SMILE/Lenticule Extraction Laser Eye Surgery

A comprehensive guidE

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What is SMILE

LASIK stands for Laser-Assisted In Situ Keratomileusis. It is a type of laser eye surgery that uses a cool-beam laser to reshape the cornea and improve vision. It is the preferred treatment of laser eye surgeons and patients. Far more LASIK eye surgery procedures are performed than other laser treatments.

If you have wanted to know how laser eye treatment achieves clear vision, this is the page for you.

LASIK belongs to the family of procedures called refractive surgery, which are treatments designed to remove a refractive error, the medical term for needing glasses or contact lenses.

Laser refractive surgery procedures:

  • LASIK
  • PRK aka LASEK
  • Lenticule extraction (SMILE, SILK, CLEAR)

Results are very similar for all treatments, and each has benefits, although the healing process will vary.

Key Takeaways

  • LASIK is a type of laser eye surgery that reshapes the cornea to improve vision and reduce the need for glasses or contacts.
  • The procedure involves creating a flap in the cornea and exposing underlying tissue to an excimer laser that sculpts the cornea into a new shape.
  • Benefits of LASIK include freedom from glasses/contacts, improved night vision, and quick recovery with immediate vision improvement for most patients.
  • Risks are rare but include dry eyes, infection, and flap complications. Proper patient selection is key.
  • Ideal candidates have healthy eyes without very high prescription or thinning corneas. Thorough pre-op evaluation and choosing an expert surgeon help minimize risks.
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Table of Contents

what happens during your procedure?

LASIK Surgery Steps

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The protective flap typically takes about 24 hours to re-adhere naturally. LASIK takes 5-7 minutes per eye and is done as an outpatient procedure under numbing drops. Patients can usually return to their normal routines within a couple of days. Patients are counselled not to expect perfect vision. However, most patients achieve eyesight that matches or exceeds what they could see with their glasses or contact lenses.

How Does LASIK Work?

  • Short-sight (myopia) – The cornea is flattened so that distant objects come into focus. This is done by applying more laser pulses to the centre and fewer to the periphery.
  • Long-sight (hyperopia) – The central cornea is steepened to improve close-up vision. This is achieved by applying extra laser pulses to the outer corneal zone.
  • Astigmatism – Uneven curvatures are smoothed to provide a rounder, symmetric cornea. The number and position of pulses target irregular areas.
  • Presbyopia – The non-dominant eye is corrected for near vision, while distance vision remains in the dominant eye. This is called blended vision or monovision LASIK.

By reshaping the cornea, LASIK helps focus light rays correctly on the retina for clear vision. It treats all common vision disorders. Rather than compensating for refractive errors with lenses like glasses or contacts, LASIK aims to permanently correct vision by treating the anatomical cause.

Why should you
Choose me?

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Benefits of LASIK Eye Surgery

The independence and freedom gained from LASIK have changed millions of people’s lives for the better. Many advantages attract people to get LASIK vision correction:

  • It is a minimally invasive laser eye procedure.
  • Eliminates or reduces dependence on glasses and contact lenses. No more need to insert contacts, clean lenses, or find misplaced glasses.
  • Allows you to see more clearly for activities like driving at night. Research has confirmed that LASIK achieves better night vision than contact lenses.
  • Lets you more easily participate in sports, adventures and rigorous activities without vision correction interfering.
  • Provides quick recovery with minimal discomfort compared to past procedures. Most patients see well within 24 hours.
  • Offers the convenience of a short outpatient procedure with immediate vision improvement in most cases, typically faster than lens options.
  • Boosts confidence, self-esteem and quality of life by correcting debilitating vision problems.

Risks of LASIK

Although laser eye surgery is generally safe and highly effective, there are potential risks to consider, including:

  • Overcorrection or undercorrection – Enhancement surgeries may be needed if vision is imperfect. This occurs in 1-2% of cases and is more likely with very high prescriptions.
  • Worsening of night vision – Some patients experience more glare, halos and difficulty driving at night after LASIK. The risk is raised for those with extreme prescriptions.
  • Dry eyes – LASIK can cause dry eyes, requiring frequent use of artificial tear drops for months.
  • Corneal flap complications – Rarely, the flap may heal incorrectly with wrinkles or epithelial in-growth. Fortunately, these problems are now very rare.
  • Infection – The chances of infection are around 1 in 21,000 cases with proper postoperative care.
  • Ectasia – Weakening of corneal strength is possible but rare with modern LASIK techniques. Modern scanners have greatly reduced the chance of ectasia, and the development of collagen crosslinking treatments has provided an effective therapy.

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Patient Selection:

Who is a Candidate for LASIK?

01

Age

Is at least 18 years old with documented vision stability over 1-2 years and no significant vision changes.

