Ophthalmology Outcomes
Refractive Surgery (Laser Vision Correction)
The Refractive Surgery Service provides the most advanced forms of refractive procedures, ranging from laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) to small incision lenticule extraction (SMILE) and implantable lenses.
Learn more about the Refractive Surgery ServiceLASIK for Myopia and Myopic Astigmatism: Achieving Target Refraction (Spherical Equivalent)
During the 2023 calendar year, 176 eyes had LASIK surgery for myopia and myopic astigmatism. Of the 115 eyes that had follow-up data between one and three months postoperatively and refraction values available, 87.8% (101/115 eyes) achieved within 0.5 diopter of target refraction. Patients with astigmatism ranging up to 5 diopters were included in the analysis.
Benchmark data from U.S. Food and Drug Administration trials of LASIK for myopia showed that 71.6% of eyes resulted in a refractive error within 0.5 diopters of the intended target correction.1 Further review of the literature suggests that after LASIK surgery for myopia, approximately 70% to 83% of eyes achieve within 0.5 diopters of the intended target correction.1-2
The overall LASIK success rate for achieving within 0.5 diopters of target refraction for myopia and hyperopia combined in 2023 was 86% (105/122 eyes).
In the calendar year 2023, the Refractive Service performed LASIK on 207 eyes and SMILE on 304 eyes.
LASIK for Different Degrees of Myopia and Myopic Astigmatism: Achieving Target Refraction (Spherical Equivalent)
^Note the small sample size of only 8 patients with high myopia in 2019. With a significance level of p value = 0.5, we did not find any statistically significant difference between the percentage within 0.5 diopters of target refraction in 2018 and 2019 (Fisher exact test value = 0.062).
In calendar year 2023, 176 eyes had LASIK surgery for myopia. Of these, 115 eyes had between one- and three-months follow-up data and refraction values available for analysis. The success rates based on the degree of myopia are illustrated here. LASIK for low myopia was performed on 46 eyes, and of these, 93.5% (43/46 eyes) were successful (achieved within 0.5 diopters of target refraction at their follow-up). For the 53 eyes with moderate myopia, 86.8% (46/53 eyes) were successful, and for the 16 eyes with high myopia, 75% (12/16 eyes) achieved within 0.5 diopters of target refraction at one-month follow-up. Similar results were reported for low myopia for calendar years 2014 to 2022.
The Refractive Surgery Service continues to maintain a high overall success rate for LASIK surgery for myopia.
LASIK for Hyperopia and Hyperopic Astigmatism: Achieving Target Refraction (Spherical Equivalent)
^Note the small sample size of only 10 patients in 2021. With a significance level of p value = 0.05, we did not find any statistically significant difference between the percentage within 0.5 diopters of target refraction in 2020 and 2021 (Fisher exact test value = 0.3348).
Of the 31 eyes that had LASIK surgery for hyperopia during the 2023 calendar year, 7 had between three and six months of follow-up data and refraction values available for analysis. The overall LASIK success rate for achieving within 0.5 diopters of target refraction was 57.1% (4/7 eyes) for hyperopia in 2023. Patients with astigmatism ranging up to 1.75 diopters were included in the analysis.
A review of the literature suggests that the success rate for achieving within 0.5 diopters of the intended target correction after LASIK for hyperopia ranges between 66.7% and 91%.1-3
LASIK: Enhancement/Retreatment Rates at Six Months Follow-up
During the 2023 calendar year, 122 of the 207 eyes that had LASIK surgery had sufficient follow-up data and refraction values for analysis. Sufficient follow-up was defined as data available between one and three months for myopia and between three and six months for hyperopia. Of these, three eyes 1.45% (3/122 eyes) had an enhancement/retreatment procedure within six months of surgery. Similar results have been reported since calendar year 2010 when data collection for enhancement/retreatment rates began.
LASIK retreatment rates between 3.8% and 29.4% have been reported in the literature.1-3
For the past 14 years, the Mass Eye and Ear Cornea and Refractive Surgery Service has maintained low enhancement/retreatment rates when compared to international benchmarks.
SMILE for Myopia and Myopic Astigmatism: Achieving Target Refraction (Spherical Equivalent)
During the 2023 calendar year, 304 eyes had small incision lenticule extraction (SMILE) surgery for myopia. Of the 215 eyes that had between one and three months of follow-up data and refraction values available for analysis, 88% (189/215 eyes) achieved within 0.5 diopter of target refraction. Patients with astigmatism ranging up to 3 diopters were included in the analysis.
Of these 215 eyes, 1.0% (2/215) had an enhancement/retreatment procedure within six months of surgery.
SMILE is an FDA-approved procedure for the treatment of spherical myopia and myopic astigmatism. SMILE uses the latest laser technology to gently create a thin, contact lens-shaped layer just beneath the surface of the eye. This lenticule is then removed through a tiny opening. The adoption of SMILE is growing as a minimally invasive technology that allows for a rapid visual recovery, reduced risk of dry eye, and no post-operative restrictions.
