Central and Peripheral Optical Quality After FS-LASIK, SMILE, and Phakic ICL Implantation for Moderate to High Myopia

Background FS-LASIK, small-incision lenticule extraction (SMILE), and phakic intraocular lens (ICL) implantation are widely used for correcting moderate to high myopia, yet their effects on peripheral optical quality remain incompletely understood. This study compared central and peripheral optical outcomes after these three procedures using on-axis and off-axis wavefront measurements. Methods This retrospective comparative study included 598 eyes (16–35 years) that underwent FS-LASIK, SMILE, or phakic ICL implantation. Wavefront aberrations were measured centrally and at ± 30° eccentric fixation using a modified Shack–Hartmann aberrometer and reconstructed over a 4.5-mm pupil. Second-, third-, and fourth-order RMS aberrations, peripheral relative defocus, astigmatic vector J0, and horizontal coma were analyzed pre- and postoperatively, with inter-group comparisons and correlations with preoperative spherical equivalent (SE). Results All procedures achieved high refractive accuracy with minimal surgically induced astigmatism. Second-order aberrations were substantially reduced in all groups. Third-order aberrations increased postoperatively, most prominently after FS-LASIK, followed by SMILE and then ICL implantation, while fourth-order changes were small and similar among groups. Peripheral relative defocus shifted toward hyperopia after all procedures, greatest after FS-LASIK. Induced higher-order aberrations and peripheral defocus were significantly correlated with preoperative SE, particularly in the FS-LASIK group. Conclusions Although FS-LASIK, SMILE, and phakic ICL implantation effectively correct moderate to high myopia, they differ in their impact on central and peripheral optical quality. Phakic ICL implantation best preserves peripheral optics, whereas FS-LASIK induces greater SE-dependent increases in higher-order aberrations and peripheral hyperopic defocus. Peripheral wavefront assessment provides clinically relevant information beyond central aberrometry.