Frequency-dependent associations of contrast sensitivity and corneal aberrations after SMILE PRO in eyes with high astigmatism
In brief
Nearly all eyes (98.8%) reach 20/25 vision after SMILE PRO for high astigmatism
In a prospective series of 160 eyes with at least 2 D astigmatism, 98.8% achieved uncorrected distance visual acuity of 20/25 or better at three months. A larger intra-operative optical zone consistently reduced corneal higher-order aberrations, while pre-operative spherical equivalent and cyclotorsion showed modest links to specific aberrations and contrast-sensitivity patterns. Larger, longer studies are needed to confirm these exploratory associations.
- Journal
- Frontiers in medicine (Q1)
- Published
- 20 July 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Lan Huong Thi Tran, Thanh Ngoc Tran, Hong-Son Cung, Sam Khanh Tran, Van Trong Pham
- PMID
- 42549162
- DOI
- 10.3389/fmed.2026.1867550
Why clinicians should know about it
- Picked for Ophthalmology (top studies of the week, 9 August 2026): Prospective cohort, SMILE PRO outcomes for high astigmatism
Abstract
BACKGROUND: Visual quality after SMILE PRO in eyes with high astigmatism remains incompletely characterized, particularly with respect to contrast sensitivity across spatial frequencies and postoperative anterior corneal aberrations. METHODS: This prospective cohort study included 160 eyes of 102 patients with manifest astigmatism ≥2.00 D who underwent SMILE PRO using the VISUMAX 800. Patients underwent preoperative and postoperative assessment of visual acuity, manifest refraction, mesopic contrast sensitivity at 1.5, 3, 6, 12, and 18 cycles per degree, and anterior corneal wavefront aberrations calculated for a 6-mm pupil. Follow-up was performed at 1 week, 1 month, and 3 months. Generalized estimating equation models were used to account for inter-eye correlation and to evaluate associations between 3-month visual quality outcomes and preoperative refractive characteristics, intraoperative optical zone diameter, decentration category, and cyclotorsion. RESULTS: At 3 months, refractive outcomes were stable, with 98.8% of eyes achieving uncorrected distance visual acuity of 20/25 or better. Preoperative astigmatism subgroup was not significantly associated with postoperative total higher-order aberrations, coma, spherical aberration, or contrast sensitivity. A larger intraoperatively selected optical zone diameter was consistently associated with lower postoperative anterior corneal aberrations. Preoperative spherical equivalent was associated with total higher-order aberrations and spherical aberration, while absolute cyclotorsion was associated with coma. Exploratory analyses of contrast sensitivity showed frequency-specific nominal associations with preoperative spherical equivalent, cylinder, and decentration category. CONCLUSION: At 3 months after SMILE PRO in eyes with high astigmatism, anterior corneal aberration and contrast sensitivity outcomes showed exploratory associations with refractive magnitude and intraoperatively selected optical zone diameter, with additional findings related to cyclotorsion and decentration category. Categorical astigmatism severity was not significantly associated with these outcomes. However, this null finding should be interpreted cautiously because the astigmatism subgroups were imbalanced and relatively few eyes had very high astigmatism. These short-term findings require confirmation in larger comparative studies with longer follow-up.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.