Evaluation of Early Accommodation Outcomes Following Femtosecond Laser-Assisted in situ Keratomileusis and Small Incision Lenticule Extraction

Purpose: The aim of this study is to assess the changes and differences in early postoperative binocular accommodative function following femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE). Methods: In this retrospective study, 120 patients (240 eyes) diagnosed with low-to-moderate and high myopia, who underwent either FS-LASIK or SMILE procedures were included. The assessment encompassed measurements of accommodative facility, accommodation time, relaxation time, and accommodation-to-relaxation ratio using a smart flipper. Measurements were taken preoperatively, as well as at 1 day, 1 week, and 1 month postoperatively. Additionally, the visual fatigue scale score was assessed and compared at the 1 month mark post-surgery. Changes in parameters were quantified by calculating the difference between preoperative values and those recorded at each postoperative time point. Results: At 1 month post-surgery, both FS-LASIK and SMILE procedures demonstrated potential for recovery or even improvement in accommodative facility, accommodation time, relaxation time, and accommodation-to-relaxation ratio compared to preoperative levels. The FS-LASIK group exhibited a greater magnitude of change in accommodative facility postoperatively compared to the SMILE group. In the low-to-moderate myopia subgroup, the FS-LASIK group exhibited lower changes in accommodation time and visual fatigue scale score at 1 month post-surgery compared to the SMILE group, with all associated p-values <0.05. Conclusions: Early postoperative recovery of accommodation function was slower following SMILE compared to FS-LASIK. Additionally, the severity of visual fatigue at 1 month post-surgery was greater in the SMILE group than in the FS-LASIK group. This difference in visual fatigue levels may be attributed to the delayed recovery observed in postoperative SMILE procedures.