Relex SMILE – Laser correction of myopia and astigmatism
SMILE (Small Incision Lenticule Extraction) is the latest refractive surgery technique developed to correct myopia and astigmatism. It is a relatively new procedure, but it uses a laser with over 30 years of experience: the femtosecond laser used in LASIK. The operation is performed under local anesthesia. A lens is created with a laser within the thickness of your cornea and then extracted through an incision of less than 3 mm. This technique has the advantage of being more durable in the long term than the LASIK flap, causing less dry eye, and allowing for a painless visual recovery within 48 hours. SMILE is currently undergoing validation for the treatment of hyperopia and presbyopia by American and European authorities.
What is a SMILE?
Small Incision Lenticule Extraction (SMILE) is the latest laser refractive surgery technique. We have approximately 10 years of experience with these procedures. The laser corrects myopia and astigmatism.
During SMILE, your surgeon corrects your vision by reshaping the cornea from the inside, unlike PRK where the cornea is reshaped on the surface. This technique allows for a much shorter healing time.
The laser technique makes it possible to do without glasses and lenses until a small pair of magnifying glasses is needed for near vision between the ages of 42 and 45 to compensate for presbyopia.
Why choose a SMILE?
If you participate in combat sports, have an active lifestyle or job, or don't want to take five days off work for refractive surgery, SMILE may be a better option for you than PRK or LASIK. This is because SMILE doesn't involve creating a flap in your cornea like LASIK, making it more durable in the long run.
The healing process does not involve the regrowth of the epithelium, so the results are visible more quickly than with PRK and there is less pain.
Because the cut is finer, there is less eye dryness.
Eligibility
To be eligible for SMILE surgery, you must meet certain conditions. Here are the main ones:
Being nearsighted and/or astigmatic. (Far-eyedness and presbyopia will be approved by 2023)
Be at least 20 years old (but ideally 23 years old), the age at which any corneal abnormalities contraindicating surgery have been revealed.
Your corrections must not have changed by more than 0.50 over 3 years before age 25 and 2 years after age 25.
Your cornea must be more than 500 µm thick.
The correction must leave more than 300 µm of residual thickness after remodeling.
Your prescription must be SMILE-compatible. The correction limits are generally: -10 for myopia, -6 for astigmatism, +6 for hyperopia.
Your visual expectations must be in line with the results that the operation delivers.
Contraindications and ineligibility
Some patients are excluded from SMILE. In particular, if you have:
Unstable corrections.
An abnormal cornea, too thin or too curved.
Corneal dystrophy or opacities.
A corneal scar preventing the laser from making the cut.
Uncontrolled or advanced glaucoma.
Uncontrolled diabetes.
Being pregnant or breastfeeding.
Severe skin healing disorders such as keloids (relative contraindication).
Your ophthalmologist can discuss other conditions that might prevent you from undergoing SMILE surgery. LASIK, PRK, or phakic intraocular lens implants (ICL) can then be discussed!
Pre-operative assessment and examinations
To determine if you are a candidate for PRK, your ophthalmologist will examine your eyes. Here's what will be done:
Refraction – Your prescription will be checked dynamically. Precise adjustments will be made.
Clinical examination – Dry eye, cataracts or fundus abnormalities will be sought.
Topography – Your cornea will be analyzed in 3D to detect irregularities or thinning that may indicate fragility.
Pachymetry – The thickness of your cornea will be checked; it must be greater than 500 µm and sufficient for treatment.
Pupillometry – The size of your pupil will be checked; enlarged treatment will be required if the pupil is large.
Cycloplegia – Your myopia and astigmatism will be controlled with accommodation-releasing drops (Skiacol) to ensure perfect correction.
Scleral localization – The latest development to improve the accuracy of treatment, the machine performing the preoperative assessment is connected to the laser in order to recognize your eye and the axis of the astigmatism.
SMILE Procedure
Before the operation
Once the pre-operative assessment is completed and the procedure approved, the surgeon's secretary will give you a surgery date and provide you with certain formalities. You will also receive a cost estimate and written consent from the French Society of Ophthalmology. Payment for the procedure will be made on the day of the operation at the laser center.
Here are some tips:
Once you have received the quote, contact your health insurance provider. They often contribute to the cost of your optical care as part of your coverage.
