SMILE for LASIK: A New Technique in Laser Vision Correction
With a surgery as successful as Lasik, you would wonder, what's next?
Well, here we go. Our constant quest for a flawless procedure with maximized vision continues and we may end with a SMILE!
Wait, no we are not digressing into any dentistry advice, we are still talking about your eyes and life without glasses.
SMILE is an acronym for Small Incision Lenticule Extraction technique, an all laser, no-cut technique of the future. Propelled by a dear friend and colleague of mine, Dr. Rupal Shah of India, I believe this marks a paradigm shift in laser vision corrective surgery.
To appreciate why this is superior, let’s understand Lasik surgery as it is done today (ref: previous Khaasbaat article).
In Lasik surgery, we first cut a flap in the cornea using a Femtosecond Laser. Then an Excimer Laser is used to sculpt the cornea, painlessly and invisibly to correct the glasses prescription Thus, there is involvement of two lasers and also the cutting of the flap is the step, which can present any complication possibility.
In looking at the future horizon, we would always want a procedure where we do not need to cut a flap and, therefore, leave the patient’s cornea more robust (strong with enough tissue thickness) and also prevent another scourge of cutting a flap and that is dry eyes.
When a Lasik flap is cut, it severs the nerves that provide sensation to our corneas and these nerves work as a circuit for tearing mechanism. Thus, dry eyes are a problem quite often associated with Lasik surgery.
Here’s introducing ReLEx or Refractive Lenticule Extraction, which is a new technique for laser vision correction. It is an all-in-one femtosecond laser vision correction procedure, which does need an Excimer laser to complete the refractive correction procedure.
This ReLEx procedure can further be divided into FLEx and SMILE.
FLEx (Femtosecond Lenticule Extraction)
FLEx is similar to Lasik, in that a flap is created, and lifted to a side. However, instead of the standard bladeless Lasik where a flap is made with the femtosecond laser, and the refractive correction done with the Excimer laser, FLEx involves using the femtosecond laser to cut a refractive lenticule (imagine a slice of tissue, which usually in Lasik is vaporized by the Excimer laser but here is actually removed as a physical entity) in the same step as the flap creation. The refractive lenticule is peeled off the corneal bed. FLEx offers all the safety of no blade Lasik, with more stable results than a standard blade-free Lasik.
SMILE: (Small Incision Lenticule Extraction)
SMILE takes FLEx even further. Instead of creating and lifting a flap, a refractive lenticule is carved within the cornea, and removed through a small incision. SMILE is the culmination of the ReLEx technique. It offers many advantages to both the patient and the doctor. It is quick, extremely safe, gives predictable and stable results, and causes least patient discomfort.
A recently published British study showed promising results and also comparable advantage over Lasik surgery.
Presently, the only Femtosecond Laser that can do the SMILE technique is the Carl Zeiss Meditec VisuMax femtosecond laser. Also, this technique is presently able to correct only myopia (nearsightedness). We are eagerly looking forward to the United States FDA approval in the near future.
All patients with glasses and contact lenses can look forward then to adding not only “Sparkle” but also a “SMILE” to their eyes!
Arun C. Gulani, M.D., M.S., is director and chief surgeon of Gulani Vision Institute in Jacksonville. He can be reached at [email protected] or visit www.gulanivision.com