SMILE

SMILE is a femtosecond laser procedure without a corneal flap to remove glasses or contact lenses.

What is SMILE?

SMILE is the only technique available in the world where laser surgery is performed without using any blade and without having to make and lift a corneal flap. The combination of precise refractive femtosecond laser technology and lenticule extraction marks the start of a new era in refractive surgery.

Unlike most femtosecond lasers in the market, with SMILE there is no need to apply a surgical blade to the cornea and its integrity preserved. There are also minimal risks involved in this type of surgery compared to conventional LASIK or FemtoLASIK treatments.

Advantages of the SMILE procedure

  • Minimally invasive surgery.
  • Preserves integrity of upper corneal layers.
  • Ensures preservation of corneal biomechanical stability.
  • Fewer nerves damaged and therefore, less varying severity of dry eye syndrome.
  • Absence of flap eliminates the risk for flap complications such as epithelium in-growth, flap dislocation, infections and striae.
  • Faster healing of epithelium.

Tissue removal instead of ablation

The SMILE procedure offers many advantages compared to conventional refractive correction methods due to these unique features:

  1. Flapless – it works by creating a small incision rather than a full flap.
  2. All-Femto – FS lenticule cutting substitutes for excimer tissue ablation.
  3. Single-step – one integrated procedure using a laser device.

Comprehensive eligibility test
(pre-laser test)

Preoperative Assessment

Be prepared for extensive eye tests prior to laser vision surgery. The process includes: eye test using topical anaesthetic drops and eye dilation.

A major step towards the road to the SMILE procedure is the detailed, comprehensive eligibility test. The test consists of various diagnostic examinations and is completely painless.

Our team of experts will determine the power to be treated and consider whether the patient is a suitable candidate or not, and if so, indicate which treatment modalities best suit their requirements to achieve the best possible outcome, which is ideally that of perfect vision without glasses or contact lenses. 

Important notes before pre-laser assessment

  • The entire examination takes about 1.5 hours.
  • If you have a previous ophthalmological evidence or a prescription for glasses, bring them to the test.
  • To ascertain the refraction and examine the fundus correctly, dilating eye drops are added, resulting in a slightly blurred vision after the test. Please avoid driving for 3 hours immediately following the examination.
  • Bring with you any medication that you are taking.

Please arrange for alternate transport and sunglasses when coming for the assessment.

Eligibility

To be eligible for the SMILE procedure, patients must be over 18 years of age and have not had a significant change in their glasses or contact lens prescription for the preceding 12 months. 

Other factors, such as general health of the eye, will be examined at the preoperative assessment.

Contraindications

Patients will not be eligible if any of the following apply:

  • Recurrent eye inflammations or infections
  • Excessive corneal disease or scarring
  • Degenerative disease of cornea
  • Use of certain drugs
  • Pregnancy and nursing
  • Certain rheumatological conditions
  • Severe dry eyes
  • Inadequate corneal tissue
  • Uncontrolled diabetes
  • Pacemaker

Removal of contact lenses before pre-laser test

Contact lens type Length of time lenses need to be out
before the pre laser appointment
All soft contact lenses At least 1 week before
Extended wear soft lenses At least 1 week before
Toric soft lenses At least 2 weeks before
Rigid gas permeable
Worn for 0-10 years At least 4 weeks before
Worn for 10-20 years At least 8 weeks before
Worn for 20-30 years At least 12 weeks before
True hard lenses (Polymethyl methacrylate) At least 12 weeks before

The Procedure

What Happens Before Surgery?

  • Arrange alternative transportation after surgery, as we do not advise driving for approximately 1-2 days after the procedure.
  • Don’t use eye make up 24 hours prior to the surgery.
  • We recommend avoiding alcohol 24 hours prior to and 48 hours after surgery.

The Day Of The Surgery

Patients usually feel nervous, anxious or excited prior to their procedure. This is a completely natural and normal response.

  • Refrain from wearing perfume or cologne on the day of your surgery. 
  • Don’t use any hair products containing alcohol; hair spray or mousse.
  • Remember to bring good-quality sunglasses.

What Happens After The Procedure?

The first mandatory post-operative appointment will take place within 24 hours and additional follow-ups will be at one week, one month and 3 months after the day of the surgery

Each post-operative appointment takes approximately 15 to 30 minutes for evaluation.

Recommended activity schedule after routine SMILE procedure

Day of surgery

The day of surgery should be a day of rest; preferably sleep one hour after the surgery with eyes covered with protective eye shield.

  • Always be careful about activities where the eye may be poked, rubbed or touched.
  • Always avoid rubbing eyes, instead use lubricant drops for irritation.

24 hours after surgery

  • Take a bath instead of shower. Avoid any soap or water in the eyes.
  • Restrict movement to light activities
  • Work at home is acceptable.
  • Reading and watching TV is permitted as long as the eyes are lubricated.
  • Flying in aeroplanes is allowed provided eyes are lubricated every 30 minutes with lubricating drops or every 2 hours with lubricating gel.

48 hours after surgery

  • Driving can be resumed if adequate vision is confirmed at the postoperative evaluation.
  • Shower, but continue avoiding soap and water in the eyes.
  • Face make-up may be used, but not eye make-up.
  • Office work can be resumed
  • Computers can be used, but it’s very important to keep eyes lubricated.

