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SMILE Eye Surgery: A Comprehensive Guide

smile eye surgery

Did you know that over 3.5 million SMILE eye surgeries have been performed worldwide? This innovative procedure is revolutionizing the field of laser vision correction, offering an alternative to traditional methods like LASIK. However, despite its growing popularity, many people are still unaware of what SMILE surgery entails and how it could benefit them.

In this comprehensive guide, we will delve into the world of SMILE eye surgery, shedding light on its procedure, benefits, and how it compares to other eye surgeries.

Understanding SMILE Eye Surgery

SMILE, or Small Incision Lenticule Extraction, is a cutting-edge laser eye surgery designed to correct nearsightedness and astigmatism. Unlike traditional procedures, SMILE laser eye surgery is minimally invasive, involving only a tiny incision in the cornea. This results in a quicker recovery time and less discomfort for the patient.

Overview of what SMILE eye surgery involves

  • The procedure begins with the application of a topical anesthetic to numb the eye.
  • A state-of-the-art Carl Zeiss VisuMax laser is then used to create a small, lens-shaped piece of tissue (known as a lenticule) within the cornea.
  • This lenticule is then removed through a tiny incision, thereby reshaping the cornea and correcting the patient’s vision.

The entire procedure typically takes only a few minutes per eye and is performed on an outpatient basis, meaning patients can return home the same day.

In the next part of this guide, we will delve deeper into the workings of SMILE eye surgery and how it compares to other laser vision correction procedures like LASIK. Stay tuned!

How Does SMILE Eye Surgery Work?

SMILE eye surgery is a revolutionary procedure that uses advanced laser technology to correct vision. Here’s a detailed step-by-step breakdown of how it works:

smile laser eye surgery steps
  1. Preparation: Before the surgery begins, the patient’s eye is numbed using topical anesthetic drops. A special device is used to keep the eye open throughout the procedure, ensuring the patient doesn’t blink.
  2. Creating the Lenticule: The surgeon uses a state-of-the-art Carl Zeiss VisuMax laser to create a small, lens-shaped piece of tissue (known as a lenticule) within the cornea. This step is carried out with extreme precision to ensure the lenticule is the correct shape and size to correct the patient’s vision.
  3. Removing the Lenticule: The surgeon then makes a small incision in the cornea, through which the lenticule is removed. This process reshapes the cornea, correcting the refractive error that causes nearsightedness or astigmatism.
  4. Post-Surgery: Since the incision made during SMILE eye surgery is very small, it heals quickly, without the need for stitches. Most patients experience a significant improvement in their vision within a few days of the procedure.

SMILE Eye Surgery vs. LASIK: A Detailed Comparison

SMILE (Small Incision Lenticule Extraction) and LASIK (Laser-Assisted In Situ Keratomileusis) are two popular forms of laser vision correction that have helped countless patients achieve better vision. However, they differ in several key aspects:

smile vs lasik incision sizes
  • Procedure: LASIK is a two-step surgical procedure that involves creating a thin flap in the cornea with a femtosecond laser, then reshaping the underlying corneal tissue with an excimer laser. On the other hand, SMILE surgery is a minimally invasive surgery that uses a femtosecond laser to create a small lenticule within the cornea, which is then extracted through a small incision. This difference in procedure can impact recovery, comfort, and the risk of certain complications.
  • Recovery: Both SMILE surgery and LASIK offer quick recovery times. However, because SMILE is a less invasive refractive surgery that doesn’t involve a LASIK flap, many patients find the recovery process to be more comfortable. With SMILE, patients often experience less dryness and discomfort in the days following surgery compared to LASIK patients.
  • Dry Eyes: LASIK can sometimes lead to dry eyes post-surgery. This is less common with SMILE due to the smaller incision and lack of a corneal flap. This can be a significant advantage for individuals who already struggle with dry eyes or those who frequently wear contact lenses.
  • Correction of Refractive Errors: SMILE surgery has been shown to be particularly effective in correcting higher levels of myopia (nearsightedness). While the LASIK procedure can also correct high myopia, some studies suggest that SMILE may provide more stable outcomes for these patients.
  • Flap-Related Complications: Because LASIK involves the creation of a corneal flap, there is a risk of flap-related complications, such as flap dislocation or epithelial ingrowth. These risks are eliminated with SMILE, as no flap is created.
  • Preservation of Corneal Strength: Some research suggests that SMILE may better preserve the biomechanical strength of the cornea compared to LASIK, as it involves a smaller incision and leaves the anterior corneal layers largely intact.
  • Visual Outcomes: Both SMILE and LASIK have been shown to provide excellent visual outcomes. Most patients achieve 20/20 vision or better. However, individual results can vary, and it’s important to have a thorough discussion with your eye surgeon about what you can expect.

