What’s Behind That SMILE?

What’s Behind That SMILE?

It’s human nature to always want the latest and greatest. When the new iPhone comes out everyone rushes to the Apple store to wait in line. Why buy an ordinary gas car when you can get a Tesla? We live in an age where there’s always something newer, always something better, but is that the case with everything?

SMILE (Small Incision Lenticule Extraction) is a refractive procedure that earned FDA approval in the United States in September of 2016.  SMILE is known for its’ similarity to LASIK in the sense that it’s purpose is to reduce the use of glasses or contacts, but here are a few things to keep in mind about Smile:

#1. SMILE is more difficult to perform and has more complications than LASIK:
a. SMILE removes a lens shaped lenticule of tissue from the cornea, which can be difficult to do. Sometimes the lenticule is not fully cut by the laser and fragments of the tissue remain. This causes severe irregular astigmatism in the patient’s eye.

#2. It takes several days for the visual recovery from SMILE, whereas patients see well within hours after LASIK:
a. The vision after SMILE can take days to become clear, which can make driving or working difficult for several days. Compare this to LASIK, where most patients see 20/20 or better the day after their procedure.

#3. The femtosecond laser used to do SMILE is less precise than the excimer laser used to do LASIK:
a. The femtosecond laser for the SMILE procedure does not have the inherent accuracy and precision of the excimer laser used for LASIK. This means the outcomes of SMILE are nowhere near as good as with LASIK.

#4. Enhancement rates with SMILE are higher than LASIK enhancement rates, plus there is a lot of disagreement on the best way to enhance a SMILE eye:
a. Studies show the outcomes for SMILE are nowhere near as good as LASIK outcomes. 88% of patients see 20/20 or better after SMILE; 99.7% of Dr. Manger’s patients see 20/20 or better after LASIK.
b. There is no consensus on the best way to enhance a SMILE eye. Typically, a patient has to have a LASIK or PRK enhancement after SMILE, so why not just have LASIK done initially?

#5. Some theorize that SMILE eyes are anatomically stronger than LASIK eyes, but the reality is that SMILE eyes are still subject to similar, very small, risks of ectasia or trauma as LASIK eyes.

#6. SMILE does not use the latest vision correction technology:
a. The femtosecond laser used for SMILE does not have the capability to use the custom, wavefront technology used in LASIK. Wavefront technology is one of the major advancements in refractive surgery in the past 15 years, and it helps patients achieve superior visual outcomes after LASIK.