Clinical and patient-reported visual outcomes following corneal refractive surgery in adults: A systematic review protocol

Corneal refractive surgery is widely used for the correction of ametropia and has demonstrated high efficacy in improving visual acuity and refractive accuracy. However, reliance on conventional clinical metrics alone may not adequately capture postoperative visual quality or patient experience. This has increased interest in patient-reported outcome measures (PROMs), postoperative complications, and long-term refractive stability as complementary indicators of refractive surgical success. This systematic review will synthesize evidence on both clinical and patient-reported outcomes following corneal refractive surgery in adults in sub-Saharan Africa, with emphasis on visual quality, postoperative complications, and long-term stability across surgical modalities. Eligible studies will include randomized controlled trials, prospective and retrospective cohort studies, and case-control studies involving adults (≥18 years) who have undergone procedures such as laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), or small incision lenticule extraction (SMILE). Studies must report objective clinical visual outcomes and/or validated PROMs related to visual quality, functional vision, or vision-related quality of life. A systematic search will be conducted in Ovid Medline, Ovid Embase, Web of Science, Cochrane Library, and African Journals Online. Data extraction will be performed independently by two reviewers, and risk of bias will be assessed using study design–appropriate tools. Where feasible, meta-analyses will be conducted; otherwise, findings will be synthesized narratively. This review will provide an integrated synthesis of clinical and patient-reported outcomes following corneal refractive surgery, with particular attention to visual quality, complication profiles, and long-term stability.