SMILE: Enhancement/Retreatment Rates at Six Months Follow-up
During the 2023 calendar year, 215 of the 304 eyes that had SMILE surgery had sufficient follow-up data and refraction values for analysis. Sufficient follow-up was defined as data available between one and three months for myopia and between three and six months for hyperopia. Of these, two eyes 1.0% (2/215 eyes) had an enhancement/retreatment procedure within six months of surgery. Data collection for SMILE enhancement/retreatment rates began in 2020.
SMILE retreatment rates between 1% and 4% have been reported in the literature.1-5
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LASIK for Myopia and Myopic Astigmatism: Achieving Target Refraction (Spherical Equivalent)
1. Bailey MD, Zadnick K. Outcomes of LASIK for myopia with FDA-approved lasers. Cornea 2007; 26(3), 246–254.
2. Yuen LH, Chan WK, Koh J, et al. A 10-year prospective audit of LASIK outcomes for myopia in 37,932 eyes at a single institution in Asia. Ophthalmology 2010; 117(6): 1236–1244.
LASIK for Hyperopia and Hyperopic Astigmatism: Achieving Target Refraction (Spherical Equivalent)
1. Alió JL, EI Aswad A, Vega-Estrada A, et al. Laser in situ keratomileusis for high hyperopia (>5.0 diopters) using optimized aspheric profiles: efficacy and safety. J Cataract Refract Surg 2013; 39(4): 519-527.
2. Keir NJ, Simpson T, Hutchings N, et al. Outcomes of wavefront-guided laser in situ keratomileusis for hyperopia. J Cataract Refract Surg 2011; 37(5): 886-893.
3. Cole Eye Institute. Outcomes 2012.
LASIK: Enhancement/Retreatment Rates at Six Months Follow-up
1. Bragheeth MA, Fares U, Dua HS. Re-treatment after laser in situ keratomileusis for correction of myopia and myopic astigmatism. Br J Ophthalmol 2008; 92(11): 1506-1511.
2. Yuen LH, Chan WK, Koh J, et al. A 10-year prospective audit of LASIK outcomes for myopia in 37,932 eyes at a single institution in Asia. Ophthalmology 2010; 117(6): 1236-1244.
3. Alió JL, EI Aswad A, Vega-Estrada A, et al. Laser in situ keratomileusis for high hyperopia (>5.0 diopters) using optimized aspheric profiles: efficacy and safety. J Cataract Refract Surg 2013; 39(4): 519-527.
SMILE for Myopia and Myopic Astigmatism: Achieving Target Refraction (Spherical Equivalent)
1. Sekundo W, Kunert KS, Blum M. Small incision corneal refractive surgery using the small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism: results of a 6 months prospective study. Br J Ophthalmol 2011; 95(3): 335-339.
2. Vestergaard AH, Grauslund J, Ivarsen AR, et al. Efficacy, safety, predictability, contrast sensitivity, and aberrations after femtosecond laser lenticule extraction. J Cataract Refract Surg 2014; 40(3): 403-11.
3. Kanellopoulos AJ. Topography-guided LASIK versus small incision lenticule extraction (SMILE) for myopia and myopic astigmatism: a randomized, prospective, contralateral eye study. J Refract Surg 2017; 33(5): 306-312.
4. Kamiya K, Takahashi M, Nakamura T, et al. A multicenter study on early outcomes of small-incision lenticule extraction for myopia. Sci Re 2019; 9(1): 4067.
SMILE: Enhancement/Retreatment Rates at Six Months Follow-up
1. Liu YC, Rosman M, Mehta JS. Enhancement after small-incision lenticule extraction: incidence, risk factors, and outcomes. Ophthalmology. 2017;124:813-821.
2. Siedlecki J, Luft N, Kook D, et al. Enhancement After Myopic Small Incision Lenticule Extraction (SMILE) Using Surface Ablation. J Refract Surg. 2017;33(8):513-518.
3. Reinstein DZ, Carp GI, Archer TJ, Gobbe M. Outcomes of small incision lenticule extraction (SMILE) in low myopia [published correction appears in J Refract Surg. 2015 Jan;31(1):60] [published correction appears in J Refract Surg. 2015 Jan;31(1):60]. J Refract Surg. 2014;30(12):812-818.
4. Moshirfar M, Shah TJ, Masud M, Linn SH, Ronquillo Y, Hoopes PC Sr. Surgical options for retreatment after small-incision lenticule extraction: Advantages and disadvantages. J Cataract Refract Surg. 2018;44(11):1384-1389.
5. Siedlecki J, Luft N, Mayer WJ, et al. CIRCLE Enhancement After Myopic SMILE. J Refract Surg. 2018;34(5):304-309.
