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Article Article

A good time to SMILE®

Dr Tess Huynh

09/03/2018

smile-laser-eye-surgery

More than three million eyes have now been treated with the revolutionary keyhole laser eye surgery known as SMILE® (or SMall Incision Lenticule Extraction for the more technical among you).

However, I still get many patients who think SMILE is new and not backed by years of scientific data. Having personally performed many SMILE procedures, I’d like to address these concerns and explain how SMILE fits into our laser eye surgery offering.

SMILE involves the creation of a precise piece of corneal tissue (called a lenticule) with a cool-temperature laser, and the subsequent removal of that tissue through a tiny 3–4 mm incision. Ultimately, this addresses the patient’s refractive error (short-sightedness and/or astigmatism) to restore vision.

1. SMILE is not new

This minimally invasive, bladeless procedure was first performed over ten years ago. After reviewing the data available for SMILE when it was released in Australia several years ago, I was satisfied that a significant number of my patients would benefit from having access to this procedure. Not long after, I became one of the first surgeons in Sydney to perform SMILE.

Of course, it’s important to note that SMILE is not for everyone. For starters, people with long-sightedness (hyperopia) and astigmatism related to long-sightedness cannot be treated with SMILE, but they can be treated with LASIK or ASLA.

2. SMILE offers the same and sometimes better visual correction as LASIK and ASLA

The specific laser that is used is different, but this one-step, one-laser procedure nevertheless achieves the same visual result for patients with short-sightedness or astigmatism.

3. SMILE is flapless and less likely to cause dry eye

While uncommon, flap-related complications with LASIK are possible and must be acknowledged with patients – SMILE avoids these complications entirely.

Furthermore, by avoiding the need for the corneal flap that is required with LASIK, the patient’s corneal nerves are mostly left intact. This means that there is less risk of developing dry eye after the operation, which is a really important consideration for patients who are predisposed to developing or already suffer from mild dry eye.

4. SMILE offers a quicker return to swimming and contact sports

While visual recovery is slower with SMILE than with LASIK, patients are able to return to swimming and contact sports much more quickly. This is particularly ideal for athletes and swimmers.

5. Enhancement options are available following a SMILE procedure

On the rare occasion that my patients need a second (enhancement) procedure to fine-tune their visual results, I use a second SMILE procedure, thin-flap LASIK, a circle procedure or ASLA. In my practice, all of my SMILE patients have achieved their desired visual outcome within one week.

Enhancement rates for SMILE are similar to LASIK and ASLA, which are in the order of 1–2%.

AND, most importantly:

6. The end result depends on the experience and skill of your surgeon

As with any new technology, there is a steep learning curve. It’s important to ensure that your surgeon is familiar and comfortable with the procedure – this includes a thorough understanding of potential complications and how to address these should they occur.

More and more of my patients are now electing to have SMILE surgery due to the advantages discussed.

Is SMILE right for you?

When patients come to me for laser eye surgery, I perform comprehensive eye tests and have a detailed discussion with them to determine the type of vision correction that is best suited to their situation, whether that be SMILE, LASIK, ASLA or a non-laser procedure.

Our clinics invest in the latest technology so that we can offer our patients the most appropriate treatment for their situation. This is something you should take into account when choosing a laser eye surgeon – your options shouldn’t be limited by the fact that a clinic simply doesn’t have access to other technology.

Book a consultation to see whether laser eye surgery is an option for you.

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Dr Tess Huynh is a highly respected laser eye surgeon (LASIK, SMILE and ASLA) with over 20 years of experience. In addition to vision correction surgery, Dr Huynh specialises in cataract surgery, collagen cross-linking for keratoconus and pterygium removal using autografting. She practises at Vision Eye Institute Hurstville.

SMILE® is a registered trademark of Carl Zeiss Meditec

References

  1. Chan C, Lawless M, Sutton G, Versace P, Hodge C. Small incision lenticule extraction (SMILE) in 2015. Clin Exp Optom 2016;99(3):204–12.
  2. Lawless M. Refractive Laser Surgery: Who’s Interested Now? mivision 2019;141:33–37.
  3. Blum M, Lauer AS, Kunert KS, Sekundo W. 10-Year Results of Small Incision Lenticule Extraction. J Refract Surg 2019;35(10):618–23.
  4. Doane JF, Cauble JE, Rickstrew JJ, Tuckfield JQ. Small Incision Lenticule Extraction SMILE – The Future of Refractive Surgery is Here. Mo Med 2018;115(1):82–4.
  5. Zeiss. SMILE: A brief guide. Germany, 2020. Available at https://www.zeiss.com/vision-care/int/better-vision/health-prevention/smile-laser-eye-surgery.html[Accessed 6 January 2021].
  6. Choice. A guide to laser eye surgery. NSW, 11 August 2020. Available at https://www.choice.com.au/health-and-body/optical-and-hearing/optical/articles/guide-to-laser-eye-surgery [Accessed 6 January 2021].
  7. Wilkinson JM, Cozine EW, Kahn AR. Refractive Eye Surgery: Helping Patients Make Informed Decisions About LASIK. Am Fam Physician 2017;95(10):637–44.
  8. Bohac M, Biscevic A, Koncarevic M, Anticic M, Gabric N, Patel S. Comparison of Wavelight Allegretto Eye-Q and Schwind Amaris 750S excimer laser in treatment of high astigmatism. Graefes Arch Clin Exp Ophthalmol 2014;252(10):1679–86.
  9. SCHWIND eye-tech-solutions. Frequently asked questions from patients. Germany, 2020. Available at https://www.eye-tech-solutions.com/en/patients/faq [Accessed 6 January 2021].
  10. Cai WT, Liu QY, Ren CD, Wei QQ, Liu JL, Wang QY, Du YR, He MM, Yu J. Dry eye and corneal sensitivity after small incision lenticule extraction and femtosecond laser-assisted in situ keratomileusis: a Meta-analysis. Int J Ophthalmol 2017;10(4):632–38.
  11. Mimouni M, Vainer I, Shapira Y, Levartovsky S, Sela T, Munzer G, Kaiserman I. Factors Predicting the Need for Retreatment After Laser Refractive Surgery. Cornea 2016;35(5):607–12.
  12. Stonecipher M, Stonecipher K. Influences on Enhancement Rates in Laser Vision Correction. US Ophthalmic Review 2016;9:107–09.
  13. Chua D, Htoon HM, Lim L et al. Eighteen-year prospective audit of LASIK outcomes for myopia in 53 731 eyes. Br J Ophthalmol 2019;103:1228–34.
  14. Siedlecki J, Luft N, Priglinger SG, Dirisamer M. Enhancement Options After Myopic Small-Incision Lenticule Extraction (SMILE): A Review. Asia Pac J Ophthalmol (Phila) 2019;8(5):406–11.

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The information on this page is general in nature. All medical and surgical procedures have potential benefits and risks. Consult your ophthalmologist for specific medical advice.

Date last reviewed: 2024-10-29 | Date for next review: 2026-10-29

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