Dealing with astigmatism, cataracts and other debilitating ocular conditions is not easy. Laser eye surgery is not an entirely new concept. It has been around for decades, and in that time, it has advanced considerably. Many people with eye conditions have wondered if an operation could solve their issues. Instead of wondering, learning about the specific options available can help you take the important first step towards treatment. There are primarily three categories of laser surgery. They include Photorefractive Keratectomy (PRK), LASIK (Laser-Assisted In-Situ Keratomileusis) and SMILE. Today, we’ll discuss SMILE eye surgery at length to help you determine if it’s something you should consider.
What Is SMILE Laser Surgery?
SMILE stands for small incision lenticule extraction. It is a laser-based operation that helps correct specific vision problems. There are several components to the technique that make it special. For starters, it is designed to be minimally invasive. While it does involve moving tissue and making an incision, it does so on a smaller scale than most alternative methods.
This is accomplished by using a femtosecond laser. This extremely rapid pulse rate on the surgical tool allows doctors to perform alterations to the eye with more precision and in less time than by other means.
Because of this, the average surgical time for a SMILE procedure is only 24 seconds. That incredibly small amount of physical correction reduces risks for a number of complications. It also allows a single technique to be applied to different sources of visual problems.
The Differences Between SMILE and LASIK
One of the easiest ways to understand SMILE laser vision correction is to compare it to Keratomileusis. The latter has been a popular surgical 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 beam to create a corneal flap. This bit essentially sits on a hinge of tissue. The surgeon will then pull the tissue back. Then, a different tool (an excimer laser) is used to reshape the lens.
With surgery SMILE, that flap is never created. Instead, the rapidly pulsing 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, and with less invasion overall.
No Corneal Flap
The lack of a flap is 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 Keratomileusis. By removing that step from the procedure, all of the negative side-effects attached to the methodology disappear. This doesn’t mean that this method is complete without side-effects, but the range of things that can go wrong is reduced by the simplified procedure.
The lack of a hinge also changes the nature of incision lenticule extraction as an option for vision problems. Ultimately, it forces this refractive surgery to be more specialized than Keratomileusis. This is both a pro and a con. The technique treats a narrower range of vision issues, but it treats problems within that range to a higher degree than Keratomileusis can. This difference is ultimately what helps doctors 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).
Benefits of SMILE
This method is rising in popularity for good reasons. It offers genuine benefits that are hard to match with other procedures. The full range of benefits is hard to fit into a single list, but these are the most promising ways that they can help your eyes when compared to alternative refractive surgery options.
After the operation, patients have reported far less frequent and less severe cases of dry eyes. 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 incision itself is much smaller. Regardless, it seems clear to medical science that reducing the invasiveness of the treatment also reduces the side-effects, and this is one way that manifests.
Another way this method shines is in biomechanical stability. The incision is smaller, so that allows the new 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 procedures that can be done fairly quickly, but lenticule extraction 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.
Lenticule extraction 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. These exceedingly fast pulses allow the doctor to make incredibly minute adjustments to the operation. That’s a big part of how lenticule extraction is able to treat more advanced nearsightedness than other optical techniques.
Some corrective techniques can only treat a small range of underlying conditions. With lenticule extraction, doctors 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. 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.
Shortcomings of SMILE
Lenticule extraction has a lot to offer prospective patients, but there is no perfect cure for 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.
SMILE eye surgery only treats nearsightedness. It can’t deal with night vision issues. It doesn’t help with farsightedness. A large number of vision issues can never be treated with this operation. That may change in the future, as the 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 procedures can offer options that this method cannot.
It has already been stated that this 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 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.
There are fewer doctors who are fully trained and qualified to work with lenticule extraction techniques. 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 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. It has been around for enough years to be reasonably safe and available, but it uses a more advanced removal tool than other 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 technique have led to a recent drop in prices. As of the end of 2019, the U.S. average cost of a lenticule extraction 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 options. To put it as simply as possible, this method 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 to alternative treatments. When it comes to other optical surgeries, 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 surgeries, it seems like an easy choice.
Any surgical decision should be discussed with a doctor, and your ophthalmologist should be included in conversations about treating vision issues. With that said, there is a good chance that SMILE will prove to be the best cost vs risk option available to many patients. The low procedural time, recovery time and overall risk are hard to beat, 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 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. 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.