SMILE is one of the newest forms of laser vision correction, with more than 3 million SMILE procedures performed worldwide. Just like LASIK and PRK, SMILE is designed to correct nearsightedness and astigmatism to help free patients of their glasses and contact lenses. But compared to these other two procedures, SMILE takes a different surgical approach, employing only a single femtosecond laser for the patient’s treatment.
SMILE treatment is performed on the ZEISS Visumax femtosecond laser. During the SMILE procedure, Dr. Hyver uses the Visumax to create a small, lens-shaped piece of tissue, called a “lenticule,” within the middle layer of the cornea, after which he extracts this tissue through a small incision he makes in the cornea with the same laser (thus the SMILE acronym: Small Incision Lenticule Extraction), thereby completing the procedure.
Dr. Hyver will determine if you are medically-qualified for SMILE based on a review of your diagnostic test results, including your prescription, corneal shape and thickness, baseline tear function, pupil size, and general overall eye health. If these criteria meet Dr. Hyver’s approval threshold, he’ll then approve you for SMILE; otherwise, he’ll either approve you for a different form of laser vision correction, such as PRK, or not medically approve you for any form of treatment.
The SMILE procedure takes about five minutes per eye. While lying on the surgery bed, we’ll numb your eyes with drops, after which one eye will be held open with an eyelid holder. You’ll then stare at a blinking fixation light during which you’ll feel a gentle pressure on your eye for about 30 seconds. Following this, you’ll be aligned under a brighter microscope light, and then you’ll feel Dr. Hyver moving your eye a bit as he completes the procedure. He’ll then remove the eyelid holder at which time you can freely blink.
Most patients experience little, if any, discomfort during SMILE. Aside from the gentle pressure on the eye for 30 seconds, some patients may feel a brief, pinching sensation on the eye.
Someone will need to take you home after the procedure. Your vision will be hazy, and your eyes will experience some stinging and light sensitivity for the first few hours. You should rest during this time. Most SMILE patients can resume working the next day, with vision expected to be about 80-90% of final vision. Your vision will then gradually improve over the next few months.
During the first week, you’ll apply various eye drops throughout the day. Most patients can resume their normal lifestyles the day after their procedure, including showering, working, computer use, exercising, and air travel. You should not swim for two weeks following your procedure.
You can expect your visual outcome to last for many years. If your vision does decline, however, the change is likely to be relatively small compared to your original prescription, and it’s something we can most likely address with an enhancement procedure.
Experiencing glare around lights at nighttime — including starbursts, ghosting and halos — is fairly common early in the SMILE recovery process, but these effects shouldn’t prevent you from driving at night. The effects gradually lessen and, in the majority of patients, fully resolve within three to six months following surgery. A small percentage of patients, however, will continue to experience some degree of night disturbance indefinitely, but the effects are typically mild.
It’s fairly common to experience dry eye sensation early in the SMILE recovery process, especially upon awakening in the morning, but also possibly at different points of the day. Artificial tear drops may be used for relief. While the dry eye sensation is generally mild and gradually resolves within three to six months following surgery, for a small percentage of patients, some degree of dry eye sensation may persist indefinitely, but the effects are typically mild.