Purpose To perform a systematic analysis of articles on the ophthalmological implications of the global COVID-19 pandemic. Methods PubMed.gov was searched for relevant articles using the keywords “COVID-19”, “coronavirus”, and “SARS-CoV-2” in conjunction with “ophthalmology” and “eye”. Moreover, official recommendations of ophthalmological societies were systematically reviewed, with a focus on the American Academy of Ophthalmology (AAO) and the Royal College of Ophthalmologists (RCOphth). Results As of April 16, 2020, in total, 21 peer-reviewed articles on the ophthalmological aspects of COVID-19 were identified. Of these, 12 (57.1%) were from Asia, 6 (28.6%) from the United States of America, and 3 (14.3%) from Europe. There were 5 (23.8%) original studies, 10 (47.6%) letters, 3 (14.2%) case reports, and 3 (14.2%) reviews. These articles could be classified into the topics “Modes and prevention of (ocular) transmission”, “Ophthalmological manifestations of COVID-19”, “Clinical guidance concerning ophthalmological practice during the COVID-19 pandemic”, and “Practical recommendations for clinical infrastructure”. Practical recommendations could be extracted from official statements of the AAO and the RCOphth. Conclusion Within a short period, a growing body of articles has started to elucidate the ophthalmological implications of COVID-19. As the eye can represent a route of infection (actively via tears and passively via the nasoacrimal duct), ophthalmological care has to undergo substantial modifications during this pandemic. In the eye, COVID-19 can manifest as keratoconjunctivitis.

Purpose: To analyse in depth the associations between objectively measured corneal higher‐order aberrations (HOAs) and subjectively perceived visual quality after small incision lenticule extraction (SMILE) as quantified with the standardized and clinically validated quality of vision (QOV) questionnaire.Methods: This cross‐sectional study included patients after bilateral simultaneous SMILE for the treatment of myopia and/or myopic astigmatism with plano target refraction. Scheimpflug imaging (Pentacam HR; Oculus Optikgeräte GmbH, Wetzlar, Germany) was used to objectively quantify corneal HOAs. The standardized and validated QOV questionnaire was employed to gauge patients’ subjectively perceived visual quality regarding frequency, severity and bothering effect of visual disturbances.Results: A total of 394 eyes of 197 patients with a mean age of 32.4 ± 7.7 years and a mean postoperative follow‐up of 24.3 ± 14.1 months were included. SMILE induced a statistically significant (p < 0.001) increase in spherical aberration (0.074 ± 0.131 µm), coma (0.142 ± 0.179 µm), trefoil (0.018 ± 0.067 µm) as well as in total HOAs (0.191 ± 0.176 µm). Surgically induced and postoperative levels of HOA showed no correlation with the three QOV scores representative of overall visual symptom frequency, severity and bothering effect (all R² values ≤ 0.016). In addition, the associations between specific visual symptoms (e.g. starburst) and singular HOA terms (e.g. haloes) were very weak (all Rho values ≤ 0.164).Conclusions: Small incision lenticule extraction induced significant amounts of corneal HOAs that, however, showed no clear relationships to patient‐reported QOV or specific long‐term visual symptoms.

PURPOSE: To compare the outcomes of enhancement after small incision lenticule extraction (SMILE) using surface ablation versus the VisuMax CIRCLE option (Carl Zeiss Meditec AG, Jena, Germany), which converts the SMILE cap into a femtosecond laser–assisted laser in situ keratomileusis flap. METHODS: The databases of the SMILE Eyes centers in Munich, Marburg, and Cologne, Germany, and Linz, Austria, were screened for eyes that had undergone enhancement using surface ablation with mitomycin C or CIRCLE. Eyes from both enhancement methods suitable for a retrospective matched analysis were identified based on pre-SMILE and pre-enhancement mean refractive spherical equivalent (MRSE), astigmatism, age, and corrected and uncorrected distance visual acuity (CDVA/UDVA). Refractive and functional outcomes were compared after a follow-up of 3 months. RESULTS: After the application of the matching criteria on 2,803 SMILE procedures, 24 eyes (12 in each group) with a follow-up of 3 months or longer were available for analysis. Enhancement was performed after a mean 9.7 ± 7.2 (surface ablation) and 11.0 ± 4.4 (CIRCLE) months for a residual MRSE of −0.91 ± 0.55 (surface ablation) and −0.90 ± 0.61 (CIRCLE) diopters. At 3 months, residual MRSE showed comparable accuracy with −0.07 ± 0.19 (surface ablation) and 0.04 ± 0.22 (CIRCLE) diopters ( P = .18). UDVA improvement was similar to a final value of 0.02 ± 0.10 (surface ablation) versus 0.03 ± 0.07 (CIRCLE) logMAR ( P = .78). Only one eye in the surface ablation group and no eye in the CIRCLE group lost one line of CDVA. At 3 months, the safety (surface ablation: 1.00, CIRCLE: 1.06; P = .36) and efficacy (surface ablation: 0.95, CIRCLE: 1.03; P = .36) indices were equivalent. In terms of speed of visual recovery, at week 1 UDVA and CDVA were significantly better after CIRCLE than surface ablation ( P = .008 and .002, respectively). CONCLUSIONS: In this first study directly comparing surface ablation versus CIRCLE enhancement after SMILE, both methods yielded comparable results at 3 months. However, CIRCLE re-treated eyes showed a markedly increased speed of recovery concerning UDVA and CDVA compared to surface ablation. [ J Refract Surg . 2019;35(5):294–300.]