You may have heard about the latest SMILE eye surgery that offers an alternative to LASIK eye surgery. What separates these two procedures, though?
Why would you want to choose SMILE instead of LASIK?
Which procedure is safest, or gives the best results?
These are excellent questions, so let’s find out!
First of all, both LASIK and SMILE are acronyms. LASIK stands for Laser-Assisted In-Situ Keratomileusis, which is a bit of a mouthful. SMILE stands for SMall Incision Lenticule Extraction. They’re both very technical, which is why most people refer to them by their acronyms, but their differences are much wider than a simple difference in terminology.
LASIK obviously involves a laser – the L stands for laser, after all. The first step is creating a hinged flap in the eye’s cornea (usually about 20mm in diameter) using a surgical device called a microkeratome or femtosecond laser. Once there’s a clear access to the corneal tissue, a specialized excimer laser is used to reshape the cornea to a shape more ideal for refracting light into the back of the eye. Then the flap is placed back down, and it will naturally heal over the course of a week or so.
In SMILE, the opening only needs to be about 4mm wide, and the initial flap is made with a laser. After the outer layer is clear, a second flap is made with the laser in the corneal tissue, and a precise amount of it is sculpted away and removed from the eye. Once the surgery is complete, the surface of the cornea will heal naturally over the course of a few days and improvement in vision is noticeable within that same time frame.
These might seem like minor shifts in the procedure, but when you’re working with something as intricate and delicate as the human eye, small differences can produce large differences in outcomes. In order to decide what’s best in the SMILE vs LASIK arena, it’s best to understand what each procedure is best at accomplishing.
SMILE vs LASIK: Advantages of SMILE Eye Surgery
Research has shown that, in cases of nearsightedness, SMILE and LASIK results are very similar. One survey of 328 people that received SMILE procedures reported every patient but one achieved uncorrected visual acuity (UCVA) of at least 20/40 from the surgery, and almost 90 percent of them were seeing with 20/20 vision after the surgery.
Other studies, such as this one, have shown that the risks of developing dry eye symptoms might be reduced in SMILE procedures when compared to LASIK procedures. It’s suspected that, because SMILE doesn’t involve the creation of a large 20mm corneal flap, the corneal nerves are less aggravated and prone to producing negative symptoms. It is also possible that the small incision made in a SMILE procedure protects the eye’s biomechanical stability, while the larger trauma inherent to LASIK might injure the eye’s flexibility in changing shape.
In cases of severe nearsightedness, a single LASIK procedure might not prove sufficient, and a second enhancement pass might be required. In correcting these same cases of severe myopia, SMILE is thought to produce better outcomes. This might be because the cornea doesn’t become as dehydrated during a SMILE procedure as it does during a LASIK procedure.
SMILE vs LASIK: Limitations of SMILE Eye Surgery
These advantages are certainly enticing, but SMILE doesn’t completely replace LASIK. There are some things that LASIK does better than SMILE procedures.
The first, and most important, difference is that SMILE is suitable only for correcting cases of nearsightedness. If a patient is looking to correct farsightedness or hyperopia then LASIK remains the better choice. Removal of a lenticule might cause less surface damage to the eye, but it’s more difficult to accomplish the sort of reshaping needed for correcting farsightedness or astigmatism through the SMILE procedure. This doesn’t mean it’s impossible; correcting mild farsightedness via SMILE is currently occurring in Europe, and as the technology advances it’s very possible that the US market might see similar applications here in the future.
LASIK and PRK procedures are also capable of treating higher-order aberrations (HOAs) in the eye. SMILE isn’t good at fixing night vision issues, for instance. Even the presence of a HOA can make SMILE a less attractive choice. On an otherwise healthy eye, SMILE involves less surface damage, but the procedure could actually cause the exacerbation of already-existing aberrations. As with many procedures like this, SMILE carries the risk of causing refractive errors, and in such a case a PRK procedure would be the right answer to clear up any such error.
There are also risks attached to SMILE simply because it’s still fairly new to the field. An eye surgeon who isn’t as familiar with SMILE will likely need to perform the procedure multiple times before they get can produce optimal results and keep risks to an absolute minimum. It’s worth inquiring about the experience level that any eye surgeon has with a given procedure before signing up to be one of their patients, and this is a bigger concern with SMILE than it is for LASIK, given that LASIK has been around longer.
SMILE vs LASIK: The Cost of SMILE Eye Surgery
The majority of refractive eye surgeons charge at similar rates for both LASIK and SMILE eye surgery — $2000 to $3500 per eye is the common range of costs. Certain things might cause this price to end up on the higher end, such as the surgeon’s experience in the field and with the procedure, the location of the clinic or hospital, and the sort of follow-ups that are required for the procedure.
If you are nearsighted and have astigmatism, and this article leads you to wonder if you’d be a good candidate for SMILE or LASIK eye surgery, then your next step is easy and comes with no strings attached. Simply reach out to your local eye doctor or set up a consultation with a refractive surgeon and discover if either procedure is right for you.