What Is SMILE Laser Eye Surgery?

Since being introduced in 2007, small incision lenticule extraction (SMILE) laser eye surgery has been used to treat refractive errors such as myopia and astigmatism.

SMILE laser eye surgery shares similarities with other refractive surgeries such as LASIK, PRK, and Refractive Lens Exchange. However, the procedure offers a new approach for patients looking for clearer vision and freedom from glasses and contacts.

To select a refractive surgery that best meets their eye care needs, patients should learn more about what they can expect from SMILE laser eye surgery.

SMILE (small incision lenticule extraction) is a laser eye surgery used to treat refractive errors, astigmatism, and myopia—as well as help patients achieve clearer vision and freedom from glasses and contacts.

During SMILE laser eye surgery, the eye doctor uses a femtosecond laser to create a corneal lenticule in the patient's eye. Lenticules are tiny disc-shaped pieces carved into the cornea. The doctor will then make an additional incision to remove the lenticules.

The process of removing these pieces changes the shape of the patient’s cornea, allowing them to enjoy clearer, crisper vision.

Most healthy adults can safely have the procedure. Patients with a higher prescription or issues with dry eyes may even prefer SMILE laser eye surgery over similar procedures.

Candidates for SMILE laser eye surgery must meet the following criteria:

• Be over the age of 21.

• Have not had a significant change in their glasses prescription in the past calendar year.

• Have a prescription range that falls between -1 and -10 for nearsightedness or up to 3 diopters for astigmatism.
  

• Have healthy corneas.

While SMILE laser eye surgery is a safe and reliable refractive surgery, eye doctors may recommend that certain patients avoid the procedure.

Patients who are not good candidates for SMILE may fit one or more of the following:

• Under the age of 22.

• Have frequent changes in glasses or contact prescriptions, or have had a major change in prescription during the past year.

• Suffer from conditions such as: severe glaucoma, keratoconus, unmanaged diabetes, or a visually disruptive cataract.

• Female patient that is pregnant or breastfeeding.

Prior to the procedure, a surgeon will look at a patient's eyes to ensure they are a good candidate for surgery. This will typically begin with a visual acuity test to make sure a patient's vision is stable.

Next, the surgeon will confirm that the patient does not have any conditions that will prevent them from having surgery. They do this by measuring and mapping the surface of the cornea to program the computer-based laser used during SMILE laser eye surgery.

Additionally, the surgeon may measure pupil size and offer dietary and supplement recommendations for the days prior to surgery.

SMILE laser eye surgery is a fast and safe procedure. The entire surgery typically takes 10 to 15 minutes.

Before surgery a laser is programmed with specific measurements for the patient. The surgeon will then use eye drops to numb the patient's eye and use an eyelid holder to keep the patient from blinking.

During the procedure, a laser creates a disc-shaped piece of cornea called a "lenticule" that gives the surgery its name. The surgeon will then make a small incision that allows them to access the lenticule.

They will then remove the lenticule and reshape the cornea. The laser-assisted part of the surgery typically takes less than a minute.

As with similar refractive surgeries such as LASIK, patients may have sore eyes and blurred vision following SMILE laser eye surgery. It is recommended that they have someone to drive them home following the procedure.

The surgeon will also prescribe patients eye drops to help soothe blurry vision and mild side effects in the days immediately following surgery.

Blurry vision will gradually improve on its own. Most patients will be able to resume normal activities within a few days following the procedure. However, after surgery patients should make an effort to:

• Wear protective eyewear such as sun and safety goggles to shield their eyes from the sun and debris.
  

• Avoid using makeup.
  

• Refrain from water-based activities like swimming and hot tubs that may irritate their eyes.

There are a variety of procedures to correct refractive errors and enjoy clearer vision. SMILE is one of the newest refractive surgeries, and has several advantages over similar surgeries like LASIK and PRK.

Unlike LASIK, there is no corneal flap in SMILE surgery. In a procedure like LASIK the surgeon creates a flap on the surface of the cornea to operate on the eye.

In SMILE eye surgery the doctor cuts out pieces of tissue called corneal lenticule and then removes them from the patient's eye—without removing the corneal flap.

This is typically less invasive and may be preferable for patients with thin corneas, high risk of eye injury, or active jobs.

Additionally, SMILE laser eye surgery may be preferable for patients who suffer from dry eye. During SMILE, the corneal disk is removed through a small incision. Since this is minimally disturbing, long-term dry eye is less common when compared with procedures like LASIK.

SMILE has a strong track record and is considered a safe surgical option for clearer vision. However, like any surgery, there are potential complications associated with the procedure.

Possible adverse side effects for SMILE laser eye surgery include:

• The experience of glowing or halos around lights. This is especially common during the night time.

• Debris collecting in the area where the corneal disc is removed.

• Inflammation within the treated area.

• Infection.

In rare instances SMILE may over or under correct a patient’s vision. This can often be improved with glasses or contacts.

As with any surgery, patients should consult with their eye doctor to make sure the procedure is a good fit.