Author: Dr Val Phua MBBS, MMed (Ophth), FRCOphth, FAMS
Photo by: Jamie Brown
Peace begins with a SMILE – Mother Teresa
How does SMILE lead to better vision?
SMILE (Small Incision Lenticule Extraction) is a newer technique for laser vision correction compared with LASIK and it is able to correct both myopia as well as astigmatism. It is minimally invasive, utilizing only a 3mm wound for the entire procedure.
This procedure begins with numbing eye drops given and the eye held in position by a vacuum. It then involves using the femto-second laser to shape a thin disc of corneal tissue (lenticule) from the internal layers of the cornea. This part of the procedure is painless and is done within seconds. This lenticule is then manually dissected and removed from a small side opening.
Unlike LASIK, there is no LASIK flap created in this procedure and the recovery is also fast and with minimal discomfort. The absence of a flap carries with it inherent advantages including leaving a slightly stronger cornea to reduce the risk of further shape changes, avoiding flap related complications like folds within the flap, less dry eye and interface inflammation.
However there remains a small risk of having to convert to the more time tested means of laser vision correction should there be suction loss during the procedure preventing an effective application of the femto-second laser to create the lenticule. The current platform on which SMILE can be performed also does not have an eye tracker to correct for torsion which may occur when the patient goes from a sitting to a lying position. This may make correcting astigmatism slightly less accurate compared with the LASIK procedure. SMILE also currently cannot be used for patients with long-sightedness and if future “touch ups” or enhancements are needed, the more time tested procedures may have to be employed. The visual outcomes of SMILE is comparable with LASIK although the recovery to achieve good uncorrected vision takes slightly longer compared with LASIK.
Overall SMILE is a safe and effective method for addressing myopia and astigmatism. It offers the advantage of a flap-free laser vision correction but visual recovery may take slightly longer with the above listed limitations. Is SMILE suitable for you? A personalised recommendation based on your specific needs should be made after taking a thorough ophthalmic history, examination and specialised tests which can highlight the suitability for each procedure for your eye. Journey alongside your eye surgeon to discuss how best to achieve your vision goals.