Introduction

Small incision lenticule extraction (SMILE) and other femtosecond laser assisted keratorefractive procedures are well established options for the correction of myopia and myopic astigmatism, with high efficacy, safety, and predictability across large clinical series. Over the past decade, device evolution from the first generation VISUMAX 500 (500 kHz) to the second generation VISUMAX 800 (2 MHz) has focused not only on visual outcomes but also on workflow efficiency, with the newer platform designed to shorten laser time, docking time, and overall procedural duration.

The VISUMAX 800 features a higher pulse repetition rate and upgraded scanning system that allow refractive lenticule creation in less than 10 to 11 seconds compared with approximately 25 to 30 seconds on the VISUMAX 500, and can reduce total surgical time by approximately 1.5 to 2 minutes per case without compromising visual results. Recent comparative studies have demonstrated significantly shorter docking time, laser time, and overall surgical time with the VISUMAX 800 while maintaining similar refractive accuracy, safety indices, higher order aberrations, and contrast sensitivity when compared with the VISUMAX 500.

Beyond intraoperative timing, the cumulative time from preoperative assessment to completion of surgery including diagnostics, counseling, preparation, laser treatment, and immediate postoperative evaluation directly influences operating room throughput, staff utilization, and patient experience in high volume refractive centers.

Although published data confirm intraoperative time savings with the VISUMAX 800, there is limited evidence quantifying how this translates into overall perioperative time flow across the entire patient pathway when compared with the VISUMAX 500.

A structured evaluation of time flow from preoperative assessment to completion of surgery for VISUMAX 800 versus VISUMAX 500 can therefore provide critical information for service planning, scheduling, and resource allocation in refractive surgery units. By mapping and comparing time points at key steps such as preoperative diagnostics, slit lamp evaluation, consent and counseling, surgical preparation, docking, laser delivery, and immediate postoperative checks, this study aims to determine whether the newer platform delivers meaningful gains in overall efficiency without compromising clinical outcomes or patient reported experience.

Aim

To evaluate and compare the preoperative and intraoperative time flow between the VISUMAX 500 and the VISUMAX 800.

Material and Methods

This prospective observational single center study will be approved by the Institutional Ethics Committee of Nethradhama Superspeciality Eye Hospital and will adhere to the tenets of the Declaration of Helsinki. Verbal and written informed consent will be obtained from all patients participating in the study.

Preoperative Visit

Subjects will provide demographic information and medical history and will undergo the following assessments at the preoperative visit. The time taken to conduct each test will be recorded.

Visual acuity testing
Manifest refraction
Slit lamp examination
Dilated fundus examination
Intraocular pressure measurement
Corneal topography
MS 39
Pupil diameter measurement
Anterior segment optical coherence tomography
ITrace analysis
In patients opting for VISUMAX 800, IOL Master 700 measurement will also be performed

Operative Visit

For patients undergoing SMILE on the VISUMAX 500, preoperative axis marking will be performed on the slit lamp prior to shifting to the operating theater, and the time taken for this step will be recorded.

The time taken by optometrists to evaluate the patient, change into surgical scrubs, and enter patient data into the VISUMAX 500 will be recorded. For the VISUMAX 800, the time taken for remote data transfer will be noted.

Intraoperative time including patient transfer, bed positioning, docking, laser firing, and lenticule dissection will be recorded.

Postoperative Follow Up

Postoperative evaluations will be conducted at day 1, 2 weeks, and 3 months after surgery and will include:

Slit lamp examination
Measurement of uncorrected and corrected distance visual acuity using ETDRS charts
Manifest refraction
Objective scatter index and modulation transfer function using HD analyzer