A new technique being used to treat myopia is called SMILE. That stands for SMall Incision Lenticular Extraction. It is a little different to LASIK.

With LASIK a femtosecond laser is used to make a flap in the cornea which is semicircular and which is lifted up to expose the underling corneal stroma.

An excimer laser is then used to reshape the stroma before the flap is put back down over the treated area.

It is a procedure with a very long history of safety and accuracy making it most popular.

Furthermore…it is improving all the time.


How Small Incision Lenticular Extraction (S.M.I.L.E) Works

With SMILE the femtosecond laser is the only laser used. It outlines a lenticule (like a pancake) of stroma within the cornea and then makes a small incision at the side for the surgeon to open up. The lenticule (pancake) is then pulled out (extracted) through the small incision.

The purported advantages over SMILE are that there is no flap that could move, less weakening of the cornea and less dry eye compared to LASIK.

Already sturdies are coming out demonstrating no significant differences in dry eye symptoms between S.M.I.L.E and LASIK.

How Does S.M.I.L.E Compare with LASIK?

There has already been at least one report of corneal weakening (ectasia) following S.M.I.L.E and there will be more to come.

Indeed there is no flap that could, theoretically, be dislodged. However, there have been reports of wrinkles and inflammation within the stroma very similar to flaps in LASIK .

In other words, there is very little difference in the safety profile of the two procedures.

On the other hand, S.M.I.L.E can only treat myopia and astigmatism in association with it. Not astigmatism alone or longsightedness.

S.M.I.L.E cannot be used to retreat an eye (so called ‘enhancement’) if the vision is not quite right or if it deteriorates with time. Other techniques need to be employed to do that.

With S.M.I.L.E it takes longer for the vision to recover. That’s because the lenticule needs to be manipulated out of the cornea manually  and the tissues need a bit more time to recover.

That’s not so bad…if there was a real benefit to the patient.

S.M.I.L.E is still very new. LASIK has had time to incorporate refinements to give people optimal results.

With S.M.I.L.E there is no automated tracking of the pupil. The eye is just tightly held still while the laser is being applied.

With S.M.I.L.E there is no automated pupil centration. The surgeon just estimates the centre of the pupil when performing the procedure

With S.M.I.L.E there is no wavefront analysis or guidance in the procedure. It’s back to the original formula in calculating how much tissue needs to be removed to treat myopia.

However, marketing wizards tell us you need to DIFFERENTIATE yourself in competing for business. S.M.I.L.E is different to LASIK.

Perhaps S.M.I.L.E is enough to lure patients to a particular clinic. Because it’s ‘Different’!

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