02

Eye health

Has good general eye health with no diseases like advanced glaucoma, cataracts, keratoconus or uncontrolled diabetes.

03

Eye lubrication

No significant dry eye disease. Your eye doctor will confirm this at the consultation

04

Immune status

No autoimmune disorders like rheumatoid arthritis that could impede healing

05

Cornea

No signs of corneal abnormality and meets corneal thickness requirements.

Who is Not Suitable for LASIK?

  • Unrealistic expectations
  • Thin corneas
  • Very dry eyes
  • Participate in strenuous contact sports
  • Previous eye infections with the herpes virus
Other vision correction options

Alternatives to LASIK

If you are not suitable for LASIK, other laser eye surgery procedures are available: PRK and lenticule extraction (SMILE).

Another non-laser alternative for patients aged 20-60 is an implantable contact lens (ICLs), especially for higher or extreme prescriptions.

For patients aged 50+, refractive lens exchange (RLE) could be the best option.

PRK or lenticule extraction (SMILE)

Laser eye surgery options. PRK is better for thinner or weaker corneas. Lenticule extraction (SMILE, SILK) may be an option for short-sight and astigmatism but not for long-sightedness.

Implantable Contact Lenses (ICLs)

Miniature soft lens implants that are placed between the iris and the natural lens. The implants can remain in place for 10-20 years.

Refractive Lens Exchange (RLE)

Your natural lens is removed and replaced with an intraocular lens (IOL). RLE can treat all kinds of prescriptions with premium multifocal implants.


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LASIK vs PRK: Comparison Table

LASIK and PRK are the two most common laser vision correction surgeries that reshape the cornea to reduce dependency on glasses or contacts. Both use the excimer laser and are equally effective, but key differences exist in the procedures, recovery, risks, and results.

LASIK Advantages

  • Much less postoperative discomfort
  • Immediate vision improvement – within 4-24 hours
  • Treats a broader range of short-sight and astigmatism

PRK Advantages

  • Less risk of ectasia
  • No flap complications
  • Better for thin corneas

   

PRK

LASIK

Can treat all prescriptions

Prescription range *

Up to -12D (dioptres)

Up to -12D (dioptres)

Thin corneas

Fix astigmatism

Fast recovery


Post-op pain

Yes

No

Needs operating theatre

Infection rate

1 in 7,000

1 in 21,000

Talk to me about your specific vision goals and eye health to determine if LASIK or PRK is most appropriate. Both procedures are effective vision correction options with proper patient selection and technique.

LASIK vs SMILE: Comparison Table

LASIK and SMILE (Small Incision Lenticule Extraction) are two popular laser vision correction options that reshape the cornea. Both have advantages depending on the patient’s specific needs and eye profile.

LASIK Advantages

  • Quicker visual recovery within 24 hours
  • Treats a wider range of nearsightedness and astigmatism
  • Much easier to enhance if needed
  • Extremely high success rate of over 98%

SMILE Advantages

  • No flap complications
  • Potentially better tensile strength preservation
  • Lower dry eye symptom rate in first months

   

SMILE

LASEK

Treat all prescriptions

Treat long-sight?

Prescription range *

Up to -10D (dioptres)

Up to -14D (dioptres)

Thinner corneas

Fix astigmatism

Astigmatism max D

5 dioptres

6 dioptres

Vision recovery

1-7 days

4-7 days


Post-op pain

No

Yes


Needs operating theatre

Infection rate

Yes, rate unknown

Rare = 1 in 7,000

For mild to moderate nearsightedness, both SMILE and LASIK offer excellent safety. However LASIK remains superior for higher prescriptions with astigmatism correction and ease of re-treatment if required. Consult me as an experienced refractive surgeon to determine which procedure best meets your vision needs.

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How to Prepare for LASIK Surgery

Proper physical and mental preparation helps everything go according to plan before, during and after your LASIK treatment. Taking the following steps helps set the stage for the smoothest LASIK experience and recovery:

Preparing for LASIK Surgery

Proper physical and mental preparation helps everything go according to plan before, during and after your LASIK treatment. Taking the following steps helps set the stage for the smoothest LASIK experience and recovery:

  • If you are a contact lens wearer, you must discontinue wearing contact lenses for 1 to 4 weeks before your treatment, depending on the lens type.
  • Have a comprehensive eye exam to determine if LASIK is appropriate and meets the criteria set by your eye surgeon.
  • Follow your ophthalmologist’s instructions on stopping certain medications that could interfere with surgery.
  • Make arrangements for transportation on the day of surgery, as you cannot drive immediately after.
  • Limit your computer and phone screen time in the days leading up to surgery to rest your eyes.
  • Avoid wearing cosmetic products like eyeliner, mascara and perfume around your eyes before the procedure.

