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Ten years on – a good time to SMILE®

Dr Tess Huynh



Last November marked a momentous occasion – more than one 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 in to 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 3–4mm incision. Ultimately, this fixes the patient’s refractive error (short-sightedness and/or astigmatism) to correct vision.

1. SMILE is not new

This minimally invasive, bladeless procedure was first performed over ten years ago, and there are now more than 1300 eye surgeons around the world who offer SMILE. 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 or 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.

Now you know that SMILE stacks up, book a consultation to see which laser eye surgery procedure is right for you.

Dr Tess Huynh is a highly respected laser eye surgeon with over 16 years of experience. She performs LASIK, SMILE and ASLA. In addition to vision correction surgery, Dr Huynh specialises in cataract surgery and corneal conditions. She practices at Vision Eye Institute Hurstville.

All medical and surgical procedures have potential complications. Check with your doctor before proceeding.

SMILE® is a registered trademark of Carl Zeiss Meditec

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