ORIGINAL RESEARCH article
Front. Med.
Sec. Ophthalmology
This article is part of the Research TopicAdvances in Corneal Astigmatism Management: Diagnostic and Surgical ApproachesView all articles
Comparative Astigmatic Accuracy and Optical Quality of SMILE, FS-LASIK, and TICL in Mild-to-Moderate Myopia with ≥1.00 D Astigmatism
Provisionally accepted
- 1Renmin Hospital of Wuhan University, Wuhan, China
- 2Aier Eye Hospital of Wuhan University, Wuhan, China
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Purpose: Considering the unresolved trade-offs between astigmatic precision and optical quality in mild-to-moderate myopia with ≥1.0 D astigmatism, this study compares astigmatic correction accuracy and higher-order aberrations (HOAs) among three methods: small incision lenticule extraction (SMILE), femtosecond laser-assisted in situ keratomileusis (FS-LASIK), and toric implantable collamer lens (TICL) implantation. Methods: This retrospective, non-randomized comparative study enrolled 159 eyes of 159 patients. Study participants underwent either SMILE (n = 51 eyes), FS-LASIK (n = 53 eyes), or TICL implantation (n = 55 eyes), and their visual acuity, refractive outcomes, and optical quality parameters were assessed preoperatively and at 3 months postoperatively. Astigmatic correction efficacy was evaluated using Alpins vector analysis, with results stratified by preoperative cylinder axes. Results: At 3 months, the residual cylinder value was significantly lower in the SMILE (−0.21 ± 0.25 D) and FS-LASIK (−0.30 ± 0.23 D) groups than in the TICL group (−0.50 ± 0.26 D) (p < 0.05). Vector analysis demonstrated comparable target-induced astigmatism across groups. However, the TICL group exhibited significantly higher difference vectors, absolute angles of error, and index of success values than both the SMILE and FS-LASIK groups. Conversely, patients who received TICL presented lower surgically induced astigmatism, correction index, and magnitude of error values than those who received SMILE and FS-LASIK. Specifically, for against-the-rule and oblique astigmatism, the surgically induced astigmatism, magnitude of error, and correction index values were significantly higher in the SMILE and FS-LASIK groups than in the TICL group. Optical quality assessment revealed that TICL induced significantly fewer total HOAs, total coma, vertical coma, and spherical aberrations than both SMILE and FS-LASIK at 3 months. Conclusion: SMILE, FS-LASIK, and TICL implantation are all effective for correcting mild-to-moderate myopia with ≥1.0 D astigmatism. SMILE led to superior astigmatic correction accuracy compared with TICL and showed better astigmatic correction than FS-LASIK in this cohort. Meanwhile, TICL implantation induced significantly fewer HOAs than both SMILE and FS-LASIK, resulting in superior postoperative optical quality.
Keywords: Mild-to-moderate myopia, Astigmatism, smile, FS-LASIK, TICL
Received: 26 Aug 2025; Accepted: 13 Nov 2025.
Copyright: © 2025 Huang, Yang, Wang, Zhang and Yanning. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yang Yanning, ophyyn@163.com
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