Part of an eye exam is reviewing the refractive options with patients. Glasses? Contact lenses? Surgery to correct your vision? Patients often respond “Surgery? You mean LASIK?” but lately sometimes the patient response has been “Surgery? You mean SMILE?”
At Monarch Bay Optometry, we educate our patients on all options of refractive surgery which can include PRK, LASIK and now, SMILE. SMILE is the most recent technique and was approved in 2016. But being the latest does not also always mean greatest.
LASIK ( Laser assisted in situ keratomileusis) has been available in the US for more than 30 years. There have been various technique improvements that have expanded the range of corrections that could be improved and reduced side effects such as glare. It has also become very reproducible over this time period. It is often a life changing event for most patients.
Refractive surgery continues to evolve and improve. SMILE is one of those advances. SMILE (small in situ lenticule extraction) is still relatively new and although it can correct vision like LASIK, it is still in its infancy stages.
How do LASIK and SMILE differ?
LASIK uses two different lasers. The first is a femtosecond laser that creates a thin, hinged flap from the top layers of the cornea. The flap is lifted and folded back to allow the second laser to treat the exposed cornea. The second laser is a excimer laser that sculpts and reshapes the cornea so it bends light more accurately and equally to allow the patient to become free of glasses and contact lenses.
A computer program accurately measures the topography ( surface of the cornea) and therefore refractive error of over 1200 areas of the cornea. This provides the patient with a customized vision correction treatment that helps to reduce things like glare and give the patient a “better 20/20”. After the excimer laser program is complete, the flap is repositioned on the cornea and acts as a self bandage.
SMILE reshapes the cornea by creating a small lens (lenticule) within the cornea and creating a pocket in the cornea instead of a LASIK flap. The lenticule is removed from this pocket. It can be described as a contact lens shape created within the cornea and removed from the pocket.
Is the latest the greatest?
Latest is not always the greatest. Being the new kid on the block, SMILE is limited in the range of prescriptions (refractive errors) that it can correct. Being a newer procedure, there is less long term outcome data which is a nice way of saying it is more difficult to say how it will change over the years.
So why is SMILE so interesting? If you have dry eye and are within the SMILE parameters, SMILE could be the best voice for you. Because a pocket is made instead of a flap, less of the cornea is disturbed and there is less chance of significant dry eye.
What if you have dry eye and are not within the recommended range for SMILE? There is still hope for a successful LASIK. At Monarch Bay Optometry, we can do additional testing and treatment to prepare your cornea for a successful refractive surgery. Treatments could include specific supplements such as omegas, special eye drops, punctual plugs, LLLT (Low Level Light Therapy) and IPL (Intense Pulsed Light).
Contact Monarch Bay Optometry for a refractive surgery consultation and we can determine the best plan to get you glasses and contact lens free!