What Is SMILE Surgery?

ReLEx SMILE is a groundbreaking form of laser eye surgery that has revolutionized corrective treatments for individuals with short-sightedness.

Pioneered by Carl Zeiss Meditec and developed further by Dr. Dan Reinstein, the minimally invasive procedure enables surgeons to provide flapless surgery, effectively rendering the process a keyhole procedure. Around since 2007, the procedure has been embraced by the ophthalmological community following clinical trials starting in 2011 and 2012, and is becoming more widely practiced throughout the world as early adopters report positively on the procedure.

With a shorter recovery period, fewer side-effects and excellent results, this groundbreaking surgery is paving the way to the future of corrective vision surgery.

Here, Valerie Saw, Consultant Ophthalmic Surgeon at Moorfields Eye Hospital, describes the surgical technique used for SMILE surgery and outlines the advantages this procedure has over other treatments:


Video Transcript

"There is a new way of carrying out the surgery where we can do a flap-free corneal laser surgery and that’s called SMILE, ReLEx SMILE and the laser that does that is here (gestures to the machine behind). The laser cuts a very precisely shaped disk of tissue in the cornea and the piece of tissue is customised to correct the focus of the eye. Then that little piece of tissue is removed from the cornea through a keyhole incision, so there’s no need to cut a Lasik flap.

The advantages are the eye is stronger, there is evidence that there is less dry eye as well, and that the visual recovery is quicker than with surface laser treatment, which takes at least 7 to 14 days for the vision to recover.

At the moment it is being offered to a portion of our patients, which is really exciting but it’s only available at the moment for people with shortsight and astigmatism. It’s not possible to correct longsight at the moment with this technology. Also there is some refinements in terms of tracking of the eye and registration to make sure they are worked on at the moment.

That’s really an exciting field because potentially it could make the need to have the Lasik flap less common. I don’t think it’s going to mean that Lasik and surface treatment are not performed, but it’s good to have an alternative for people who can’t take time off work for the surface treatment, and they don’t want the flap or there are reasons why they can’t have the flap."

Valerie Saw, Consultant Ophthalmic Surgeon at Moorfields Eye Hospital


How Does ReLEx SMILE Work?

SMILE Surgery

Standing for “small incision lenticule extraction”, SMILE is a high-precision procedure that is changing the face of visual correction.

Traditional surface laser surgeries such as LASIK use an excimer laser to make a flap, which is then folded back so that the corneal tissue can be removed. ReLEx SMILE surgery is a minimally invasive way of correcting vision without having to create this flap, using a high-frequency VisuMax femtosecond laser that emits light at one millionth of a nanosecond.

Just as with surface laser surgery, the patient will be made comfortable and will receive numbing drops to eliminate any pain or sensation during the process. Lid-guards will be positioned so as to keep eyes open without any accidental blinking. A refractive lenticule (a precisely disc-shaped piece of tissue) and small incision measuring roughly 2-4mm are then created with the laser. This incision is roughly 80% smaller side-cut when compared to the flap created with LASIK surgery (a side-cut created with LASIK tends to be around 20mm). The lenticule is removed through the keyhole incision, which changes the shape of the cornea and therefore achieves the refractive change required to correct the patient’s vision.

The process is swift, with the laser only in operation for a short period of time. Once given the all clear, patients can leave the same day.

The result is flap-free corneal laser surgery, which poses many benefits to those who are able to have the surgery. Currently, ReLEx SMILE surgery is only available for people with short-sight (myopia) or astigmatism, and therefore cannot be used to correct hyperopia, or long-sightedness. It is not a replacement for surface laser treatment either, but rather can be used instead of on patients that fit the criteria.

How Is ReLEx SMILE Different To Surface Laser Surgery?

There are similarities between LASIK and ReLEx SMILE, but also a number of differences, chief among them being the flapless method of incision.

As it is a minimally invasive procedure, patient discomfort is minimized, and many have reported faster recovery periods than those who underwent surface laser corrective surgery. The actual process is faster too, as the laser is single-step so there is no need to use more than one instrument or move patients to different angles. This means the procedure can be carried out in just a few minutes.

The method of surgery, the laser and the patient experience are all different to surface procedures such as LASIK, but the results are the same – enhanced, clear vision with no more need for glasses.

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Benefits Of ReLEx SMILE Surgery

Clinical trials revealed that the recovery period is quicker with SMILE than with other types of visual corrective surgery.

While patients may have to wait up to 24 hours for vision to begin to return to normalcy with other surgeries, patients who underwent ReLEx SMILE saw their vision was 80% better straight away, and reached 100% within days. Along with the faster visual recovery, there are many other benefits to this type of procedure. For example, as there is less trauma to the eye during the surgery, this means the eye is left stronger. There is also less dry eye, something common following surface laser eye surgery. Studies found that when comparing the number of patients using drops to treat dry eye after having visual corrective surgery, 80% of ReLEx SMILE patients had finished their drops six months after surgery, compared with just 57% of the patients who had undergone LASIK.

The minimally invasive nature of the surgery means that patients who may have been unsuitable for surface laser treatment (such as those with a predisposition for dry eyes or thin corneas) can now undergo a procedure for vision correction. Complications have arisen infrequently, with those that have been associated with the ReLEx SMILE being easily fixed and impermanent.

ReLEx SMILE Surgery – The Future Of Corrective Vision Care

While ReLEx SMILE cannot be used to treat long-sightedness, it has proved to be very successful in the correction of myopia and astigmatism.

In a clinical study, 269 eyes were analysed over three study centres, all of which had a Best Corrected Visual Acuity of 20/20 or better before undergoing the procedure. BCVA is the best vision that can be achieved with corrective measures such as prescription glasses and contact lenses. Following the treatment, 85% of patients with a preoperative BCVA of 20/20 or higher achieved uncorrected visual acuity of 20/20 or higher, meaning they no longer required glasses or corrective measures to enjoy 20/20 vision thanks to ReLEx SMILE.

Although not as common a procedure as LASIK, SMILE is quickly becoming a promising alternative to this treatment. The keyhole correctional ability, fast patient recovery periods and the speed of the procedure are all positive benefits that could help many people throughout the world attain 20/20 vision without the need for glasses.

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