Refractive Surgery Techniques for Myopia Correction

Myopia affects a growing proportion of the global population and imposes significant socioeconomic burdens. Refractive surgery techniques address this by reshaping or supplementing ocular tissues to achieve emmetropia. Traditional laser ablation methods such as LASIK and PRK have undergone continual evolution, giving rise to flapless or minimally invasive approaches like SMILE, which utilises a femtosecond laser to create and extract an intrastromal lenticule through a small incision. In parallel, phakic intraocular lenses (ICLs) provide a reversible option by implanting a supplementary lens in the posterior chamber without removing corneal tissue. Across all modalities, advances focus on optimising precision, preserving corneal biomechanics, minimising postoperative discomfort and accelerating visual recovery. Current research increasingly incorporates artificial intelligence for patient selection, refined laser platforms for smoother stromal surfaces and improved diagnostics to predict and prevent complications such as ectasia.

Research from Nature Portfolio

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Research from all publishers

Machine learning algorithms trained on large clinical datasets now assist surgeons in selecting the most appropriate refractive procedure. These models achieve high agreement with expert decision-making by analysing parameters such as corneal thickness, topography and patient lifestyle, thereby personalising the choice between LASIK, PRK and SMILE.

Studies of corneal optical density using Scheimpflug imaging systems have established densitometry as a vital marker of corneal transparency and postoperative wound healing. Comparative analyses reveal distinct regional alterations in density after each technique, guiding clinicians in monitoring recovery and optimising laser ablation profiles to preserve clarity.

A systematic review and meta-analysis of corneal biomechanics demonstrates that SMILE better maintains corneal hysteresis and resistance factor compared with femtosecond-assisted LASIK and surface ablation approaches. The absence of a full-thickness flap in SMILE contributes to superior biomechanical integrity, offering a reduced risk of postoperative ectasia, particularly important in high-myopia correction.

Refractive Surgery Techniques for Myopia Correction publication trend

The graph below shows the total number of articles in refractive surgery techniques for myopia correction across all publications each year (not limited to Nature Index journals).

Technical terms

Laser-Assisted in Situ Keratomileusis (LASIK): Creation of a hinged corneal flap followed by posterior stromal ablation with an excimer laser to reshape the corneal curvature.

Photorefractive Keratectomy (PRK): Removal of the corneal epithelium and excimer laser ablation of the anterior stroma without flap formation.

Small Incision Lenticule Extraction (SMILE): Femtosecond laser-assisted generation and extraction of an intrastromal lenticule via a small incision, avoiding a corneal flap.

Phakic Intraocular Lens (ICL): Implantation of a biocompatible lens in the posterior chamber between iris and crystalline lens to correct refractive error without altering corneal tissue.

Corneal Optical Density: Quantitative assessment of corneal transparency and light scatter, measured with densitometry imaging.

Corneal Biomechanical Properties: Viscoelastic metrics such as corneal hysteresis and resistance factor that reflect the structural strength of the cornea.

References

1. Choice of refractive surgery types for myopia assisted by machine learning based on doctors’ surgical selection data. BMC Medical Informatics and Decision Making (2024).
2. Corneal optical density: Structural basis, measurements, influencing factors, and roles in refractive surgery. Frontiers in Bioengineering and Biotechnology (2023).
3. Small incision lenticule extraction (SMILE) history, fundamentals of a new refractive surgery technique and clinical outcomes. Eye and Vision (2014).
4. Corneal biomechanical properties after SMILE versus FLEX, LASIK, LASEK, or PRK: a systematic review and meta-analysis. BMC Ophthalmology (2019).