SMILE Laser Eye Surgery

WHAT IS SMILE LASER SURGERY?

As you know, SMILE stands for small incision lenticule extraction. Comparable to LASIK and refractive surgery, it is a laser-based operation that helps correct specific cornea-related visual problems, like myopia. There are several components to the technique that make it special for treating the eye. For starters, it is designed to be a minimally invasive correction. While it does involve moving tissue and making an incision with a laser, it corrects problems on a smaller scale than most alternative methods without sacrificing results.

A SMILE procedure is accomplished by using a femtosecond laser. This extremely rapid pulse rate on the laser surgical tool allows surgeons to perform alterations to the eye with more precision and in less time than by other means, including LASIK.

Because of this, the average surgical time for a small incision lenticule extraction (SMILE) procedure is only 24-29 seconds (approx. 3 times faster than LASIK). That incredibly small amount of physical correction reduces risks for a number of complications. It also allows a single laser technique to be applied to different sources of visual problems.

THE DIFFERENCES BETWEEN SMILE AND LASIK

One of the easiest ways to understand small incision lenticule extraction (SMILE) laser vision correction is to compare it to Keratomileusis (LASIK) or refractive treatments. The latter has been a popular surgical laser method for decades, and many people have at least some familiarity with it. In essence, the two procedures take a very different approach to optical treatments. Keratomileusis uses a laser beam to create a corneal flap first. This flap essentially sits on a hinge of tissue. The surgeon will then pull the tissue flap back. Then, a different tool (an excimer laser) is used to reshape the lens.

With surgery SMILE procedure, however, that LASIK flap is never created. Instead, the rapidly pulsing femtosecond laser light is used to build up tissue inside of the cornea. The same stimulated light amplification is then used to make a small incision in order to remove the built-up tissue in the middle. The end result is a reshaped cornea without a hinging flap, with a much smaller incision, less laser exposure and with less invasion overall than you would see with LASIK.

NO CORNEAL FLAP

The use of a femtosecond laser allows a lack of a LASIK flap and a pretty big deal. The substantially larger cut necessary to make the peeled layer is a source of much inflammation, irritation, and complication that can occur after the Keratomileusis excimer laser finishes. By removing the cornea flap step from the SMILE laser procedure, all of the negative side-effects attached to the methodology disappear. This doesn’t mean that this method is completely without side-effects, but the range of vision and other issues that can go wrong is reduced by the simplified SMILE procedure.

SPECIALIZATION

The lack of a LASIK hinge also changes the nature of incision lenticule extraction (SMILE) as an option for cornea-related vision problems like myopia. Ultimately, it forces this refractive eye surgery to be more specialized than Keratomileusis, enhanced by the femtosecond laser (as opposed to the excimer laser). This is both a pro and a con. The technique treats a narrower range of vision issues, but the SMILE procedure treats problems within that range to a higher degree than Keratomileusis can and often with better results. This difference is ultimately what helps surgeons and patients determine which method is the right one for each case. Sometimes the specialization shines; other times it is a drawback (which will be discussed further in a moment).

MORE BENEFITS OF SMILE

This method is rising in popularity for good reasons. It offers genuine benefits that are hard to match with other cornea correction procedures (like LASIK and PRK). The full range of SMILE benefits is hard to fit into a single list, but these are the most promising ways that they may help your eyes when compared to alternative refractive eye surgery options that don’t use a femtosecond laser.

DRY EYES

After the laser operation, SMILE patients have reported far less frequent and less severe cases of dry eyes as compared to LASIK and other refractive procedures. There are a few possible reasons for this. One is that the lack of a corneal flap causes less overall irritation to the eyes. Another is that the SMILE incision itself is much smaller. Regardless, it seems clear to medical science that reducing the invasiveness of the treatment may also reduce the side-effects, and this is one way that manifests.

BIOMECHANICAL STABILITY

Another way this method shines is in biomechanical stability. The incision is smaller than with the LASIK procedure and refractive treatments, so that allows the new corneal shape to be maintained with less trauma and eye strain. Combined with the extremely short procedure time, the eye is undergoing substantially less stress with this method. That leads to better long-term stability.

SINGLE SESSION APPLICATION

There are Keratomileusis (LASIK) procedures that can be done fairly quickly, but lenticule extraction (SMILE) is a single-session procedure. It only involves one cutting tool. By removing the excimer laser from the technique, it simplifies the procedure and that helps lower risks and complications in the long run.

ZEISS TECHNOLOGY

Lenticule extraction (SMILE) uses advanced optical technology. The tools in question perform extremely fast pulses. This increases precision and control in the operation.

To put this in context, a femto-second is a quadrillionth of a second. That’s difficult to put in perspective, but here are a few attempts. Light is the fastest thing in the universe, yet it can only go about 30 centimeters between the pulses of this tool. In a full second, light can circle the globe 7 times.

Here’s another way to look at it. The surgery only takes 8 seconds. That’s 8,000,000,000,000,000 femtosecond pulses.

