ATEF EID MADKOUR ELSAYED, ABDALWAHAB ALENEZY, ESSA SULTAN ALSULTAN, FAWAZ METEIB ALMUTAIRI, ZAHRA SHAKER AL-KALAIF, SALEH KHALID ALSHERAIWI ,MARYAM ABDULLAH ALMULHIM, OLA EMAD SHAKRAH, RAZAN MOHAMMAD ALENAZI, ABDULLAH ABDULAZIZ ALANAZI, ABDULRAZAG MISHAL IBNSHAMSAH
DOI: https://doi.org/Background: Refractive surgery has evolved significantly, with SMILE (Small Incision Lenticule Extraction) and LASIK (Laser-Assisted In Situ Keratomileusis) emerging as leading procedures for correcting myopia and astigmatism. While both techniques offer high efficacy, distinctions in visual recovery, higher-order aberrations, and postoperative complications remain a subject of clinical and academic debate.
Methods: This systematic review was conducted following PRISMA 2020 guidelines, synthesizing peer-reviewed studies published between 2010 and 2024. Databases including PubMed, Scopus, Web of Science, and Embase were searched for clinical trials, cohort studies, and meta-analyses comparing SMILE and LASIK. Studies were selected based on criteria related to population (≥18 years), interventions (SMILE vs. LASIK), and outcomes (visual acuity, quality, aberrations, dry eye, nerve damage). Data were extracted, verified, and narratively synthesized without meta-analysis due to heterogeneity.
Results: Both SMILE and LASIK achieved comparable uncorrected distance visual acuity in the long term. However, SMILE was associated with fewer dry eye symptoms, better preservation of corneal nerves and biomechanics, and lower induction of higher-order aberrations. LASIK showed advantages in early visual recovery and astigmatism correction precision. Patient satisfaction trends favored SMILE in cases of mild-to-moderate myopia with minimal astigmatism.
Conclusions: SMILE represents a structurally conservative and functionally effective refractive procedure with key advantages in ocular surface health and long-term optical quality. LASIK remains superior for patients needing rapid recovery or precise astigmatic corrections. Personalized refractive surgery selection based on anatomical and lifestyle factors remains essential.
