SMILE is the latest and minimally invasive procedure of laser eye surgery

SMILE

Minimally invasive laser eye surgery

SMILE corrects myopia and astigmatism, or a combination of both refractive errors with only a very small incision at the corneal surface. This high-precision procedure is the latest development in the refractive laser treatments.

  • What is SMILE?

    SMILE

    Minimally invasive surgery for correcting vision

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    See how SMILE treats refractive errors.

    SMILE, Small Incision Lenticule Extraction, uses a femtosecond laser system with high precision and speed to reshape the cornea. The laser creates a small lens shaped pieces of corneal tissue known as lenticule, inside the cornea. It takes an average of 23 seconds. The surgeon then removes the lenticule through a small incision at the front part of the eye. This reshapes the cornea and corrects the refractive error.

    SMILE is the most recently developed method of laser eye surgery. This advanced procedure allows the minimally invasive correction of some vision defects. By May 2017, SMILE had corrected myopia and/or astigmatism in more than 750,000 eyes in over 60 countries worldwide.

    SMILE may be an option for many people with a variety of vision impairments – from mild refractive errors to severe nearsightedness and astigmatism.

    Characteristics

    Single-step procedure: SMILE is performed with a single short pulse and fast repetition femtosecond laser system. The laser selects a thin layer just beneath the surface of the eye at the same time as creating a tiny opening at the surface of the eye. The laser works silently and quickly without producing odour. Furthermore, the patient remains in one place from start to finish.

    All-femto: SMILE uses only a femtosecond laser, which is programmed to harmlessly pass through the upper layers of the cornea, becoming focused only at a specific sub-layer of the cornea to create the lenticule:

    • No removal of the outer layer of the cornea 
    • Only a very small incision on the surface of the eye

    Corneal nerves stimulating the tear glands are less affected and so they are still able to help keep the eye lubricated. Side effects such as dry eye syndrome are rare after SMILE.

    Benefits

    Minimally invasive: With the SMILE procedure only a 2mm - 4mm wide incision is made on the surface of the eye. A thin lenticule formed by the laser inside the cornea is removed through this opening.

    Maintained eye stability: The entire upper layers of the cornea are virtually unaffected with SMILE – these are the most important contributors to the cornea’s stability.

    Eligibility: SMILE corrects myopia, astigmatism or a combination of the two, but is not a treatment option for hyperopia yet. As with other Laser Vision Correction methods, you will first need to undergo a detailed eye examination to determine whether you are a suitable candidate. If you have mild, moderate or even severe myopia, SMILE may be an option for you.

    Potential Side Effects

    Like all surgical procedures, no intervention is free of risks and side effects. Your physician can explain all potential risks to you and decides whether you are eligible for surgery.

    These are some side effects that can occur after surgery.

    Over- or undercorrection:
    Over- or undercorrection can occur after any laser procedure. Not everyone achieves a spot-on refractive outcome after laser eye surgery. The amount of vision correction can vary depending on individual conditions and a residual refractive error can remain which may cause patients to still need glasses or contacts after surgery. However, if you are significantly undercorrected, your physician may recommend that you undergo a retreatment. A treatment with eye drops or wearing soft contact lenses for several months can help treat over-correction.

    Further possible complications and side effects of SMILE and alternative types of Laser Vision Correction procedures are explained on the page that lists potential risks.

  • Treatment Steps

    SMILE

    Determining if SMILE is right for you

    Talk to your eye doctor about laser eye surgery as well as other solutions for your vision problem. Your doctor will decide if you are a good candidate for SMILE after completing several diagnostic tests. Together, you and your doctor can determine the best option to suit your needs.

    Preparing for Surgery

    Before and on the day of surgery

    Patients are usually directed by their doctor to:

    • Stop wearing hard contact lenses for at least four weeks and soft lenses for two weeks before surgery, because they may interfere with preoperative diagnostic tests.
    • Wear no make-up, perfume or lotion the day before the procedure. These products may leave debris around the eye and eyelashes, which increases the chance of infection. 
    • Arrange for alternative transportation after the surgery and possibly also for the next few days.
       

    Surgery:

    What are the treatment steps of SMILE?

    Woman on surgical bed for SMILE

    Numbing the Eye

    To reduce pain during the surgery, anaesthesia drops are given to numb the eye. An eyelid holder is used to prevent the eye from blinking during surgery.

    A femtosecond laser creates a lenticule

    Creating the Lenticule and the Incision

    After the eye is numb, it needs to be immobilized for the surgery. This is done with a contact glass which is placed gently on the eye and connected to the laser device. A slight pressure may be felt when this occurs. Once the eye is held stationary, the laser creates a lenticule within the stroma, an inner sub-layer of the cornea, and creates an access incision on the corneal surface that is less than 4mm wide.

    The lenticule is removed

    Removing the Lenticule

    The surgeon removes the lenticule through the laser-generated small incision.

    The eye recovers itself after surgery

    Refractive Error Corrected

    Removing the lenticule changes the shape of the cornea, correcting the refractive error. The incision is so small that it will seal itself after some time.

    After Surgery

    Healing with minimum discomfort

    After surgery, it is recommended not to rub the operated eye, to rest and not to overexert yourself. The doctor may recommend wearing a patch for one week while sleeping to avoid accidentally scratching the eye before it heals. Doctors typically require a follow-up exam the day after surgery and after one month.

    SMILE is a minimally invasive procedure, which means discomfort is usually minimal during the healing period. In most cases vision stabilizes within one week after the operation. After SMILE, patients are normally able to drive, work, wear make-up and participate in sports, just a few days following treatment.

  • Questions & Answers

    Frequently Asked Questions About SMILE

    Laser Vision Correction with minimum discomfort

    • Who is eligible for SMILE?

      Today SMILE corrects nearsightedness, astigmatism, and a combination of the two. As with all other Laser Vision Correction methods, you will have to undergo a detailed eye examination to find out if this method is suitable for you. The nature and degree of the refractive error, and the curvature and thickness of the cornea, play a role in your doctor determining if SMILE is an option for you.

      Also important are your profession and hobbies. If you often participate in strenuous contact sports, your doctor might recommend SMILE over alternative Laser Vision Correction treatments. Your doctor will advise you after conducting a detailed examination.

    • PRK/LASEK also requires no flap in the cornea. How do these procedures differ from SMILE?

      In PRK/LASEK procedures, the top layer of the cornea (epithelium) is removed manually. The exposed deeper layers of the cornea are then reshaped using an excimer laser.

      PRK/LASEK procedures have a longer healing time and involve some discomfort until reaching the final stabilized vision result. The stabilization of visual acuity also takes more time. Furthermore, PRK/LASEK is not typically recommended for the treatment of severe nearsightedness.  

    • My eye doctor has never heard of SMILE. Is this not a popular procedure?

      SMILE is the latest advancement of Laser Vision Correction and has been available since 2011. Its technique is known and recognized by medical trade associations related to refractive laser eye surgeries. The familiarity of SMILE continues to grow, but this is taking some time, especially among general ophthalmologists. Over 1,000 surgeons have already successfully treated more than 750,000 eyes with SMILE.

    • Is SMILE a proven procedure?

      Femtosecond laser technology is clinically proven and has been used for LASIK as well as in cataract surgery. SMILE is the latest procedure developed using this laser technology. SMILE has been performed in controlled clinical studies since 2007 and has been commercially available since 2011. The first SMILE-patients have been monitored for over five years post-treatment. SMILE is now established in many countries worldwide.

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