What’s the Difference between LASIK and SMILE?

Posted by: Clear Vision Cataract & LASIK Center

You’ve probably heard about a newer laser vision correction procedure called SMILE and have questions about how it compares to the most commonly performed laser vision correction procedure, LASIK. First of all, SMILE is NOT a dental procedure designed to give you extra white teeth! Although after having SMILE, you will be smiling a lot more given your new independence from glasses and contacts!

What is SMILE?

SMILE stands for SMall Incision Lenticule Extraction. Basically, think of SMILE as small-incision version of LASIK! This procedure uses the advanced Zeiss Visumax femtosecond (very fast!) laser to create a round disc of excess tissue inside the cornea (the lenticule) which is then carefully removed by the laser surgeon through a very small incision. The laser portion takes less than 30 seconds, and the lenticule removal just a few minutes. Overall, SMILE is painless, as the eye is numbed with eye drops prior to the procedure, and typically takes less than 15 minutes per eye. Given the small incision, you can get back to your life faster too!

How is SMILE different from LASIK?

With LASIK, a corneal flap is created by a femtosecond laser, and then the vision correction is performed by a second, excimer laser which essentially vaporizes excess tissue in the cornea. In both procedures, excess corneal tissue is removed, which reshapes the cornea and gives you the desired vision correction. With SMILE, that tissue is removed by an experienced surgeon instead of the laser, but both effectively create the desired vision correction. SMILE only requires one laser, the Zeiss Visumax femtosecond laser, and requires a much smaller incision than LASIK.

What are the advantages of SMILE?

With SMILE, the incision to remove the tissue is very small. This preserves the corneal nerves which are often disrupted by the larger flap created in LASIK. With less corneal nerve disruption, having dry eye symptoms after the procedure is much less common with SMILE. Also, since no flap is created, we avoid potential flap complications such as flap dislocations, which may be a concern for those with high-impact lifestyles or professions. Recovery from SMILE is also typically painless and fast, meaning you can be back to work typically by the next day. SMILE is best for people who are concerned about limiting their recovery time and/or worried about their eyes feeling dry.

What are the limitations of SMILE?

Unlike LASIK where vision quality is often excellent immediately following the procedure, it is common for SMILE patients to take 3-5 days for the vision to reach its best quality. However, large clinical studies have shown that the vision results are comparable between LASIK and SMILE! In the US, SMILE is only approved to correct myopia (nearsightedness) with or without astigmatism, and not hyperopia (farsightedness). It also doesn’t correct presbyopia (loss of near vision with age), so an alternative procedure may be indicated if you are 45 or older.

What are the risks of SMILE?

As with any procedure, SMILE has some risks, which we review in detail at your consultation. While we carefully screen every patient prior to any procedure, not every scenario can be predicted ahead of time. Similar to LASIK, patients having SMILE may experience dry eye symptoms, under or over correction of vision requiring laser enhancement, and night vision issues such as glare or halos. Infection or inflammation is very rare, and typically treatable with eye drops.

What is the recovery after SMILE?

Most people will have some mild blurred vision in the first few days after SMILE vision correction as the tissue heals. Mild discomfort or a feeling of dryness is common as well. We restrict lifting/bending/straining for 5 days, and you can otherwise resume normal activities afterward. You will be on eye drops for one week, but sometimes longer if needed.

Will SMILE wear off?

No, SMILE has a very low rate of regression. In some cases, depending on your unique eyes, you may need a vision enhancement in the form of either surface ablation (PRK) or LASIK. Enhancement rates are less than 5%. As you age into your late 40s and 50s, you may require reading glasses for lens dysfunction (presbyopia).

Does the SMILE procedure hurt?

No, SMILE is not typically painful. We using numbing eye drops and offer a mild sedative pill (valium) to take during the procedure, so that the procedure itself is not painful. Recovery is typically painless as well.

What are situations where LASIK might be better than SMILE?

SMILE is unable to correct farsightedness and very low levels of nearsightedness. It also cannot do custom treatments (Contoura), so if you would benefit from any of the above, we may recommend LASIK over SMILE. At Clear Vision Center, we offer all modern vision correction options to ensure you get the recommendation that works best for your eyes and expectations for recovery.

Which procedure is better for me: LASIK or SMILE?

We get this question a lot, and really it depends! At your consult, we do a detailed eye analysis and understand your vision, goals, and hobbies before making a recommendation. Either LASIK or SMILE can be a safe and effective way to correct vision in a good candidate!

Ready for next steps?

We know you’re thinking about getting out of those glasses or contacts. If you have more questions, just set up a consultation and we can let you know if you are a candidate for either LASIK or SMILE vision correction!