What is SMILE eye Surgery and how does it compare to LASIK?
SMILE stands for Small Incision Lenticule Extraction. It was created by Carl Zeiss Meditec as a procedure to replace LASIK. The goal of SMILE was to make LASIK a procedure with no flap and the good news is that despite this being an incredibly complex task, Zeiss was successful. Essentially SMILE uses a femtosecond laser that fires pulses at 500,000 times per second to precisely carve a lens inside of your cornea that your laser surgeon then microscopically removes under an operating microscope. This is currently only a laser eye surgery for people who are nearsighted but it also works for patients who are nearsighted with astigmatism. SMILE laser eye surgery has been performed for over ten years throughout the world and SMILE originally received FDA approval for use in the United States in 2016. In 2016 we could only correct nearsightedness which limited its adoption in the US compared to LASIK vision correction. Fortunately, in 2018 the FDA expanded SMILE in the US to allow correction of astigmatism and allowed changes in energy settings that made day postoperative one vision comparable to LASIK.
Informational video on Small Incision Lenticule Extraction (SMILE)
Why would I want SMILE vs LASIK?
Both procedures are excellent and we perform both SMILE laser eye surgery and LASIK at Las Vegas Eye Institute, but SMILE does have several advantages:
- No flap creation in the cornea— Many patients are concerned about the creation of a flap at the time of LASIK. The likelihood of a LASIK flap becoming dislodged in the future is very low however some SMILE candidates that have jobs in law enforcement, the military, or those who practice martial arts may find this to be an advantage
- Microscopic Incision– Small Incision Lenticule Extraction only creates a 4 mm incision in the cornea while a LASIK flap in comparison is about 20mm in length.
- Decreased symptoms of dry eye— Multiple studies have shown that LASIK does not cause long term eye dry eye but it does cause short term symptoms of eye dryness. These symptoms typically last from 1-6 months. SMILE has been shown to have less of an effect as its incision is 1/5th the size it only cuts1/5th the corneal nerves. This has been shown to lead to a more comfortable postoperative course.
- Lower risk of corneal destabilization— SMILE cuts less corneal fibers in the front of the cornea than does LASIK. This is important because confocal microscopy studies show that the corneal fibers in the front of the cornea are more densely arranged than the deeper fibers. Tensile strength studies have shown that because of this, corneas treated with SMILE are stronger after the procedure than those treated with LASIK. The SMILE procedure by keeping more of these front fibers intact leaves your cornea nearly as strong after the procedure as it was before.
When is LASIK better than SMILE?
The Zeiss Visumax femtosecond laser that we use for SMILE (Small Incision Lenticule Extraction) is the same laser that we use to create a corneal flap in LASIK, but there are times we would recommend LASIK over SMILE and you can learn more about the specific situations during an in-office consultation. However, the basic advantages of LASIK over SMILE are:
- LASIK can correct farsightedness (hyperopia)— The SMILE procedure removes power from the cornea by removing a convex lens shape of tissue. It currently cannot remove a concave tissue shape (although trials are underway outside of the US to do this) which means that it cannot correct farsightedness. Farsightedness accounts for about 20% of LASIK consultations in the US and for those patients we utilize our Visx iDesign 2.0 excimer laser platform to perform bladeless all-laser LASIK.
- Advanced iDesign 2.0 LASIK can correct higher levels of astigmatism— SMILE is currently only FDA approved for the correction of astigmatism up to 3.0 Diopters. Our advanced iDesign platform can correct up to 5.0 diopters and has a sophisticated form of astigmatism alignment called iris registration which is helpful at higher corrections. This is not true for most excimer lasers though, the predecessor to iDesign called the Visx Wavescan could also only correct 3.0 Diopters.
- Advanced iDesign 2.0 LASIK can correct lower levels of astigmatism and Higher Order Aberrations— SMILE can only correct astigmatism if the value of astigmatism is 0.75D or more. So if you have under this amount we may still consider using LASIK to give your eyes the best possible vision. Higher order aberrations are subtle abnormalities that are unique to your eye. If these values are low then SMILE will give comparable results, but if these values are higher (this is often the case when patients have had LASIK over 10 years ago) then patients will often get better with our excimer iDesign 2.0 treatment to correct these minor abnormalities. We evaluate all of our LASIK and SMILE patients with the iDesign device to determine what is best for you.
