Small incision lenticule extraction (SMILE) lenticule thickness readout compared to change in axial length measurements with the IOLMaster

  • Eugene TayEmail author
  • Ram Bajpai
Refractive Surgery



To compare theoretical values from the small incision lenticule extraction (SMILE) lenticule thickness readout with change in axial length measurements taken with the IOLMaster.


We prospectively studied 214 eyes from 107 patients undergoing bilateral SMILE surgery for myopia or myopic astigmatism between December 2014 and May 2017 at an ophthalmological practice in Singapore. All eyes were examined pre-operatively and 1 and 3 months post-operatively with the IOLMaster following SMILE surgery. Achieved lenticule thickness was taken as the change in axial length after surgery. A linear mixed-effects model was used to examine changes in axial length, spherical equivalent and acuity over time. The relationships between change in axial length and theoretical lenticule thickness and spherical equivalent were examined with multiple linear regression analyses, and model prediction was assessed with adjusted R2 statistics.


Mean (95% confidence interval [CI]) spherical equivalent pre-operatively was − 5.25 (95% CI − 5.38 to − 5.12) diopters (D), at 1 month was 0.04 (95% CI − 0.09 to 0.17) D (p < 0.001), and at 3 months was − 0.02 (95% CI − 0.15 to 0.11) D (p < 0.001). Mean (95% CI) pre-operative axial length was 27,726 (95% CI 25,595 to 25,857) μm. Post-operative axial length at 1 month was significantly shorter at 25,595 (95% CI 25,464 to 25,726) μm (p < 0.001) with no change thereafter (p = 0.647). Pre-operative mean ± standard deviation (SD) refractive target was 0.24 (± 0.3) D, and mean difference between target and post-operative spherical equivalent at 1 month was 0.20 D (95% CI 0.16 to 0.25 D, p < 0.001). Multiple regression analysis showed that change in axial length at 1 month was, on average, 5% lower than theoretical lenticule thickness, indicating an average difference of 5.4 μm (95% CI 5.2 to 5.6 μm). Preoperative spherical equivalent predicted negative association with change in axial length at 1 month (β = − 14.8, 95% CI − 18.2 to − 11.3, adjusted R2 = 0.457, p < 0.001).


Calculated lenticule thickness values were less than expected, and post-operative refractive outcomes at 1 month showed a slight under-correction. Further research in this area is needed to validate these findings.


SMILE Lenticule Thickness Refractive IOLMaster 


Funding information

No funding was received.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the local institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and animal rights and informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

417_2019_4529_MOESM1_ESM.pdf (219 kb)
ESM 1 (PDF 218 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Singapore Eye Research InstituteThe Academia, 20 College RoadSingaporeSingapore
  2. 2.Centre for Population Health Sciences, Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
  3. 3.School of Primary, Community and Social CareKeele UniversityStaffordshireUnited Kingdom

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