What is SMILE?

SMILE is an acronym for Small Incision Lenticule Extraction.  It’s a new refractive surgery that became approved by the FDA in 2016.  In SMILE, the surgeon uses a laser to create a small, lens-shaped bit of tissue (lenticule) within the cornea.  Then, with the same laser, a small arc-shaped incision is made in the surface of the cornea, and the surgeon extracts the lenticule through this incision and discards it.  With the tiny lenticule removed, the shape of the cornea is altered, correcting nearsightedness. The corneal incision heals within a few days without stitches, and vision clears rapidly.

Who is a good candidate for SMILE?

• Near-sighted people with -10.00D of myopia or less
• People ages 22 and up
• People with less than 0.50D of astigmatism
• People whose prescription has been stable over the past 12 months.

Advantages of SMILE compared to other refractive procedures

• Research is showing SMILE produces virtually the same visual acuity as LASIK for the correction of nearsightedness, without the need to create a LASIK-style corneal flap.
• In one study of 328 people who underwent the SMILE procedure, all but one had uncorrected visual acuity (UCVA) of 20/40 or better after surgery, and 88 percent had UCVA of 20/20 or better.
• Also, it appears there may be less risk of dry eye symptoms after SMILE, compared with LASIK. There may be several reasons for this, including that because SMILE takes place within the cornea without a large corneal flap, fewer corneal nerves are affected by the procedure.
• The very small SMILE incision may also enable the cornea to have more biomechanical stability after SMILE, compared with its ability to maintain shape (especially following trauma) after LASIK.
• Finally, for correction of high amounts of nearsightedness, with LASIK there’s a greater risk of needing an enhancement procedure to attain the clarity of vision desired without glasses. It appears there is less risk of needing an additional procedure after SMILE for correction of high amounts of myopia, possibly because less dehydration of the cornea occurs during the SMILE procedure.

Disadvantages of SMILE compared to other refractive procedures

• SMILE can only correct nearsightedness, whereas LASIK and PRK can also correct significant amounts of farsightedness and astigmatism.
• Also, LASIK and PRK can treat higher-order aberrations (HOAs) that can affect night vision, whereas SMILE cannot. In fact, SMILE might increase HOAs to some degree.
• And if you need additional visual correction after a SMILE procedure,, typically PRK would be the preferred enhancement procedure for best results.
• Finally, as with any newer vision correction surgery, it may be necessary for a surgeon to perform a significant number of SMILE procedures before he or she masters the surgical techniques required for optimum outcomes and minimal risks. You’ll want to make sure your surgeon has plenty of experience.