Who Is Eligible for SMILE Vision Correction?

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You may have heard of LASIK eye surgery, but did you know there are other options for laser vision correction?

Small incision lenticule extraction (SMILE) is a minimally invasive procedure that uses lasers to correct myopia and astigmatism.

SMILE has been around for more than 20 years but only received approval from the U.S. Food and Drug Administration (FDA) in 2016. More than 12 million procedures have taken place worldwide.

The UPMC Vision Institute is currently the only provider in western Pennsylvania offering SMILE laser vision correction surgery.

Find out if the SMILE procedure is right for you and how to prepare for it.

What Is SMILE Laser Eye Surgery?

SMILE eye surgery is a minimally invasive procedure that corrects two common eye conditions:

• Astigmatism — When your cornea is irregularly shaped, causing your vision to be slightly to moderately blurred.
• Myopia (nearsightedness) — When you can see nearby objects clearly, but images beyond that look fuzzy or out of focus.

For your vision to work properly, the cornea and lens must refract (bend) light rays onto your retinas. This tissue lining the back of your eyes sends messages to your brain through your optic nerves. When light refracts from the cornea in an abnormal way, you can have refractive errors, or vision problems, such as nearsightedness.

Glasses or contact lenses can correct nearsightedness and astigmatism. But the SMILE procedure is an option to correct myopia and astigmatism permanently.

The SMILE procedure takes only about 15 minutes, but it can dramatically improve vision. Many people are able to ditch corrective lenses altogether.

What Happens During the SMILE Procedure?

SMILE uses a computer-based laser programmed with the exact measurements of your eyes and corneas. A surgeon numbs the eyes with drops and uses an eyelid holder to keep the eyes from blinking.

From there, they place a small suction on the eyeball to hold it in place and flatten the cornea. This provides a good platform for the procedure.

The laser then cuts a “lenticule,” or tiny disc shape, in the corneal tissue that lies under the surface of the eye. The laser makes another tiny cut along the cornea so the ophthalmologic surgeon can remove the lenticule through that incision.

People can usually go home the same day and recover at home with medicated eye drops and rest. It’s normal for vision to be blurry for a few days, but it should improve over the next week or two.

With the SMILE procedure, most people can return to their normal activities within a few days. Many will no longer need their corrective contact lenses or glasses.

What Is the Difference Between SMILE and LASIK?

SMILE and laser-assisted in-situ keratomileusis (LASIK) are both refractive surgeries that use lasers to correct vision problems.

LASIK is a well-known and successful surgery option that can correct refractive errors like:

• Astigmatism
• Hyperopia (farsightedness)
• Myopia (nearsightedness)

During a LASIK procedure, a small laser creates a thin flap along the tissue of the cornea. A surgeon folds the flap back to reshape the cornea with a bright laser, then folds the flap back and smooths it down. The flap will reattach and heal itself within a few minutes.

The SMILE technique is a flap-free laser vision correction option. Instead of creating a flap, the surgeon removes lenticule tissue through a tiny incision they made along the cornea. It’s less invasive and provides faster healing.

“If someone rubs their eyes after LASIK, it can affect the flap we just repositioned,” says Deepinder K. Dhaliwal, MD, vice chair, Communications and Wellness, and chief, Refractive Surgery Service, UPMC Vision Institute. “With SMILE, there is no flap to displace. We are correcting vision while preserving more of the cornea’s natural structure with greater stability and less dryness.”

Who Is a Good Candidate for SMILE Laser Eye Surgery?

SMILE may be the right vision correction procedure for you if you:

• Are nearsighted with a stable prescription between -1 and -10 diopters (the standard measurement of lens correction strength).
• Are over 22 years of age.
• Have healthy eyes with minimal complications.
• Lead an active lifestyle.

SMILE isn’t recommended for people who:

• Are pregnant or breastfeeding.
• Have a changing lens prescription.
• Have any history of cornea damage or disease.
• Have any history of eye infections, diseases, or prior procedures.
• Have cataracts that affect vision.

If you’re interested in the SMILE procedure, talk with your ophthalmologist. They can perform a physical evaluation to see if you’re eligible. You can expect them to:

• Determine your overall eye health and make sure there aren’t any other eye problems present.
• Measure the thickness and surface of your cornea to sync the laser with the shape of your eye.
• Measure your nearsightedness and astigmatism, if applicable.

What Are the Risks of the SMILE Procedure?

While SMILE can permanently correct your vision, it does come with risks. Some possible side effects after SMILE include:

• Halos surrounding lights, especially at nighttime.
• Infection.
• Inflammation.
• Reduced vision.

SMILE can be a great option for people whose glasses or contacts interfere with their active lifestyles. But it may not be the best option for everyone. Talk with your eye doctor and primary care provider (PCP) about your benefits and risks before deciding.