Advantages of the SMILE procedure:
- Minimally invasive surgery
- Preserves integrity of upper corneal layers
- Ensures preservation of corneal biomechanical stability
- Less 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
To be eligible for the SMILE procedure, you must be over 18 years of age and not have had a significant change in your glasses or contact lens prescription for the preceding twelve months. Other factors, such as thegeneral health of your eye, will be examined at the preoperative assessment.
- Recurrent eye inflammations or infections
- Excessive corneal disease or scarring
- Degenerative disease of cornea
- Use of certain drugs
- Pregnancy and nursing
- Certain rheumatological conditions (Lupus, Rheumatoid arthritis, Sjogrens etc)
- Severe dry eyes
- Inadequate corneal tissue
- Uncontrolled diabetes
You can request a copy of you consent Form(s).
An overwhelming success rate with SMILE achieved in most cases after the initial procedure. However, due to an individual’s prescription level and unique physiology, an additional treatment or enhancement procedure may sometimes be required. If this is the case, you would need to return to your original surgeon, for re -evaluation and if possible for retreatment.
In general, patients must wait at least three months after the first procedure, and complete all mandatory post-operative appointments, before requesting an enhancement. In majority of cases, the decision about any need for enhancement can be made at the three- month post-operative visit. You may also be required to complete an annual eye examination prior to requesting a re-treatment. Whether or not you experience the need for an enhancement, keep in mind that all patients will eventually require reading glasses as part of the unrelated and natural aging process of the eye.
Like any surgical procedure, SMILE involves 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 your surgeon, nor your optometrist, not the eye clinic nor its staff, can promise or guarantee that the procedure will be 100% effective or make your vision better than it was before the procedure. During your pre-operative examination, the likely surgical efficacy outcome (e.g. the chances of you seeing well without glasses or contact lenses after one surgery) will be conveyed to you based on the level of your particular refractive error.
There is a small possibility that the procedure or a complication arising from the procedure could cause your 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. In the event this should occur, your surgeon will discuss and offer you 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 the vision may be a corneal transplant.
However, 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 Starburst
The SMILE technique is well designed to reduce the incidence of halos and star bursts. However, some patients do not see clearly at night or dim light and may notice glare and star burst 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.
Rarely the equipment can fail to operate and can produce undesirable result. However our maintenance standards are equivalent to the best in the world and tested by German technology from Carl Zeiss. The instrument goes through a testing protocol before each surgery.
Under-or Over Correction
The 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
The smile technique 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.
SMILE technique 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 punctual occlusion.
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.
The cornea is a 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 lens.
A certain amount of corneal tissue must remain after 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, sometime requiring collagen cross linkage 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).
Some 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.
- Be prepared for extensive eye tests prior to laser vision surgery. The process includes: eye test using topical anaesthetic drops and eye dilatation.
- Please arrange for alternate transport and sunglasses when you come for the assessment