Quality of Vision and Patient Satisfaction After Refractive Surgery: A Comparative Analysis of LASIK, SMILE, and PRK.

Background: This study assessed patient-reported outcomes (PRO) of active-duty U.S. Military Servicemembers following refractive surgery.

Methods: We retrospectively reviewed the medical records of 375 U.S. Servicemembers who underwent LASIK (118 eyes), photorefractive keratectomy (PRK, 550 eyes), or small incision lenticule extraction (SMILE, 82 eyes). Surgeries occurred at the former Walter Reed Army Medical Centers Center for Refractive Surgery or the current FBCHs Warfighter Refractive Eye Surgery Program and Research Center (WRESP-RC) from 2004 to 2019. Preoperative and 6-month postoperative data included "Quality of Vision and Patient Satisfaction Before and After Refractive Surgery" questionnaire. Outcome measures included uncorrected distance visual acuity (UDVA).

Results: In this study, 95% LASIK, 94% PRK, and 94% SMILE achieved UDVA 20/20 or better with no between-group differences (P=.308). There were no differences between groups in efficacy (P=.204) or the safety index (P=.066). Postoperative QOV was comparable between groups for far vision (P=.292) and night vision (P=.505). From before to after the operation, far vision significantly improved in LASIK (P=.009) and PRK (P<.001) but not SMILE (P=.384). Postoperative glare was comparable (P=.258). Driving difficulty was significantly different between treatments (P=.025), with significant improvements in PRK and LASIK. There were no significant differences between groups for activity limitations (P=.093) or being bothered by glare, halos, or lack of sharpness of vision (P=.131).

Conclusion: This study found comparable or improved PRO six months after LASIK, PRK, and SMILE. All three yielded excellent visual outcomes with minimal visual symptoms, allowing the performance of daily activities with less difficulty and limitation.