What to Expect After LASIK Surgery

In the first few hours after your LASIK procedure, you can expect:

  • Improved vision, though still blurry, hazy and variable. Some degree of blurred vision is normal in the first few hours.
  • Mild burning or stinging sensation as the anaesthetic eye drops wear off.
  • Watery eyes, sensitivity to light and difficulty keeping eyes open. Wear the provided sunglasses.
  • Instructions to use medicated eye drops to prevent infection and reduce inflammation.
  • Follow-up appointment with your surgeon the very next day to check your eyes.

Over the first week following LASIK:

  • Vision continues to improve after your eye surgery but may fluctuate day-to-day.
  • Avoid rubbing your eyes for the first month to prevent flap displacement.
  • Use preservative-free artificial tears frequently to minimize dryness and irritation.
  • Wear protective shields at night to avoid accidental rubbing while sleeping.
  • Limit visual activities like reading and screens to prevent overexertion.
  • Take over-the-counter pain medication like paracetamol (acetaminophen) as needed for discomfort.

Complete healing and vision stabilization takes 1-3 months on average. Attend all prescribed follow-up visits for monitoring.

Types of LASIK Surgery

There are several variations of the LASIK technique:
01

All-laser or Bladeless LASIK

 This is the gold-standard LASIK, which utilises a femtosecond laser instead of a blade to create a more precise, customizable flap with less corneal trauma.

02

Custom LASIK

Including wavefront-guided and topography-guided LASIK, incorporates detailed 3D mapping of the eye’s unique aberrations or shape to personalise the laser vision correction.

03

Conventional LASIK

Uses a surgical blade called a microkeratome to create a protective corneal flap that is gently lifted during the laser treatment. This treatment is inferior to all-laser LASIK and is best avoided.

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LASIK Recovery Tips and Timeline

  • Use preservative-free artificial tear drops liberally to keep your eyes lubricated, especially the first 1-2 months.
  • Wear your protective eyewear at night as directed to avoid accidentally rubbing your eyes.
  • Limit visual stimulation like screens, reading and driving to prevent overexertion and optimise healing.
  • Avoid eye makeup or swimming for at least 1 week after surgery.
  • Take over-the-counter pain medication like paracetamol (acetaminophen) if you experience discomfort.
  • Keep all follow-up appointments for vision checks and monitoring.

The typical LASIK recovery timeline is:

  • 1-2 days – vision improves but varies, eyes sensitive
  • 1 week – eyes start to feel normal, vision stabilises
  • 1 month – generally comfortable. Dryness is common in the first few weeks
  • 3 months – fully healed with stabilised vision. The patient can resume contact sports.

Closely following your surgeon’s post-op instructions facilitates rapid recovery.

LASIK Results and Patient Satisfaction

Various studies confirm LASIK provides some of the highest patient satisfaction rates of any elective surgery based on visual outcomes. Our published results at Focus Clinics at here.

Of course, individual results depend on the patient’s pre-operative prescription and eye anatomy. Your ophthalmologist will determine your likely outcomes.

  • 100% achieve 20/20 vision or better – short-sight up to -6.00 dioptres, including astigmatism up to 2.00 dioptres.
  • 99.7% achieve better than 20/20 vision after LASIK – this is considered excellent sharp vision.
  • Around 99% of patients are satisfied with their vision improvement from LASIK.
  • Most patients report seeing substantially better within 24 hours after their procedure.
  • For many, the vision improvements from LASIK are long-lasting when performed on suitable candidates.
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Frequently Asked Questions

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Is laser eye surgery safe?

Following a high degree of technology development, better patient selection and improved surgical technique over the past 30 years, LASIK eye surgery is considered safe and serious complications are very rare.

The femtosecond laser has ensured a highly reliable and repeatable method to create a LASIK flap and eliminated epithelial ingrowth from the primary procedure (this was a common complication with the old blade-cut devices).

The risk of vision loss is lower than occurs with regular use of contact lenses.

Does laser eye surgery hurt?

Using anaesthetic eye drops ensures you feel no pain from the corneal surface. You may be aware of a sensation of pressure while the LASIK flap is created. Most patients consider laser treatment to be less painful than the dentist!

How much does laser eye surgery cost?

Refractive surgery does entail a large upfront cost. However, studies have confirmed that laser surgery is cheaper than glasses and contact lenses in the long term.

Financing options are routinely available. You can learn more on our eye treatment Pricing page.

Other OPTIONS

Alternatives to LASIK Surgery

The most common alternatives to LASIK are the surface laser treatments: PRK or LASEK eye surgery. These procedures are identical in recovery and results and can be considered the same surgery.

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