Visual and refractive outcomes of small incision lenticule extraction planned with a VISULYZE-generated nomogram for myopia and astigmatism: a retrospective comparative study

PURPOSE: Small-incision lenticule extraction (SMILE) is a widely used procedure for correcting myopia and myopic astigmatism. However, variability in refractive outcomes, particularly astigmatic correction, remains a concern. This study aimed to compare visual, refractive, and optical outcomes of SMILE planned with a VISULYZE-generated nomogram versus a conventional nomogram in patients with moderate myopia and astigmatism. METHODS: This retrospective comparative study included 120 eyes from 60 consecutive patients. Eyes were allocated to groups at the eye level, with both eyes from the same patient potentially included and independently assigned to either the VISULYZE-generated nomogram group (60 eyes) or the conventional nomogram group (60 eyes). Visual acuity, refractive outcomes, astigmatic axis deviation, and higher-order aberrations (HOAs) were evaluated preoperatively and at 3 months postoperatively. Statistical analyses accounted for inter-eye correlation using mixed-effects models to properly consider the independence of observations. RESULTS: Preoperative demographic and refractive characteristics were comparable between groups. At 3 months postoperatively, a higher proportion of eyes in the VISULYZE-generated nomogram group achieved uncorrected distance visual acuity (UDVA) of 20/20 or better than in the conventional group. With respect to astigmatic axis deviation and residual astigmatism, the VISULYZE group showed numerical trends toward closer alignment, although differences did not reach statistical significance. Postoperative increases in total HOAs and coma were observed in both groups, with smaller increases in the VISULYZE group. Changes in spherical aberration and trefoil were minimal and comparable between groups. CONCLUSION: SMILE planned with a VISULYZE-generated nomogram was associated with differences in early visual, refractive, and optical outcomes compared with conventional nomogram planning. VISULYZE-generated nomogram group has lower HOAS. Both groups' total HOAs and coma increases postoperatively, with smaller increases in the VISULYZE group.