–15 have reported an improved ability to perform Acknowledgments
tasks, including military studies of task performance. Shams et The authors would like to thank Mr. Bryan Morgan and Ms.
al. found better vision-related quality of life in subjects who Mariam Mossavi for their contributions to data collection.
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underwent refractive surgery compared to those who were
wearing contacts or glasses but not compared to emmetropes. Author Contributions
Patients in this study reported a significant decrease in limita- DSR, RKS, HB, and BAR provided the concept and design.
tions in activity after all procedures. SBR and BAR participated in data acquisition. DSR and HB
analyzed and drafted the original manuscript. KEE and ZPS
While this study is limited to myopic patients to compare interpreted the study findings. All authors reviewed, edited,
treatment types adequately, comparing outcomes meaning- and approved the final manuscript.
ful to patients is essential. Outcomes that are patient-focused
are more important than subjective quality of vision and are Disclosures
a focus area of the Food and Drug Administration (FDA). BA Rivers retired from the U.S. Army and is now the Medical
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Previous studies have shown refractive surgeries such as PRK Director for Envue Eye & Laser Center. BA Rivers and DS
to significantly improve quality of life in terms of general vi- Ryan are Key Opinion Leaders for Carl Zeiss Meditec.
sion and health, driving, role difficulties, mental health, and
distance activities compared to nonsurgical correction. In a Portions of this material were presented at the annual meet-
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study of vision-related quality of life and perception of mili- ings of the American Society of Cataract and Refractive Sur-
8
tary readiness, Sia et al. reported perceived improvements in gery, Washington, DC, April 2022; American Academy of
functional performance, enhanced capability and readiness, Ophthalmology, San Francisco, CA, October 2019; and Amer-
and improved quality of life to support refractive surgery in ican Academy of Ophthalmology, Chicago, IL, October 2018.
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the U.S. Armed Forces. More recently, Lang et al. reported
better vision-related quality of life in patients undergoing Disclaimer
SMILE compared to controls. The views expressed in this article are those of the authors
and do not necessarily reflect the official policy or position of
Ultimately, numerous techniques and advances are available Belvoir Hospital, The Henry M. Jackson Foundation for the
for vision correction, some surgical and some not. Aligning Advancement of Military Medicine, Inc., the Defense Health
clinical data and patient expectations with the appropriate Agency, the Department of Defense, or the U.S. Government.
treatment will yield the highest satisfaction. The PROWL stud- The identification of specific products or scientific instrumen-
ies found the mean satisfaction with surgery score was 93.1 tation is considered an integral part of the scientific endeavor
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(95% CI 91.3–95.0) at 6 months in the PROWL-1 study; the and does not constitute an endorsement or implied endorse-
rate of dissatisfaction with surgery was 2% (95% CI 1%–5%), ment on the part of the authors, DoD, or any component
with a moderate correlation between satisfaction and dry eye agency. Institutional clearance was approved.
symptoms. Association between symptoms and clinical find-
ings is limited. The PROWL studies did emphasize the need Funding
for adequate patient counseling on the development of new No funding was received for this work.
symptoms. Similarly, a study by Wei et al. found that ap-
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propriate patient selection and counseling of glare and haloes References
could manage postoperative expectations. 1. Sellers B, Townley JR, Ropp C, Legault G. Brief report: refractive
surgery trends at tri-service refractive surgery centers and the im-
pact of the COVID-19 pandemic, fiscal years 2000–2020. MSMR.
This study found comparatively high satisfaction with the 2022;29(3):17–19.
treatments. Findings from comparative studies are a resource 2. Madigan WP, Bower KS. Refractive surgery and protective eye-
to guide counseling and optimize patient selection for laser wear in the military. Ophthalmology. 2004;111(5):855–856. doi:
refractive surgery. This study was limited in its retrospective 10.1016/j.ophtha.2004.01.004

90 | JSOM Volume 24, Edition 4 / Winter 2024