Abstract
Background: To investigate the differences in visual quality after laser epithelial keratomileusis (LASEK), femtosecond laser in situ keratomileusis (FS-LASIK) and small-incision lenticule extraction (SMILE) in different degrees of myopia.Methods: This prospective study incorporated 200 consecutive myopic subjects (200 eyes). Myopia was subdivided into 3 levels based on the preoperative spherical equivalent (SE) value: low myopia (SE ≥ -3.0 D), moderate myopia (−3.0 D > SE ≥ −6.0 D), and high myopia (SE < −6.0 D). Visual quality was recorded and analyzed both objectively using the Optical Quality Analysis System II (OQAS II), and subjectively with uncorrected distance visual acuity (UDVA) and a questionnaire, preoperatively, 1 month and 6 months postoperatively. Results: Six months after LASEK, FS-LASIK and SMILE in myopia, the logarithm of the minimum angle of resolution (LogMAR) UDVA statistically decreased compared with preoperative values (all P < 0.001). While preoperatively, in three surgical procedure groups, objective visual quality parameters demonstrated no significant difference among three degrees of myopia (all P > 0.05), at 6 months postoperatively, after FS-LASIK and SMILE, the modulation transfer function (MTF) cutoff frequency in low myopia was significantly higher than that in high myopia (both P < 0.05). Moreover, intergroup differences in LASEK, FS-LASIK and SMILE groups were not statistically significant, before and 6 months after surgery (all P > 0.05), except that FS-LASIK provided a significantly higher preoperative LogMAR UDVA than SMILE in high myopia (P < 0.05).Conclusion: LASEK, FS-LASIK and SMILE could achieve similar improvement in visual quality to each other after myopia correction. Low myopic patients may achieve better postoperative visual quality after FS-LASIK and SMILE than high myopic patients.Trial registration: This is a prospective study. The study followed the Declaration of Helsinki and was approved by the Institutional Review Board of the Second People’s Hospital of Yunnan Province.