- Treatments of Presbyopia (the decline of near vision over age 40) often require our femtosecond LASIK procedure– This is because these laser vision candidates require an increase in the power of their cornea which SMILE currently cannot perform. The increase in power can be performed with iDesign 2.0 LASIK through which can give presbyopic patients the boost they need to correct their near vision.
Am I a good candidate for SMILE laser surgery?
We perform the same comprehensive eye evaluation for SMILE as we do for all of our LASIK candidates. A good SMILE candidate tends to be a patient with less than 3.0 Diopters of Astigmatism and has nearsightedness (myopia) up to 9.0 Diopters.
I’m worried about dry eye, is SMILE a better option?
Studies have shown a more rapid return of eye comfort after SMILE and less dry eye sensation compared to LASIK. However, neither procedure should cause long term eye dryness. As mentioned above SMILE with its smaller incision can lead to a more rapid recovery in dryness symptoms versus LASIK. Even studies looking at LASIK have found patients have less dry eye symptoms 6 months after LASIK than before, this is assumed to be due to the drying effects of contact lenses.
I want all-laser femtosecond LASIK. Is this similar?
Yes. SMILE has no use of a blade. The Zeiss Visumax femtosecond laser creates a contact lens-like shape of tissue in your cornea. Then, Dr. Swanic gently removes this tissue which corrects your myopia. The recovery is rapid with most patients seeing as well as LASIK patients on day one and exactly the same at week one. The vision is typically very good the very next day and people can return to work and even wearing eye makeup the very next day.
If SMILE is new, how many people have had the procedure?
SMILE is the most rapidly growing refractive procedure in the world, due to its advantages discussed above. Over 2 million procedures have been performed worldwide and the safety and efficacy have been shown in multiple clinical trials to be excellent.
Is a corneal flap created with SMILE?
No. SMILE is a flapless form of LASIK. You can think of SMILE as similar to laparoscopic surgery where only one small incision is made in the cornea and the lens tissue is removed through this 4mm incision. With LASIK we use a femtosecond LASER to create a flap and then an excimer laser to ablate a lens shape from the cornea. The corneal flap is repositioned after this laser ablation is performed. Both procedures lead to rapid and effective vision correction.
Why should I consider SMILE surgery at Las Vegas Eye Institute?
Las Vegas Eye Institute is the first and only practice in Las Vegas to own the Zeiss Visumax laser. As such we are the first and only practice performing SMILE in the Las Vegas Valley. Dr. Swanic is a native Las Vegan who performed his Residency at Tufts Medical Center in Boston and his Fellowship in Cornea and Refractive Surgery at the world-renowned Jules Eye Eye Institute at UCLA. We feel that if you want a top eye surgeon, then Las Vegas Eye Institute has you covered. Did you know that Dr. Swanic has been awarded for being a top ophthalmologist in Las Vegas for the last 2 years in a row?
How much does SMILE (Small Incision Lenticule Extraction) laser eye surgery cost?
At Las Vegas Eye Institute we perform all of our procedures at the same price point. We do not charge more for SMILE over LASIK or PRK. We perform the right procedure for the right patient and we NEVER want cost to play a role in your decision. We are not the cheapest practice in Las Vegas for LASIK, but we also aren’t the most expensive. Our goal is to make laser vision correction cost affordable. Our SMILE cost is the same as our LASIK cost so you don’t have to question our motivations for offering one procedure over another. Our prices do vary mildly based on demand so please call our office to find out our current offer.
Can I finance my SMILE eye surgery?
Of course. Dr. Swanic wants to make the cost of SMILE eye surgery affordable. We offer zero-interest financing over the course of 24 months with our partner Alphaeon Credit. For most patients this will make your cost less than 175 dollars per month.
I want SMILE laser eye surgery, what do I do now?
Please contact our office today and our staff will get you on our schedule to determine if SMILE eye surgery is the right choice for your vision needs.