Plan for a light workday the day after the operation.
Try to find someone to accompany you back home, otherwise you'll have to order a taxi.
Collect post-operative medications from the pharmacy before the operation.
Do not wear your contact lenses the week before the operation.
On the day of the procedure, carefully remove your makeup and wash your face with soap and water.
Avoid complex hairstyles; present yourself with your hair down or in a low ponytail to be comfortable under the laser.
Upon your arrival at the Laser Centre, do not hesitate to share any remaining questions and concerns you may have with the medical teams.
The operation – During the SMILE
The procedure usually lasts 10 to 15 minutes for both eyes. Here's what you should expect:
The laser is programmed with specific corrections and optical tracking for your eye.
Anesthesia is administered via drops.
A blepharostat, an insert that allows you to keep your eyes open, is placed on your eyelids.
The laser arm is brought close to your eye. Its sterile tip suctions itself and flattens the cornea.
Your eye is held in place and cannot move except for inappropriate voluntary movement.
The laser sculpts a disc-shaped piece of cornea under the surface of your eye. This is the "lenticle" which gives the operation its name.
The laser then makes a small 3mm incision on the side of your cornea. This will allow the surgeon to remove the lenticule.
The laser treatment lasts approximately 10 seconds and the lenticule extraction takes 1 to 3 minutes.
The procedure is painless. You will feel the surgeon slightly move your eye.
Post-operative and recovery after SMILE
Keep these points in mind in the days following the operation:
It is best if someone drives you home after the operation.
Remain calm for the rest of the day.
Start the treatments prescribed by the surgeon a few hours after the procedure.
Your vision may be blurry immediately after the SMILE procedure. It will gradually improve over the next 2-3 days.
You will be able to resume most of your normal activities after a day or two. Avoid getting water in your eyes for 7 days.
Vision after the SMILE
More than 90% of SMILE patients have vision better than 7/10 the day after the operation and 10/10 a few days later.
Final vision frequently exceeds 12/10 without correction in myopic and astigmatism patients.
SMILE can also be used to correct presbyopia in monovision. The technique involves correcting the dominant eye, which will be favored for distance vision (emmetropia), and the non-dominant eye for near vision (residual myopia). This imbalance, also called "optical shift," is first tested with contact lenses. An adaptation period and sometimes a little orthoptic therapy may be necessary.
What are the advantages of SMILE?
SMILE is a recent refractive surgery; its development is intended to improve the performance of LASIK.
No corneal flap is created during SMILE. Therefore, there can be no problems with the flap as can occur with LASIK.
The corneal disc is removed through a very small incision. Because the surface of the cornea is minimally disturbed, long-term dry eye is less common with SMILE.
What are the risks of SMILE?
As with any surgical procedure, the decision to perform a SMILE procedure is based on a benefit/risk assessment. Side effects are mild and complications are rare but not nonexistent. The main points to remember are:
Glare and halos, especially at night
Progressive thinning of the cornea (rare) – Called ectasia.
Dry eye – Less frequent than in LASIK.
The persistence of an unremoved lenticule residue in the treated area.
An abnormal inflammation inside the cornea.
Abscess – Surgical site infection.
Refractive error – A touch-up can be performed in PRK in case of residual myopia or hyperopia.
Most complications can be treated without vision loss. Postoperative vision loss is rare when surgical indications and contraindications are respected.
Drought after a SMILE
The risk of dry eye is significantly reduced compared to LASIK. This is because the corneal nerves are less affected due to the smaller incision. In practice, dryness is usually nonexistent or remains mild for a few days to a few weeks.
However, be aware that the risk of drought is slightly higher than with the PKR technique.
Frequently Asked Questions
How long does dry eye last after a Relex Smile treatment?
Dry eyes after a Relex Smile procedure are temporary. They last on average one month and are generally quite tolerable.
A procedure performed by Relex Smile uses the latest lasers. Its cost is therefore slightly higher. Expect to pay between €1300 and €1500 per eye, or an average of €2600 to €3000.
Both operations utilize the femtosecond laser.
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In the case of Relex Smile, the entire correction is performed with the same laser, and the incision measures 3 mm.
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In the case of Lasik, the correction is performed by the excimer laser and the incision is more than 25 mm.