SMILE (Small Incision Lenticule Extraction) Laser Eye Surgery

What is SMILE?

SMILE (Small Incision Lenticule Extraction) is an advanced, "flapless" refractive laser surgery. It is designed to correct visual errors such as short-sightedness (myopia), astigmatism and - with the latest technology - long-sightedness (hyperopia).

SMILE offers several distinct advantages: it better preserves the structural integrity of the cornea, reduces the risk of post-operative dry eye and eliminates flap-related complications (such as displacements or epithelial ingrowth). It is an ideal option for patients seeking a minimally invasive correction with maximum ocular stability.

How does SMILE work?

1. Preparation: Topical anaesthetic drops are applied to ensure total comfort. A specialised and gentle speculum is used to keep the eyelids open securely.
2. Creation of the Lenticule: Using a high-precision femtosecond laser, a microscopic disc of tissue - known as a lenticule - is sculpted within the layers of the cornea.
3. The Corneal Cap: In this procedure, the large flap typical of LASIK is replaced by a cap. This is the superficial layer of corneal tissue that remains intact above the lenticule, preserving the eye's natural protective barrier.‍
4. Microscopic Incision: Two small incisions of approximately 2 to 3 millimetres are made. This allows access to the lenticule without the need to create a larger corneal flap as required in LASIK.‍
5. Extraction: The surgeon gently removes the lenticule through one of the micro-incisions. This changes the curvature of the cornea, precisely correcting the refractive error.‍
6. Healing: The micro-incisions heal rapidly (usually within 24–48 hours) without the need for sutures (stitches).‍
7. Results: Vision improves progressively, with most patients enjoying significantly clearer sight by the very next day.

Advantages of SMILE

• Minimally Invasive: Requires a microscopic incision of only 2–3mm, compared to the 8–9mm flap required for LASIK.
• Reduced Dry Eye Risk: Because the corneal nerves are better preserved, the incidence of post-operative dry eye is significantly lower than with LASIK or PRK.
• Superior Structural Stability: Because the cap is not a detached flap, it remains structurally integrated with the surrounding cornea. This maintains the eye's biomechanical strength more effectively than LASIK.
• Elimination of Flap Displacement: Since there is no flap to lift, there is virtually no risk of it shifting or displacing due to accidental eye contact or trauma.
• Reduced Risk of Folds: The cap architecture significantly limits the potential for microscopic folds (striae) or epithelial ingrowth, as the "interface" is accessed only through the micro-incisions rather than a 270-degree cut.
• Ideal for Active Lifestyles: Because the anterior corneal layers remain more stable, SMILE is the preferred choice for individuals in contact sports or high-risk professions (e.g., military, police, or emergency services).

Who is a suitable candidate?

• Myopia & Astigmatism: Highly effective for mild to high short-sightedness and astigmatism (up to 5 dioptres).
• Hyperopia: With SMILE® pro, it is now possible to treat long-sightedness.‍
• Stability: Your prescription should be stable for at least one year.‍
• Active Lifestyle: Excellent for those who wish to return to sports or physically demanding jobs quickly.‍
• General Health: Candidates should have healthy corneas and be free from significant ocular diseases like keratoconus or advanced cataracts.‍
• Pregnancy: As with all refractive surgeries, candidates should not be pregnant or breastfeeding.

What are the risks?

SMILE is exceptionally safe, though as with any surgery, minor side effects can occur:

• Temporary Dry Eye: Significantly less common than with other laser techniques (LASIK and PRK).
• Visual Disturbances: Transient halos or glare at night, which usually resolve within a few weeks to months.
• Neuroadaptation: Slight fluctuations in vision during the initial healing phase.‍
• Infection: Extremely rare (estimated at less than 1 in 10,000 cases).‍
• Refinement: In rare instances, a "top-up" procedure (usually with LASIK in the cap) may be required to fine-tune the result.‍
• Interface Inflammation: Occasional mild inflammation (DLK) that is easily managed with anti-inflammatory drops.
• An extremely rare weakening of the corneal structure. With modern diagnostic technology, we can identify and exclude high-risk candidates to minimise this possibility. Avoiding vigorous eye rubbing (friction) post-operatively is also a critical factor in preventing this condition.
• Slower Visual Recovery: In some instances, the initial "clearing" of vision may be slightly slower than with LASIK, though the final long-term results are identical.