Visual results after small-incision lenticule extraction (SMILE) versus femtosecond laser-assisted in situ keratomileusis (LASIK) for myopia in a single center in Jeddah, Saudi Arabia

Abstract Background Modern refractive surgery now offers various techniques based on the degree of refractive error for surgically correcting myopia and myopic astigmatism. Laser-assisted in situ keratomileusis (LASIK) is the most extensively used refractive surgical treatment worldwide for myopia and astigmatism. Recent years have seen the development of FemtoSecond laser-assisted LASIK (FS-LASIK) for clinical applications. This study aimed to compare the efficacy, safety, and predictability of Small Incision Lenticule Extraction (SMILE) and LASIK. Methods This nonrandomized retrospective cohort study included 773 eyes from Itqan Eye Center in Jeddah, Saudi Arabia, that underwent SMILE or FS-LASIK for myopia correction between January 2020 and January 2023. Including patients aged more than 20 years and excluded any patients with previous corneal surgery, scars, infections, past intraocular surgery history, or signs of ectasia. All procedures were conducted by ophthalmologists at Itqan Eye Center using a VisuMax femtosecond laser system. Results A total of 773 eligible cases were included, with (458) 59.2% undergoing FS-LASIK and (315) 40.8% undergoing SMILE. The mean age was 28.23 ± 6.94 years. The mean spherical power and mean cylindrical power were − 4.18 ± 1.94 and 0.77 ± 0.60, respectively, in the SMILE group and − 3.77 ± 2.02 and 1.32 ± 1.11, respectively, in the FS-LASIK group. Moreover, the mean uncorrected visual acuity (UCVA) was 1.15 ± 0.54 logarithm of the minimum angle of resolution (logMAR) in the SMILE group and 0.87 ± 0.54 logMAR in the FS-LASIK group. In addition, the mean efficacy index in the SMILE group was 1.05 ± 0.18 compared with 1.06 ± 0.17 in the FS-LASIK group. FS-LASIK was associated with significantly better UCVA than SMILE at 1 day ( p = 0.002), 1 week ( p = 0.022), and 1 month ( p = 0.005) postoperatively. The incidence of adverse events was significantly higher in the SMILE group 17.6% (< 0.001) than in the FS-LASIK group 6.6%. Conclusion FS-LASIK provides faster visual recovery but more flap-related adverse events, whereas SMILE is characterized by milder adverse events. Both methods have advantages, and the choice of method should be based on patient preferences.