Author: Dr Val Phua MBBS, MMed (Ophth), FRCOphth, FAMS
Photo by: Alexander Krivitskiy
In Singapore, SMILE (Small Incision Lenticule Extraction) surgery is a popular procedure to achieve freedom from glasses and contact lenses. It is a form of laser vision correction which is minimally invasive and it has a high success and safety rates. Those who have undergone SMILE surgery often describe it as life-changing. Here are 7 things to know about SMILE surgery in Singapore.
1. There are no blades involved
The SMILE procedure involves fashioning out a corneal lenticule which is completely achieved with the femto-second laser. Unlike the early days of LASIK surgery, there are no blades involved during the SMILE procedure. The eye is first held in position with the help of a vacuum to create suction. Once ready, the femtosecond laser then proceeds to cut out a thin disc of tissue within the layers of the cornea to allow for correction of the degree present in the eye. This disc of tissue is then removed through a small wound and the procedure is over.
2. It is a painless procedure
Some people have the misconception that SMILE is a painful procedure. It is in fact a painless procedure. The eye is well numbed with topical anesthetic eye drops before the procedure begins and this ensures that the entire process, from the fashioning of the corneal lenticule using the femto-second laser to its removal, is painless. Some may experience a mild discomfort during the part where the machine applies a vacuum to keep the eye steady during the corneal lenticule creation. This pressure sensation is common and usually mild. After this is done, the rest of the surgery proceeds pain-free. Some may also have concerns about pain after surgery. This is usually minimal especially with SMILE surgery. There may be some mild discomfort in the first couple of days but this quickly resolves, allowing a painless recovery.
3. It is able to treat astigmatism
Laser technology has improved vastly over the years and like LASIK surgery, SMILE surgery is able to correct the various refractive errors in the eye including short-sightedness, long-sightedness and even astigmatism at the same sitting. The concern about astigmatism comes about if there is irregular astigmatism present. This is easily seen through a special scan of the cornea. Some patients have this irregular astigmatism to such a significant degree that it makes it unsafe to proceed with SMILE surgery. These patients have corneas that have a tendency to reshape itself over time (ectasia). Should these patients undergo SMILE surgery, the cornea becomes structurally weaker and increases this risk of ectasia over time.
4. Recovery is quick
One of the many benefits of SMILE surgery is the minimal down time. In general, patients are able to see fairly well by the next day. Eye drops are given after the surgery to prevent infection and aid healing. These are instilled for about a week and thereafter, lubricant eye drops will suffice. Many are back to their normal activities like running and gymming in a week. Swimming is generally avoided for a month while the eye continues to heal and stabilise. While rubbing of the eye is avoided, the concern of potential corneal flap dislodgement is no longer there since there is no corneal flap creation involved in this procedure.
5. It can be used to treat presbyopia (老花眼)
Presbyopia is a condition of the eye that results in difficulty focusing on near objects and may necessitate reading glasses. It starts to become more apparent at about 40 years old onwards where objects need to be pushed progressively further away from you in order to remain in focus. Conservatively, reading glasses is a good choice to address this. For those looking for alternatives, SMILE surgery is an option. SMILE surgery is not only for the young. It can also be used to address presbyopia. This is done using the concept of monovision where the dominant eye is corrected for distance vision and the non-dominant eye is corrected for near vision. In this way, individuals enjoy both distance and near vision without the hassle of glasses.
6. Enhancements can be done
While laser correction is highly accurate and predictable, it is impossible to say that 100% of patients will achieve their target in every single case. There may be cases where a residual refractive error may still be present even after SMILE surgery. If this is the case, an enhancement or “touch up” laser can be done to treat the remaining amount of degree left. This is usually done once adequate recovery has taken place and the degree has more or less stabilised.
7. It has a lower risk of dry eye after surgery
The size of the wound in SMILE surgery is a fraction of that in other laser vision correction procedures. As a result, less of the corneal nerves are affected and less dry eyes result during the recovery phase of the surgery. Dry eyes are common in the population and if there is concern about worsening symptoms after laser vision correction, SMILE surgery is a good option in these patients. Patients generally find the whole procedure gentle and the recovery quick and fuss free.