SMILE Eye Surgery: Flap-Free Laser Vision Correction for Myopia and Astigmatism
Patients exploring laser vision correction may hear about SMILE or SMILE Pro as an alternative to LASIK. SMILE stands for small-incision lenticule extraction.
Like LASIK and PRK, SMILE changes the shape of the cornea so light focuses more accurately on the retina. The major difference is how the corneal tissue is removed.
How Does SMILE Work?
During SMILE, a femtosecond laser creates a thin, disc-shaped piece of tissue called a lenticule inside the cornea. The laser also creates a small opening in the corneal surface.
The surgeon separates and removes the lenticule through this small incision. Removing the tissue changes the corneal curvature and corrects the patient’s refractive error.
SMILE does not require:
A large corneal flap
An excimer-laser ablation
Removal of the entire corneal epithelium
In the United States, SMILE is approved for the treatment of myopia with or without astigmatism within the approved prescription ranges. It is not currently the standard SMILE treatment for farsightedness. FDA labeling for the established VISUMAX platform includes patients age 22 or older with a stable prescription and qualifying myopic and astigmatic measurements.
What Is SMILE Pro?
SMILE Pro is performed using the newer ZEISS VISUMAX 800 femtosecond laser platform. The FDA approved the VISUMAX 800 with SMILE Pro software in January 2024 for treating nearsightedness with or without astigmatism.
The updated system creates the corneal lenticule more quickly and includes technology designed to assist with treatment centration and cyclotorsion alignment.
The basic surgical concept remains the same: a lenticule is formed inside the cornea and removed through a small incision.
Who May Be a Good Candidate?
A potential candidate generally has:
Myopia with or without treatable astigmatism
A stable prescription
Healthy corneas
Adequate corneal thickness
Normal corneal topography or tomography
Realistic expectations
SMILE can be attractive to physically active patients because there is no LASIK-style flap. It may also disturb fewer of the corneal nerves near the surface than LASIK, although dry-eye symptoms can still occur and severe dry eye may prevent someone from being a candidate.
What Is Recovery Like?
Most patients notice improved vision soon after treatment. However, the vision may initially appear hazy, smoky, or inconsistent.
Functional vision often returns quickly, but the sharpest clarity may continue improving over several days or weeks. Recovery varies with the prescription, tear film, healing response, and treatment technique.
Patients should follow their surgeon’s instructions regarding:
Prescribed eye drops
Artificial tears
Exercise
Swimming
Eye makeup
Water exposure
Avoiding eye rubbing
Although there is no flap, the small incision and internal corneal tissue still need time to heal.
What Are the Risks?
Possible risks and limitations include:
Dryness or fluctuating vision
Glare, halos, starbursts, or ghosting
Under-correction or over-correction
Residual astigmatism
Incomplete lenticule separation or removal
Suction loss during treatment
Infection or inflammation
Corneal haze
Rare corneal ectasia
Need for glasses or an enhancement procedure
Rare loss of best-corrected vision
An enhancement after SMILE may require PRK, a flap-based procedure, or another individualized approach. The surgeon must determine which option is safest.
SMILE Versus LASIK
LASIK creates a corneal flap and then uses an excimer laser to reshape the tissue underneath. SMILE creates and removes a lenticule through a small incision without making a large flap.
LASIK can treat a broader range of refractive errors, including certain degrees of farsightedness. LASIK may also provide slightly faster initial visual clarity for some patients.
SMILE may be appealing when flap avoidance, lifestyle, or corneal nerve preservation is an important consideration.
SMILE Versus PRK
PRK removes the corneal epithelium before using an excimer laser. The surface must then regenerate beneath a bandage contact lens.
SMILE generally causes less surface discomfort and provides faster early recovery than PRK. However, PRK may be preferred when the surgeon wants a surface treatment rather than an internal lenticule procedure.
Is SMILE Right for You?
The best procedure depends on the structure of the eye rather than which technology sounds newest.
At OPT-ISM Eye Care in Tampa, a refractive evaluation can assess your prescription, corneal maps, thickness, tear film, retinal health, and daily visual needs. These findings can help determine whether SMILE, LASIK, PRK, EVO ICL, or another option deserves consideration.
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