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The New SMILE Refractive Procedure

August 25, 2017

You probably don’t keep up with all the latest news and updates in the laser eye surgery world, and that’s okay—because we do. So don’t worry if you haven’t heard of the SMILE procedure yet. We’re here to fill you in.

SMILE, or small-incision lenticule extraction, is just the latest application that the femtosecond laser makes possible. Although it has been around for about a decade, the procedure was only approved in the U.S. by the FDA in 2016. Since it’s relatively new, we thought we’d provide some answers to questions you may have about the procedure.

First and foremost, what is it?

Well, in the normal LASIK procedure, the femtosecond laser makes an incision that creates a corneal flap. Then an excimer laser ablates the tissue to change the shape of the cornea. The flap is replaced, and the patient’s vision is improved.

SMILE is different in a few ways. First, it only uses the femtosecond laser. But it also doesn’t create a corneal flap. Instead, it creates a lenticule of tissue. That lenticule is then removed through a “channel” in the cornea, and the result is also an improvement in vision.

So why would this new procedure be necessary?

Theoretically, it eliminates some of the chances of complications by removing the need to create the corneal flap. That’s because several of the complications that can arise from LASIK are related to the corneal flap. It also likely severs fewer corneal nerves. That might result in less dry eye for patients. That’s because dry eye, one of the most common side effects of LASIK, is thought to be caused in part by decreased corneal sensation—caused by those severed corneal nerves. Fewer severed nerves leads to less dry eye.

So far it looks as though SMILE has only marginally better dry eye statistics, but that could change with improved techniques and more study.

Great, so why isn’t everyone using it already?

It’s important to remember that the risk of complications for LASIK is already very low. And SMILE outcomes, while approaching those of LASIK, aren’t quite there yet. A recent study has called into question the superiority of the SMILE procedure over LASIK. We’ll likely need to continue to study and compare it to other refractive procedures before we crown it as the most effective of them all.

Also, right now there isn’t an accepted standard for secondary procedures or enhancements. LASIK patients sometimes need a secondary procedure. Right now it doesn’t seem that removing a second lenticule is an option for SMILE. There are other options, but there isn’t an agreed upon standard yet.

But it does show a lot of promise?

Most certainly. Using only one laser and eliminating any complications from the corneal flap is definitely an attractive goal. We’ll keep you updated as the SMILE procedure continues to progress now that it’s FDA approved.

Interested in learning more about your options for correcting your vision? Then talk to the experts. Call us today at OCLI and we can set up a consultation to discuss the best option for your eyes.

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