Controversies, consensuses and guidelines on Small Incision Lenticule Extraction (SMILE) by the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) and the Asia-Pacific Myopia Society (APMS)
Year: 2025
Type: article
Abstract: Small incision lenticule extraction (SMILE) surgery was developed in 2008 as an extension of the femtosecond lenticule extraction procedure. Over the years, SMILE has become a highly popular laser refractive surgery offering a minimally invasive alternative to LASIK for correcting myopia and myopic astigmatism. Despite its benefits such as a flapless femtosecond laser procedure with reduced corneal nerve disruption, the procedure's relative novelty necessitates standardization. Given the myriads of emerging information and variability, a panel of 22 international experts is formed by the Asia Pacific Myopic Society (APMS) and the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) to explore the controversy and to work out a consensus on SMILE. This consensus manuscript arises from a systematic exploration of current literature and is supported by the collective insights of international experts in the field of refractive surgery. The panel convened to review the issues, engage in discussion, develop proposals, and vote to establish consensus across four areas: 1) preoperative assessment, 2) preoperative surgical planning, 3) intraoperative considerations, and 4) postoperative management in a five-point Likert scale (strongly agree, agree, neutral, disagree and strongly disagree). Consensus was achieved when at least 75 % of the experts had voted for "strongly agree" or "agree" on the consensus statement concerned. 63 consensus statements were discussed, with 51 (81.0 %) statements reaching consensus. By establishing standardized consensus, this paper aims to reduce variability and enhance predictability and safety in refractive outcomes. Ongoing research is encouraged on issues where consensus could not be reached among the international panel of experts (IPE).
Authors: Kelvin H. Wan, Xiao Ying Wang, Kenny H.W. Lai, Jorge L. Alio, Marcus Ang, Colin Chan, Tommy C.Y. Chan, George P.M. Cheng, Ahmed Elsheikh, Jesper Hjortdal, Guofu Huang, Vishal Jhanji, Jodhbir S. Mehta, Srinivas K. Rao, Masaki Sato, Walter Sekundo, Namrata Sharma, Rohit Shetty, Yan Wang, Yueying Xiao, Yabo Yang, Changbin Zhai, Fengju Zhang, Xingtao Zhou, Dennis S.C. Lam
Institutions: Chinese University of Hong Kong, Shanghai Medical College of Fudan University, Chinese Academy of Medical Sciences & Peking Union Medical College, Fudan University, Eye & ENT Hospital of Fudan University, Miranza, Singapore National Eye Center, Singapore Eye Research Institute, Duke-NUS Medical School, The University of Sydney, University of Canberra, Hong Kong Sanatorium and Hospital, Moorfields Eye Hospital NHS Foundation Trust, University of Liverpool, National Institute for Health and Care Research, University College London, Aarhus University Hospital, Sun Yat-sen University, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, University of Pittsburgh, Philipps University of Marburg, Universitätsklinikum Gießen und Marburg, All India Institute of Medical Sciences, Narayana Nethralaya, Chinese University of Hong Kong, Shenzhen, Second Affiliated Hospital of Zhejiang University, Zhejiang University, Beijing Tongren Hospital, Capital Medical University
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,950
Funder: Chinese University of Hong Kong
OpenAlex ID: W4411928256