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A systematic review and meta-analysis of randomized clinical trials compared small-incision lenticule extraction with LASIK for myopia and myopic astigmatism. Across 11 randomized trials, overall safety and many visual outcomes were similar. LASIK showed a higher proportion of eyes within a tight refractive target in the pooled analysis, while SMILE was associated with lower spherical aberration in some measures. These findings are clinically useful because patients often ask which refractive procedure is universally “better.” The evidence instead shows that both are effective, with different technical profiles. SMILE avoids a flap and may have advantages related to biomechanics or ocular-surface symptoms, while LASIK offers highly established centration, tracking and enhancement pathways. For HCPs, procedure selection should consider corneal thickness and shape, ocular surface status, refractive error, expectations, occupation and surgeon experience. The study fits AIOC's refractive surgery curriculum, including SMILE and Contoura/topography-guided approaches.
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A systematic review and meta-analysis of randomized clinical trials compared small-incision lenticule extraction with LASIK for myopia and myopic astigmatism. Across 11 randomized trials, overall safety and many visual outcomes were similar. LASIK showed a higher proportion of eyes within a tight refractive target in the pooled analysis, while SMILE was associated with lower spherical aberration in some measures. These findings are clinically useful because patients often ask which refractive procedure is universally “better.” The evidence instead shows that both are effective, with different technical profiles. SMILE avoids a flap and may have advantages related to biomechanics or ocular-surface symptoms, while LASIK offers highly established centration, tracking and enhancement pathways. For HCPs, procedure selection should consider corneal thickness and shape, ocular surface status, refractive error, expectations, occupation and surgeon experience. The study fits AIOC's refractive surgery curriculum, including SMILE and Contoura/topography-guided approaches.
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