While both SMILE surgery and LASIK are effective procedures for vision correction, they each have their own advantages and potential drawbacks. The best option for you will depend on your specific vision needs, your lifestyle, and your personal preferences.

Always consult with a qualified ophthalmologist to discuss your options and determine the best course of action for your vision correction.

The Benefits of SMILE Eye Surgery

SMILE (Small Incision Lenticule Extraction) is a groundbreaking form of laser vision correction that offers several advantages over traditional refractive surgery methods. Here are some of the key benefits:

  • Minimally Invasive: SMILE is a minimally invasive surgery that involves making about a 4mm incision in the cornea. The small incision in SMILE results in less disruption to the corneal surface and corneal nerves, leading to fewer complications and a more comfortable recovery.
  • Quick Recovery: Most SMILE patients experience a quick recovery after surgery. Many report improved vision the next day, allowing them to return to their daily activities without the need to wear glasses or contact lenses.
  • Minimal Discomfort: There is minimal post-operative discomfort due to the size of the incision.
  • Effective in Correcting Myopia and Astigmatism: SMILE has been proven to effectively treat nearsightedness and astigmatism. SMILE is approved for patients with -1 to -10 D of myopia and -0.75 to -3 D of astigmatism.
  • Preservation of Corneal Strength: As SMILE involves a smaller incision and does not require the creation of a corneal flap, it better preserves the biomechanical strength of the cornea. This can be particularly beneficial for those who lead active lifestyles or participate in contact sports.
  • Lower Risk of Dry Eyes: SMILE has been associated with a lower risk of dry eyes compared to LASIK. This is because the procedure is less disruptive to the corneal nerves, which play a crucial role in tear production.
  • Fewer Higher Order Aberrations: Some controlled clinical studies have shown that SMILE can result in fewer higher order aberrations compared to LASIK. These aberrations can cause issues such as glare and halos around lights.

SMILE eye surgery is a revolutionary procedure that is a good alternative to traditional laser eye surgery methods. With its quick recovery time, effective results, and lower risk of complications, it’s no wonder that more and more people are choosing SMILE for their vision correction needs.

Who is a Good Candidate for SMILE Eye Surgery?

While SMILE eye surgery is a safe and effective procedure for many people, it’s not suitable for everyone. Here are some factors that may make you a good candidate for SMILE:

  • You have moderate to high myopia: SMILE is particularly effective for people with moderate to high nearsightedness.
  • You have thin corneas: Unlike LASIK, which requires a certain corneal thickness, SMILE can be performed on people with thinner corneas.
  • You lead an active lifestyle: The absence of a corneal flap in SMILE makes it a good option for those who engage in contact sports or other activities that could dislodge a corneal flap.
  • You have dry eyes: SMILE is often a better choice for people with dry eyes, as it’s less likely to exacerbate this condition compared to LASIK.

Who is Not a Good Candidate for SMILE Eye Surgery?

While SMILE eye surgery is a great option for many individuals, it’s not suitable for everyone. Certain conditions and factors may make it less effective or potentially risky. Here are some situations where eye surgery might not be the best choice:

  • Severe Dry Eyes: While SMILE is less likely to cause dry eyes compared to LASIK, those with pre-existing severe dry eye syndrome may still experience exacerbated symptoms after surgery.
  • Extreme Refractive Errors: SMILE is most effective for correcting moderate to high levels of myopia (nearsightedness) and astigmatism. However, for those with extreme refractive errors or hyperopia (farsightedness), other procedures like LASIK surgery or PRK might be more suitable.
  • Corneal Conditions: Certain corneal conditions, such as keratoconus (a thinning and bulging of the cornea), disqualify a person from being a candidate for SMILE.
  • Systemic Diseases: Individuals with certain systemic diseases, like uncontrolled diabetes or active autoimmune disorders, may face a higher risk of complications during and after surgery.
  • Age: SMILE laser eye surgery is typically recommended for adults over the age of 22, when the eyes have stopped growing and prescriptions have stabilized.
  • Pregnancy and Nursing: Hormonal changes during pregnancy and nursing can affect the shape of the cornea and visual acuity. It’s generally recommended to wait several months after childbirth or nursing before considering any refractive surgery.

