BackgroundTo investigate long-term refractive outcomes, wavefront aberrations and quality of life after small incision lenticule extraction (SMILE) for moderate to high myopia.MethodsA total of 26 patients (47 eyes) with preoperative mean spherical equivalent (SE) of -6.30 ± 1.47 diopters (D) who underwent SMILE were recruited. The measurements included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, wavefront aberrations, and quality of life.ResultsAt 4 years postoperatively, UDVA was better than or equal to 20/20 in 92 % of eyes. The efficacy index was 1.07 ± 0.16. 89 % of eyes were within ± 0.5 D of the intended refractive target. No eye lost any Snellen lines. The safety index was 1.16 ± 0.14. No significant changes of SE occurred among postoperative follow-ups at months 1, 3, 6 and years 1, 2, 4 (P > 0.05, Scheffe test). Higher-order aberrations, coma, spherical aberration and higher-order astigmatism increased postoperatively, and no significant changes of aberrations were detected among the 1-month, 6-month or 4-year follow-ups postoperatively (37 eyes). Compared to the spectacles group, the surgery group showed a significantly higher total score on quality of life (45.71 ± 2.61 vs 39.96 ± 3.56, P < 0.001).ConclusionsSMILE provides a predictable and stable correction of moderate to high myopia as documented by long-term follow-up.

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BackgroundTo investigate accommodative response and accommodative lag changes after femtosecond laser small incision lenticule extraction (SMILE) for moderate to high myopia correction.MethodsA total of 32 eyes of 32 patients with no strabismus who underwent SMILE were enrolled in this prospective clinical study. The accommodative response was obtained viewing monocularly with spherical equivalent refractive error corrected, using an open-field autorefractor at different stimulus levels (2.00D, 2.50D, 3.00D, 4.00D and 5.00D) for the right eye before a standard SMILE surgery and at 1-month follow-up after surgery.ResultsThe mean age of the patients were 23.34 ± 2.90 years and the mean preoperative manifest refraction spherical equivalent was −5.74 ± 1.98 diopters. Significant differences were detected in both preoperative and postoperative accommodative responses to different stimulus levels (P < 0.001). Multiple linear regression model analysis revealed preoperative manifest refractive spherical equivalent (P = 0.006) and preoperative accommodative lag (P = 0.04) showed a significant impact on postoperative accommodative lag.ConclusionsThis is the first report of accommodative changes after SMILE. Our preliminary results showed that a decrease in postoperative accommodative lag that might be related to the relief of the visual discomfort symptom.

BackgroundTo describe the clinical features of acquired progressive esotropia, with a larger angle at distance than near, associated with myopia in young adults.MethodsEleven adults (ages ranging from 18 to 37 years) with constant or intermittent horizontal diplopia at distance were recruited. Subjective refraction, ocular alignment, fusional amplitudes and horizontal eye movements were measured at distance and near.ResultsDistance esotropia varied from 20 to 60 prism diopters (PD). At near, the esotropic deviation ranged from 10 to 30 PD. Spherical equivalents (SE) of the right eye ranged from − 3.50 to − 8.25 diopters (D) while SE of the left eye ranged from − 0.375 to − 7.25 D. Ten of the eleven patients presented with constant diplopia at distance. Horizontal ductions and versions were full in all patients. The pathological report of seven patients who underwent lateral rectus resection showed that there were no muscle fibres, but rather, collagenous fibres.ConclusionsThis unusual sub-type of strabismus is a benign entity with slow progression that can occur in young adults with myopia. The cause of this condition is still unknown, and may be related to long periods of near work.

ObjectivesTo evaluate the relationship between pupillary response to light, myopia and disk halo size.DesignCross-sectional study.SettingSingle refractive surgery centre.ParticipantsIn this study, 197 right eyes of 197 patients between 20 and 35 years of age were evaluated for disk halo size and pupillary response to light with a vision monitor.Primary and secondary outcome measuresHalo radius, age, spherical equivalent (SE), axial length (AL), initial diameter, amplitude of contraction, latency of contraction, duration of contraction, velocity of contraction, latency of dilation, duration of dilation, velocity of dilation, maximum pupil, minimum pupil, average pupil and dark pupil.ResultsSignificant associations were found between disk halo size and SE (r=−0.219, P=0.002), AL (r=0.152, P=0.033) and minimum pupil (r=0.149, P=0.037). There were no associations between disk halo size and initial diameter, amplitude of contraction, latency of contraction, duration of contraction, velocity of contraction, latency of dilation, duration of dilation, velocity of dilation, maximum pupil, average pupil, dark pupil and age (P>0.05). A significant difference in disk halo size was detected between the low-moderate and high myopia (SE< −6 D) groups (P=0.002) and between the small and large (minimum pupil≥4 mm) minimum pupil size groups (P=0.014).ConclusionsPatients with a high SE and large minimum pupil size (minimum pupil ≥4 mm) suffered more disability glare than those with a low SE and small minimum pupil size.