SMILE Pro provides more accurate refractive cylinder outcomes than standard SMILE for myopic astigmatismComparing SMILE and SMILE Pro Surgery for Correcting Nearsightedness and Astigmatism

Frontiers in Medicine Published October 11, 2026 Study authors: Gang Li, Yinganqi Li DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Note that SMILE Pro provides more accurate refractive cylinder outcomes than standard SMILE for myopic astigmatism.

This meta-analysis evaluates the efficacy, safety, and predictability of SMILE Pro (VisuMax 800) compared to standard SMILE (VisuMax 500) in 1,692 eyes undergoing surgery for myopia and myopic astigmatism. The study synthesized data from a 1 to 6 month follow-up period to compare refractive outcomes and stability.

Key findings indicate that the SMILE Pro group demonstrated significantly better stability of corrected vision (OR, 0.47; 95% CI, 0.25 to 0.86). Regarding refractive cylinder, the standard SMILE group showed a marginally greater residual cylinder (95% CI, 0.13 to 0.00). The analysis also noted a statistically significant difference in refractive cylinder outcomes (95% CI, 2.34 to 6.24), where the SMILE group tended toward under-correction and the SMILE Pro group tended toward over-correction. No statistically significant differences were found regarding post-operative UDVA, spherical equivalent, or higher order aberrations.

Limitations of the evidence include the use of non-randomized comparative studies, short follow-up durations of 1 to 6 months, and the need for larger sample sizes. Clinical practice relevance suggests that SMILE Pro provides more accurate refractive cylinder outcomes, though its specific advantages in surgical workflow or patient comfort are not confirmed by this data.

How this fits prior evidence

This meta-analysis addresses a gap in comparing specific surgical technologies for myopic astigmatism. While previous coverage identified FS-LASIK as a versatile option for customized ablation and rapid rehabilitation in various refractive conditions, this study specifically compares two versions of SMILE technology. It provides evidence on the accuracy of refractive cylinder outcomes in SMILE Pro versus standard SMILE.

Doctors compared two types of laser eye surgery to treat nearsightedness and astigmatism. One method is the standard SMILE procedure, while the other is the SMILE Pro technique using advanced technology. Both methods aim to improve vision without the need for glasses.

The study looked at over 1,600 eyes to see which method worked better. The results showed that patients who had the SMILE Pro procedure had much more stable vision after their surgery. This means their vision stayed consistent over the first few months of healing.

When looking at astigmatism, the SMILE Pro group had better results. The standard SMILE group often had more leftover astigmatism, which can make vision blurry. While both surgeries were safe and effective for general vision, the newer technology provided more precise results for specific eye shapes.

Because the study followed patients for a short time, more research is needed to see how these results last for years. However, the current data suggests that the newer SMILE Pro method may offer more predictable outcomes for patients who have both nearsightedness and ast1igmatism.

What this means for you:

SMILE Pro surgery provides more stable vision and more accurate results for astigmatism than standard SMILE.

Common questions

How does SMILE Pro compare to standard SMILE surgery?

The study found that the SMILE Pro group had better stability of corrected vision than the standard SMILE group. While both procedures were effective, SMILE Pro provided more accurate refractive cylinder outcomes. However, because the study was not randomized and had a short follow-up of 1 to 6 months, these results are not yet conclusive.

Is SMILE Pro safer than standard SMILE?

The study did not report any specific data regarding safety, adverse events, or patient comfort for either procedure. Because the study was small and had a short follow-up period, it cannot confirm if one method is safer than the other. You should discuss safety and risks with your eye surgeon.

What are the results for patients with astigmatism?

The study included patients with myopic astigmatism. It found that the SMILE group tended toward under-correction, while the SMILE Pro group tended toward over-correction. Both methods were evaluated for their ability to correct vision and manage higher-order aberrations.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedOct 2026

View Original Abstract ↓

The aim of this study was to compare the outcomes of correcting myopia and myopic astigmatism between small incision lenticule extraction (SMILE) surgery performed using VisuMax 500 (SMILE group) and that using VisuMax 800 (SMILE Pro group). PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched up to February 2026 to identify relevant studies. The PRISMA guidelines were followed. Primary outcomes were postoperative efficacy, safety, and predictability at the end of follow-up. Secondary outcomes were the postoperative high-order aberrations (HOAs) parameters and the vector analysis parameters. A total of nine studies including 1,692 eyes were involved, with 1,036 eyes undergoing SMILE surgery, 656 eyes undergoing SMILE Pro surgery. All of the 9 selected studies were nonrandomized comparative studies (NRCSs) with the follow-up period ranged from 1 to 6 months. Compared with SMILE, SMILE Pro group had better stability of corrected vision (OR, 0.47; 95% CI, 0.25 to 0.86). As for cylinder and vector analysis, SMILE group showed a marginally greater residual cylinder than the SMILE Pro group (; 95% CI, 0.13 to 0.00). There was statistically significant difference in between the two groups (; 95% CI, 2.34 to 6.24), suggesting that the SMILE group tended toward under-correction, while the SMILE Pro group tended toward over-correction. The post-operative UDVA, spherical equivalent (SE), and higher order aberrations and other vector analysis parameters between the two groups were not statistically significant. Within the limitations of this study, we did not detect evidence of statistical difference between SMILE and SMILE Pro surgical procedures when used for the treatment of myopia and astigmatism. SMILE Pro using VISUMAX 800 provided more accurate refractive cylinder outcomes. Further multicentre studies with larger sample sizes and longer follow-up are warranted to confirm VisuMax 800 system superior practical benefits in surgical workflow, refractive outcomes and patient comfort.

SMILE Pro provides more accurate refractive cylinder outcomes than standard SMILE for myopic astigmatismComparing SMILE and SMILE Pro Surgery for Correcting Nearsightedness and Astigmatism

How this fits prior evidence

Common questions

Study Details

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SMILE Pro provides more accurate refractive cylinder outcomes than standard SMILE for myopic astigmatismComparing SMILE and SMILE Pro Surgery for Correcting Nearsightedness and Astigmatism

How this fits prior evidence

Common questions

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