Day 3 activities

  • Exercise without risk to the eyes (e.g. treadmill, Stairmaster).
  • Be careful while playing with children.
  • Moderate alcohol consumption may be resumed.

Day 7 activities

  • Applying eye make-up, jogging outdoors, roller blading, relaxed bicycling, playing golf and lifting weights are allowed

Activities that may begin in one month (with eye protection)

  • Racket sports, swimming, scuba diving, snorkeling, sailing, sun tanning, motorcycling, parachuting, baseball, basketball and skiing

Activities that can begin in 3 months (with eye protection)

  • Water skiing, windsurfing, kayaking and surfing. Proceed with caution as these are high-risk activities.

Risks & Complications

Like any surgical procedure, SMILE involves some risk of unsuccessful results, complications or serious injury, from unknown and unforeseen causes.

Although the vast majority of our patients experience a significant improvement in their vision, neither the surgeon, nor the optometrist, eye clinic and its staff, can promise or guarantee that the procedure will be 100% effective or make vision better than it was before the procedure. 

During the preoperative examination, the chances of seeing well without glasses or contact lenses after one surgery will be conveyed to the patient based on their level of refractive error.

There is a small possibility that the procedure or a complication arising from the procedure could cause vision to be blurred either temporarily or permanently, doubled, distorted, or have halos or other disturbances, and that these would NOT be correctable with glasses or contact lenses. 

If this occurs, the surgeon will discuss and advise on further treatment, which may involve medications and/ or more surgery. If the outcome cannot be corrected by medications or external surface corneal surgery, the only way of restoring vision may be a corneal transplant. 

It is believed that with current techniques and technology, the combined risk of all causes of a corneal transplant being necessary is approximately one in 20,000 or less.

Halos and starbursts

With the all-new SMILE technique the treatment is well designed to reduce the incidence of halos and starbursts. However, some patients do not see clearly at night or dim light and may notice glare and starbursts around the lights and illuminated objects after the procedure.

This may be a temporary phenomenon or rarely a permanent problem. This is more commonly seen in patients with high levels of short sightedness or long-sightedness and for patients with larger than average pupil size.

Equipment malfunction

Rarely the equipment can fail to operate and can produce undesirable results. However our maintenance standards are equivalent to the best in the world and tested by technicians from Zeiss. The instrument goes through a testing protocol before each surgery.

Under- or over-correction

SMILE surgery corrects precise amount of tissue to correct the desired refractive power. However rarely under and over correction of results is possible and it may require retreatment or use of glasses or contact lens

Light sensitivity and fluctuating vision

SMILE reduces the chance of light sensitivity and fluctuation of vision in most cases by precise correction and removal of tissue. But rarely light sensitivity and fluctuation of vision is possible, which will stabilize in most cases by 1 to 4 weeks. In 1% of cases it may be permanent.

Dry eyes

SMILE reduces the chance of dry eyes due to less chance of cutting the corneal nerve, since the corneal flap is not developed in this form of treatment.However, in some cases, dry eyes is possible and it can be treated with eye lubricants or punctal occlusion.

Optical imbalance

If the surgeon performs the procedure on each eye on different days, in the interim period the eyes may not be able to balance and focus properly until the procedure is performed on both eyes because there will be a power difference between the two eyes.

Regression

The cornea is living tissue and once any part of it is removed to reshape the cornea and correct the refractive error, it can re-grow and thicken to compensate for the changes in the shape. Therefore some effect of the correction may decrease over time and patient may require either further treatment or correction using glasses or contact lenses.

Corneal ectasia

A certain amount of corneal tissue must remain after the SMILE procedure. This is believed to relate to the long term stability of the cornea. In rare instances, less tissue is left and this may lead to bulging of the cornea thus reversing the intended flattening effect of the treatment, or it can lead to progressive corneal deformity with thinning and increasing curvature changes, and the cornea can develop an irregular shape. 

The progressive corneal deformation is called ectasia, sometimes requiring collagen cross linking or corneal transplant. This complication may occur in 1 out of 10,000 cases.

Diffuse lamellar keratitis (DLK)

1 in 500 patients experience a temporary inflammatory reaction beneath the corneal surface. This condition has been called “Sands of Sahara” or diffuse lamellar keratitis also known as “DLK”. The exact cause of this complication has not been identified, and is likely due to many different factors. 

Patients with DLK may not show any symptoms at all or may experience blurred vision and tearing, which can last from several days up to several weeks, and which can delay the healing process.

DLK generally can be treated with topical and/or oral steroids, occasionally with possible need for surgical intervention (the surgeon irrigates beneath the corneal surface).

Other rare side effects

Epithelial in-growth, vascular occlusion, Microscopic corneal surface irregularity, infection, haemorrhage, blockage and other unforeseen complications which may or may not be directly related to the surgical procedure, can occur rarely.

Other Treatments

Learn More

SMILE

A femto laser procedure without a flap to get rid of glasses or contact lenses.

FemtoLASIK

A laser procedure to eliminate glasses or contact lenses.

Laser Blended Vision

A laser procedure to minimise dependency reading glasses and distance glasses.

Surface Ablation

An excimer laser procedure suitable for people with a thin cornea.

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