SMILE® Eye Surgery – Everything You Need To Know

Laser eye surgery has been gaining in popularity over the last few decades. With advancements in both surgical tools and knowledge of the physiology and biomechanics of the eye, specialist ophthalmologists known as refractive surgeons are able to offer a greater suite of surgical vision correction options. The addition of newer refractive surgery techniques has also enabled more patients to be deemed eligible for vision correction procedures – whereas once we were restricted to simply treating short-sightedness, we now have procedures that can correct long-sightedness, astigmatism, and even address that age-related decline in near vision, presbyopia.

Short for small incision lenticule extraction, SMILE® eye surgery is one of the newest vision-correcting procedures available in Australia. As with many of the refractive surgery techniques, SMILE® laser eye surgery is based on corneal reshaping, which serves to redirect light through the cornea at the front surface of the eye such that it focuses to a clear point on the retina, providing sharp vision.

The Benefits of SMILE® Eye Surgery

The greatest benefits of SMILE® laser eye surgery arise from its minimally invasive nature. Older techniques such as LASIK and PRK, while still holding a valuable position in the suite of refractive surgery methods in modern-day, require significant disturbance of the corneal epithelium. As the laser reshaping process is applied to the deeper layers of the cornea known as the stroma, the superficial epithelial layers must first be removed; in LASIK this involves creating a hinged corneal flap which is later repositioned, while in PRK the epithelium is removed entirely and regrows during the healing stage.

During SMILE® eye surgery, the corneal epithelium is left intact and the cornea is reshaped from within using a femtosecond laser.

Because there is much less disruption to the tissues of the cornea compared to older techniques, SMILE® laser eye surgery results in an eye that is more biomechanically stable post-operation.

It also means a lower incidence of post-operative dry eye for susceptible patients, a side effect more common to techniques such as LASIK which involve greater disturbance to the corneal nerves.

The potential for flap-related complications is also eliminated with the SMILE® technique, as it is in PRK. Though extremely rare, the creation of the hinged corneal flap in LASIK opens the risk of complications such as inflammation at the flap interface, debris getting caught under the flap, or the flap losing its position. The uncompromised structural integrity of the eye after SMILE® makes it a great option for those who work in dirty environments or undertake work or hobbies that involve risk of physical trauma, such as in contact sports.

Recovery time after SMILE® is much faster than that in PRK, which requires about a week for the corneal epithelium to regrow. Compared to LASIK, SMILE® is a little slower in its visual recovery as it can take 1-2 days for vision to clear while after LASIK a patient typically experiences sharp vision immediately post-operation.

The SMILE® technique has been clinically proven to equal LASIK in terms of safety and accuracy. However, as with any surgical procedure, the final outcome and cost is largely determined by the skill and experience of the surgeon.

The SMILE® Procedure

Prior to undergoing any sort of refractive surgery, you will first have a comprehensive eye examination with the eye specialist and clinical team. The purpose of this is to determine which surgical procedure is most suitable, and will take into account factors such as your age, spectacle prescription, corneal thickness, lifestyle factors, and any other pre-existing eye diseases that may affect the final visual outcome. At this point in time, SMILE® eye surgery is appropriate only for patients with myopia, also known as short-sightedness, and can correct very high degrees of myopia even up to the double digits. You will also need to undergo a few additional tests to take specific measurements pertinent to the surgical procedure, such as axial length (the length of the eyeball) and corneal topography (mapping the surface of the cornea).

During the procedure, the eye will be numbed with a local anaesthetic. You will be directed to fixate on a target light to keep the eye still and steady while the surgeon works.

A femtosecond laser is applied to create a precisely shaped disc of tissue, known as a lenticule, within the corneal stroma, which is then extracted from the eye via a keyhole incision no larger than 3mm. The result is a cornea that has been sculpted from within that now bends light to fall clearly onto the retina without the need for glasses or contact lenses. The entire procedure takes about 20 minutes, with the actual time spent under the laser only a few minutes long.

After the operation, you will be given detailed post-operative instructions on how to protect and care for the eye as it heals. You will have some medicated eye drops to aid this healing process, including a preventative antibiotic and an anti-inflammatory drop. The ophthalmologist will want to conduct a review appointment at least once or twice after your surgery to check the progress of your eye’s physical healing and visual recovery. Though vision may take a few weeks to fully stabilise, many patients are able to see quite clearly the day after the procedure.

As with any surgical procedure, SMILE® comes with some risks. These complications may include increased glare sensitivity, eye inflammation or infection, and over- or under-correction of the eye’s prescription.

To see whether SMILE® eye surgery is the perfect option for your laser vision correction, call us on (03) 9070 5753 book an appointment with us today.

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.