For more details information on contraindications and precautions , you can FDA document on SMILE eye surgery. Download PDF.

Remember, it’s crucial to have a thorough consultation with a qualified ophthalmologist to determine whether SMILE or another vision correction procedure is right for you. They can provide a comprehensive eye exam and consider your medical history, lifestyle, and vision goals to recommend the best course of action.

What to Expect During and After SMILE Eye Surgery

If you’re considering SMILE eye surgery, here’s what you can expect during and after the procedure:

During the Procedure

The surgery itself is quick and painless, typically taking a few minutes per eye. You’ll be awake during the procedure, but your eyes will be numbed with anesthetic drops. While flat on your back, an applicator with light suction is placed on your eye, and you will be asked to focus on a blinking light. The laser portion of the procedure will begin which lasts about 60 seconds. The laser is creating the disc that will be removed through the small corneal incision.

After the Procedure

Immediately after the surgery, you might experience some blurry vision or discomfort, but these symptoms should improve within a few days. Most people can return to their normal activities the day after surgery.

Follow-Up Care

You’ll have a follow-up appointment with your surgeon a day or two after the procedure to check on your recovery. It’s important to attend these appointments and to follow your surgeon’s advice to ensure the best possible outcome.

Potential Risks of SMILE Laser Eye Surgery

While SMILE eye surgery is generally safe, as with any surgical procedure, there are potential risks and complications. These may include:

  • Vision Changes: Some people may experience changes in their vision after surgery, such as glare, halos, or starbursts around lights. These symptoms usually improve over time.
  • Dry Eyes: While less common than with LASIK, some people may experience dry eyes after SMILE eye surgery.
  • Need for Additional Surgery: Over-correction or under-correction can occur which means additional surgery may be needed to achieve the best possible vision correction.
  • Eye pain or soreness
  • Grittiness
  • Light Sensitivity
  • Poor low light vision

Rare But Serious Complications of SMILE Laser Eye Surgery

Like any surgical procedure, SMILE surgery carries a small risk of rare but serious complications. It’s important to be aware of these potential risks to make an informed decision about your vision correction options.

  • Corneal risks: weakening of the corneal tissue leading to bulging of the cornea, a condition called corneal ectasia
  • Infection or inflammation: this can lead to scarring and reduced vision
  • Retina detachment
  • Eyelid droop
  • Perforation of the corneal tissue


  • Does SMILE last as long as LASIK?

    Yes, the vision correction achieved through SMILE eye surgery is permanent, similar to LASIK. Both procedures reshape the cornea to correct refractive errors, and the changes made to the cornea are lasting. However, it’s important to note that neither procedure can prevent age-related vision changes, such as presbyopia or cataracts.

  • How long does SMILE eye surgery last?

    The actual SMILE procedure is quick, typically taking less than 15 minutes per eye. The vision correction achieved through SMILE is permanent. However, as with all types of vision correction surgery, it does not prevent age-related vision changes.

  • When was SMILE eye surgery invented?

    SMILE eye surgery was first introduced in the early 2000s. The procedure was developed by Carl Zeiss Meditec, a German company specializing in medical technology. It received FDA approval in the United States in 2016.

  • How much does SMILE eye surgery cost?

    The cost of SMILE eye surgery can vary depending on a number of factors, including the surgeon’s experience, the geographic location, and the specific needs of the patient. On average, the cost is comparable to that of LASIK, ranging from $2,000 to $3,000 per eye. It’s best to consult with a local ophthalmologist for a more accurate estimate.

  • Is SMILE more expensive than LASIK?

    The cost of SMILE eye surgery is generally comparable to that of LASIK. Both procedures range in price depending on various factors, including the surgeon’s experience, the geographic location, and the specific needs of the patient. However, it’s important to consider the potential benefits and risks of each procedure, not just the cost, when deciding on the best vision correction option for you.

Final Thoughts

SMILE eye surgery is a revolutionary procedure that offers a minimally invasive alternative to traditional vision correction methods. With its quick recovery time and effective results, it’s no wonder that more and more people are choosing SMILE for their vision correction needs.

As with any medical procedure, it’s important to discuss your options with a qualified professional. So, if you’re considering SMILE eye surgery, speak with your ophthalmologist to find out if it’s the right choice for you.