These exceedingly fast laser pulses allow the surgeon to make incredibly minute adjustments to the SMILE operation, enabling them to correct eye problems even better. That’s a big part of how lenticule extraction (SMILE) is able to treat more advanced nearsightedness than other optical techniques, like LASIK and PRK.

ELIGIBILITY

Some corneal corrective techniques can only treat a small range of underlying conditions. With lenticule extraction (SMILE), however, surgeons can treat a larger range of root issues, provided that nearsightedness is the ultimate problem. It is not limited to just myopia or astigmatism. It can treat combination issues and resolve them just as effectively. Lenticule extraction (SMILE) surgery is just as effective at astigmatism or myopia treatments. Within the scope of nearsightedness, SMILE can treat a larger range of eligible candidates than many alternative methods, which makes it very competitive with LASIK.

SHORTCOMINGS OF SMILE

Lenticule extraction (SMILE) has a lot to offer prospective myopia patients, however, there is no perfect means to correct visual acuity issues. This method does have drawbacks, and they need to be discussed. Some of those drawbacks are related to what the procedure can do to a patient’s eyes. In other cases, what it can’t do is more important.

APPLICABLE CASES

SMILE eye surgery only treats nearsightedness. It can’t deal with night vision issues. It doesn’t help with farsightedness. It doesn’t offer a wide range of corneal adjustments. A large number of vision issues can never be treated with this operation, which is probably one of the largest advantages of LASIK today. That may change in the future, as the SMILE method is still being tested and developed for expanded applications, but for now, it’s not capable of serving everyone. This makes it a two- edged sword. The range of candidates is wider for this method within certain constraints, but overall, LASIK and other refractive procedures can offer options that the SMILE method cannot.

NIGHT VISION

It has already been stated that the SMILE method cannot treat higher-order aberrations (HOAs, or halos). Worse, it is known to contribute to HOAs. Many vision treatments can cause halos or difficulties with night vision. Laser vision correction procedures, including LASIK, are among them.

If HOAs are severe enough, a SMILE operation could lead a patient to need a follow-up procedure to enable adequate night vision. In most cases, this isn’t necessary, but it is an important downside to discuss.

AVAILABILITY

There are fewer surgeons who are fully trained and qualified to work with lenticule extraction (SMILE) techniques. By comparison, LASIK equipment and qualifications are commonplace. Other corneal corrections are also widely available. That might require traveling to find a physician who can provide the service. It may also drive up prices in some regions (although prices will be discussed more in a moment). Overall, a cure is only good if it is accessible, and SMILE still has some important ground to cover in that regard.

Of course, this is only an issue in some cases. Goel Vision is able to provide SMILE treatment to patients in Maryland and surrounding areas, solving the accessibility problem in this region.

THE COST OF SMILE

We’re talking about the new kid on the block. SMILE has been around for enough years to be reasonably safe and available, but it uses a more advanced removal tool than other refractive procedures. As a result, it has been more expensive than LASIK in previous years.

With that said, the increased availability and continuous improvement of the SMILE technique have led to a recent drop in prices. The surgery has made big progress in a short time. As of the end of 2019, the U.S. average cost of a lenticule extraction (SMILE) operation was $2,750. That puts it right on par with LASIK.

This cost can be prohibitive for some, but it is considerably less expensive than many alternative refractive surgery and corneal correction options. To put it as simply as possible, the SMILE method is one that is competitively priced and within reach for many prospective recipients. Of course, the final price of everything will depend on many varying factors.

COST VS. RISK

When it comes to SMILE laser eye surgery cost vs risk, the only reasonable analysis is to compare lenticule extraction (SMILE) to alternative treatments. When it comes to other optical surgeries, like LASIK and PRK, the cost is comparable. You aren’t paying extra for this method, and it is often the very best means to treat nearsightedness. Because it is significantly less invasive than other corneal surgeries, it seems like an easy choice.

Any surgical decision should be discussed with a doctor, and your ophthalmologist and/or surgeon should be included in conversations about treating vision issues. If you think you are a good candidate for SMILE, have the conversation.

With that said, there is a good chance that SMILE will prove to be the best cost vs risk option available to many patients, even over LASIK. The low procedural time, recovery time and overall risk are hard to beat, improvements made recently and the success rate for this method is incredible. In one study, 88 percent of patients no longer needed any amount of corrective lenses after the operation.

Ultimately, deciding on SMILE surgery, LASIK or any other ocular treatment is not easy and should not be taken lightly. Comprehensive eye exams, research, detailed discussions with healthcare providers and exploring insurance are all integral parts of the process and determining if you are a candidate for SMILE. Until and unless you have taken care to look at all of it, it’s not yet time to join the 20 million + people who have benefited from laser vision correction. If you’re thinking about exploring “SMILE eye surgery near me,” contact your ophthalmologist or primary physician to get started down the path to better vision that can last for years.