Preoperative Suboptimal Correction and Early Visual Recovery After SMILE - How Full vs Under/ Over-Correction Shapes Outcomes

Q: What was the purpose of comparing full correction with under-/over-correction in SMILE patients?

To investigate how preoperative suboptimal correction affects early visual recovery in myopes undergoing SMILE and to compare those outcomes with normal values from fully corrected eyes.

Q: Which outcomes were assessed to measure visual recovery and binocular function?

The study evaluated UDVA and refraction, visual quality parameters including SR and MTF, and binocular visual function using perceptual eye position, vergence-divergence dynamics, and stereovision at multiple postoperative time points.

Sep 29, 2026

Uploaded by Damian

Preoperative suboptimal correction, including under- or over-correction, is common among myopic candidates for SMILE, yet its influence on early visual recovery and binocular function remains insufficiently quantified. This study compares 148 eyes with preoperative suboptimal correction to 72 fully corrected eyes after SMILE, evaluating UDVA, refraction, visual quality metrics (SR and MTF), and binocular measures (perceptual eye position, vergence-divergence dynamics, stereovision) across baseline, 1 week, 1 month, and 3 months.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

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Background

Methods

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Introduction

Clinical Ophthalmology Open Access Full Text Article ORIGINAL RESEARCH Preoperative Suboptimal Correction and Early Visual Recovery After SMILE: How Full vs Under/ Over-Correction Shapes Outcomes Lu Ma, Yingting Huang, Weijin Nan, Xing Yan, Yannuo Zhu, Qian Chen, Yan Zhang Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China Correspondence: Yan Zhang, Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao tong University School of Medicine, Shanghai, 200080, People’s Republic of China, Tel +86 13604334101, Email [ahzhangyolanda@163.com](ahzhangyolanda@163.com) Background: Preoperative suboptimal correction (under/over-correction) is prevalent among myopic SMILE candidates. Existing studies lack data on its impact on early visual recovery and binocular function. This study aims to investigate the impact of preoperative suboptimal correction on early visual recovery in myopes undergoing SMILE and to compare these outcomes to normal values. Methods: Visual results of 148 eyes with preoperative suboptimal correction were compared with 72 full-corrected eyes after SMILE. Assessments included uncorrected distance visual acuity (UDVA), refraction, visual quality parameters (strehl ratio (SR), the modulation transfer function (MTF) curves), and binocular visual function (perceptual eye position, vergence-divergence dynamic and stereovision) at baseline and 1 week, 1 month and 3 months postoperatively. Results: UDVA improved significantly faster in the full-correction group (1-week follow-up) versus the suboptimal group (1-month follow-up) . The full-correction group exhibited superior SR (P = 0.02) and MTF performance at 4-mm pupil (P < 0.05 at 5 and 10 cycles/degree) at 1 month. Horizontal perceptual deviation transiently increased at 1 month but normalized by 3 months in the suboptimal group. Convergence function decreased at 1 month but returned to baseline at 3 months in the suboptimal correction group, while improved at both 1-month and 3-month visits in the full-correction group. Divergence function improved in both groups with no intergroup differences (all P > 0.05) . Conclusion: Myopic subjects with preoperative suboptimal correction exhibit delayed visual recovery (notably UDVA and binocular function) compared to fully corrected peers after SMILE. These findings confirm SMILE’s safety and efficacy even in eyes with suboptimal presenting visual acuity (PVA), while indicating the need for preoperative counseling to align patient expectations and targeted postoperative visual training to accelerate recovery—strategies that may enhance patient satisfaction. Keywords: myopia, refractive surgery, suboptimal presenting visual acuity, visual quality, visual recovery Introduction Myopia is a significant cause of unilateral visual impairment, and uncorrected refractive error, accompanied by cataract, is the leading cause of visual impairment in China.1 The WHO’s Blindness and Vision Impairment Report reveals that only 36% of individuals with refractive error-related distance vision impairment globally use appropriate spectacles.2 Presenting visual acuity (PVA), defined as the visual acuity with currently available refractive correction (if any), is considered presenting vision impairment (PVI) when <0 .3 logMAR (20/40 Snellen) .3,4 PVA is often more clinically relevant than corrected distance visual acuity (CDVA), as it directly reflects an individual’s actual visual experience in daily activities.5 Notably, many patients exhibit suboptimal correction patterns (e.g., inconsistent spectacle use, outdated prescriptions) . Such inadequate correction can lead to increased risks of PVI, binocular dysfunction, and stereoscopic vision deficits.3 Received: 23 September 2025 Accepted: 24 December 2025 Published: 31 December 2025 Clinical Ophthalmology 2025:19 4989–4998 4989 © 2025 Ma et al. This

FAQs

What was the purpose of comparing full correction with under-/over-correction in SMILE patients?

To investigate how preoperative suboptimal correction affects early visual recovery in myopes undergoing SMILE and to compare those outcomes with normal values from fully corrected eyes.

Which outcomes were assessed to measure visual recovery and binocular function?

The study evaluated UDVA and refraction, visual quality parameters including SR and MTF, and binocular visual function using perceptual eye position, vergence-divergence dynamics, and stereovision at multiple postoperative time points.

How did visual recovery differ between full-correction and suboptimal-correction groups after SMILE?

UDVA improved significantly faster in the full-correction group, while the suboptimal group showed delayed recovery, with binocular functions also returning toward baseline later.

Sep 29, 2026

Uploaded by Damian