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Effect of eye laterality on correction of myopic astigmatism with small incision lenticule extraction (SMILE) using vector analysis

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Abstract

Purpose

To compare the vector analysis, visual, and refractive outcomes after myopic astigmatic correction using SMILE between the right and left eyes.

Methods

This is a retrospective study including 41 right and 40 left eyes that underwent SMILE for correction of myopic astigmatism greater than 0.75 diopters (D) with a follow-up of at least 3 months. Vector analysis for astigmatic correction was done. Visual and refractive parameters were compared between both groups by measuring mean postoperative logMAR uncorrected distance visual acuity, mean postoperative spherical equivalent (SE), cylinder, and refractive predictability in terms of SE and cylindrical correction. Efficacy and safety of SMILE were also determined.

Results

No significant difference was found between vector outcomes except for angle of error (AE). The right eye group yielded a negative mean AE (− 2.71 ± 5.35), while the left eye group yielded a positive mean AE (0.23 ± 9.60). Correction index, magnitude of error and refractive predictability of cylindrical correction showed undercorrection of astigmatism in both groups. The right eye group showed lower predictability for higher cylindrical correction. Visual outcomes were similar for both eyes.

Conclusion

Rotational errors account for vectorial outcome differences between right and left eyes. Despite achieving good visual and refractive outcomes with low cylinder correction, the tendency to undercorrect between eyes due to this error may be more evident when treating higher amounts of astigmatism. More careful preoperative control for cyclotorsion is warranted for right eyes compared to left eyes.

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Acknowledgements

Dr. Ivan Imperial for his intellectual contribution in providing the statistical analysis which was essential in yielding the significant results of this research. St. Luke’s Medical Center Vision and Laser Center, for granting our study access to data needed for the research. St. Luke’s Eye Institute and St. Luke’s Medical Center Research and Biotechnology Division, for providing support and approval of this study

Funding

This study was supported and funded by the St. Luke’s Medical Center Research and Biotechnology Division (Grant No. 19-009).

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Authors and Affiliations

  1. Eye Institute, St. Luke’s Medical Center, E. Rodriguez Ave, Quezon City, 1102, Philippines

    Patricia Camille O. Acosta, Reginald Robert G. Tan, Irwin Y. Cua & Stacey S. Sau

Authors
  1. Patricia Camille O. Acosta
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  2. Reginald Robert G. Tan
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  3. Irwin Y. Cua
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  4. Stacey S. Sau
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Contributions

All authors contributed to the study conception and design. Material preparation was performed by Stacey Sau, MD and Irwin Cua, MD. Data collection and analysis were performed by Patricia Acosta, MD and Reginald Tan, MD. The first draft of the manuscript was written by Patricia Acosta, MD, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Patricia Camille O. Acosta.

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Conflict of interest

The authors have no financial or non-financial interests to disclose.

Ethics approval

The retrospective cohort study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was not obtained due to the retrospective nature of the study. The study was approved by the St. Luke’s Medical Center Research and Biotechnology Division Ethics Committee.

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Appendix: Abbreviations and symbols

Appendix: Abbreviations and symbols

  • SMILE: Small incision lenticule extraction

  • TIA: Target induced astigmatism

  • SIA: Surgically induced astigmatism (SIA)

  • ME: Magnitude of error (ME)

  • AE: Angle of error

  • DV: Difference vector

  • CI: Correction Index

  • IOS: Index of success

  • FE: Flattening effect

  • FI: Flattening index

  • D: Diopters

  • SE: Spherical equivalent

  • UDVA: Uncorrected distance visual acuity

  • CDVA: Corrected distance visual acuity

  • CW: Clockwise

  • CCW: Counterclockwise

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Acosta, P.C.O., Tan, R.R.G., Cua, I.Y. et al. Effect of eye laterality on correction of myopic astigmatism with small incision lenticule extraction (SMILE) using vector analysis. Int Ophthalmol 42, 2439–2448 (2022). https://doi.org/10.1007/s10792-022-02242-4

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  • DOI: https://doi.org/10.1007/s10792-022-02242-4

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