Initial Visual and Refractive Outcomes of Ray-Tracing-Guided LASIK (Wavelight Plus) Versus KLEx (SMILE Pro)

INTRODUCTION: This study evaluates visual and refractive outcomes of our initial experience using ray-tracing-guided Wavelight Plus (WLP) LASIK and SMILE Pro KLEx carried out by one surgeon at a single center. METHODS: A retrospective, non-randomized study was conducted at one refractive surgery center. Patients undergoing WLP or SMILE Pro with at least 1 month of postoperative follow-up were included. Outcomes were assessed at 1 and 3 months and included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), safety and efficacy indices, and vector analysis of astigmatism. Additionally, a comparison with wavefront-optimized (WFO) LASIK, an established procedure with a well-refined nomogram at the study center, was provided as an internal benchmark. RESULTS: A total of 160 eyes from 93 patients were analyzed, including 50 eyes treated with WLP, 55 with SMILE Pro, and 55 with WFO. WLP demonstrated significantly better UDVA than SMILE Pro at both 1 month (p < 0.001) and 3 months (p = 0.033) and was more likely to achieve a UDVA of 20/20. Residual astigmatism was significantly lower in the WLP group than in both the WFO and SMILE Pro groups at 1 and 3 months (all p < 0.001). Vector analysis showed a correction index of 1.13 for SMILE Pro, 1.11 for WFO, and 1.08 for WLP at 3 months. CONCLUSIONS: In our initial experience with the WLP and SMILE Pro platforms, WLP achieved better UDVA and more precise astigmatic correction compared with SMILE Pro. Additionally, WLP, without the use of a nomogram, had comparable safety and efficacy outcomes to WFO. Based on our initial experience at one center, astigmatic correction appears to be a limiting factor for KLEx platforms in achieving outcomes similar to modern LASIK platforms.