OBJECTIVES: Refractive surgeries are used to correct refractive errors by reshaping the cornea. Surgical technologies include laser-assisted in situ keratomileusis (LASIK) and small incision lenticule extraction (SMILE). A targeted literature review was conducted to examine the costs, time, and/or healthcare resource utilization (HCRU) and learning curves associated with the LASIK and SMILE technologies.

METHODS: Searches were performed in MEDLINE with terms including “LASIK”, “small lenticule extraction”, “costs”, and “learning curve”. English-language studies published between 1/1/2002 and 9/1/2022 were included if they reported either the costs, time, and/or healthcare resource utilization associated with laser vision correction, or the learning curve associated with LASIK and/or SMILE.

RESULTS: A total of 11 studies were found in this review, including 8 publications on the learning curve (SMILE [n=4] and LASIK [n=4]) and 3 on the costs, time, and/or HCRU associated with laser vision correction. SMILE was found to be associated with a steep learning curve for inexperienced ophthalmic surgeons with significantly worse UDVA and efficacy index (p<0.043), safety index (p<0.045), longer duration of docking/suction engagement (p=0.0.34) and duration for lenticule extraction (p<0.001) for their first 100 procedures compared with their next 100 procedures. Conversely, outcomes associated with LASIK were found to be consistent between attending/resident groups compared to non-resident surgeons. LASIK was associated with both time and cost savings for patients when compared to contact lenses and eyeglasses over 30 years. These savings were driven by fewer optometrist visits (4.7 vs. 12.2), optical center visits (41 vs. 117 compared to contact lenses and 18 vs. 50 compared to eyeglasses) and contact lens care hours (1,090 hours saved). Lastly, similar incremental cost-effectiveness ratios were reported for FS-LASIK and SMILE technology.

CONCLUSIONS: While laser vision correction provides patients with long-term time and cost savings, there is a significant learning curve associated with the SMILE technology.