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We are just not convinced that there has been enough testing of the SMILE procedure to demonstrate that it is completely safe long term or better than LASIK. We don’t believe in trying something because it is ‘different’ or ‘new’ rather we prefer to offer our patients the reliable, safe and accurate procedure LASIK. In our opinion LASIK is still the gold standard in Laser Eye Surgery due to its precision, safety record, range of treatments, ease of re-treatments, and minimal side effects.

If you’re considering which type of laser eye corrective surgery is suited for you then the best place for advice is talking to your ophthalmologist during a thorough eye examination. At Bowen Eye Clinic, Dr Hall considers individual factors such as your prescription, your eye health, general health and work and lifestyle when assessing for your suitability to have laser eye surgery. At Bowen Eye Clinic we pride ourselves in offering you the safest, trusted, most advanced technology available – LASIK.  

LASIK - Laser-Assisted-In-Situ Keratomileusis

LASIK uses a femtosecond laser to make a flap in the cornea, which is semicircular and then lifted up to expose the underlying corneal stroma. An excimer laser (193nm) is then used to reshape the stroma and the flap is put back over the treated area to heal. 

LASIK has been performed for over two decades and proven to be an exceedingly safe, effective and long-lasting procedure. LASIK has been fine-tuned over the years to provide the surgeon with automated tracking of the pupil, automated pupil centration and wavefront analysis and guidance during the procedure.  

LASIK can be performed to treat astigmatism, myopia and hyperopia.

Should you require an enhancement later in life, this is possible with LASIK for any residual prescriptions or regression in the future.

SMILE - Small Incision Lenticule Extraction

While doing your own research online you will probably come across a relatively new procedure called SMILE – SMall Incision Lenticule Extraction. This procedure involves the femtosecond laser (1064nm) which cuts a lenticule of stroma within the cornea and then makes a small incision in the cornea, the lenticule (small layer of corneal tissue) is then pulled out (extracted) through the incision by the eye surgeon. 

SMILE takes a longer time to perform than LASIK and it takes longer for the vision to recover as the lenticle needs to be manipulated out of the cornea manually therefore the surrounding tissues take longer to heal. With the small incision in the cornea it is thought to reduce the amount of dry eye post-surgery and possibly provide a more stable cornea.  However, as it is a new procedure (introduced in 2012) the studies are on small numbers, and already there are studies coming out that show there is no significant differences in dry eye symptoms between SMILE and LASIK.

More concerning is that the long-term effectiveness of SMILE is yet to be established when comparing it to LASIK.  It is unknown what the effects of having an incomplete lenticule removed are, or what complications may arise later in life when the person develops a cataract and requires additional eye surgery. 

If the SMILE procedure is unsuccessful there is no SMILE re-treatment option available as the layers of the cornea have already been removed.  A totally different procedure with a longer recovery time and more discomfort may be available such as Photorefractive Keratectomy (PRK).  

SMILE is limited to a small number of patients. It can only treat a certain range of myopia. It is not as accurate to treat astigmatism as LASIK and can not treat long-sightedness.

Differences between LASIK and SMILE

                                        LASIK                 SMILE

Prescription            +4D to -10D       -1D to -8D

Astigmatism            Yes  4D        Limited <-0.5D    

Myopia                      Yes (0-10D)     Some (-1-8D)

Hyperopia                       Yes                      No

Blended Vision               Yes                      No

Corneal Extraction       No                      Yes

Treatment Time            14+12sec            30+90sec

Eyesight recovery         4-5 hrs              48-72+ hrs

Type of Laser         Femto & Excimer      Femto

Eye Tracking                  Yes                     No

Centration                      Yes                     No

Cornea reshaping         193nm                 1064nm

Discomfort                      Rare                    Rare

Dry eye                             Yes                    Yes

Complications               Rare                    Rare

Flap                                    Yes                   Partial

Re treatment                  Yes                  Difficult

Long term outcomes    Proven            Unknown

While Bowen Eye Clinic may offer SMILE in the future, we are still waiting on how it progresses over time before offering it to our patients. Our current LASIK has evolved into 5th generation LASIK where as SMILE is only 1st generation and is limited on centration of treatment, correction of astigmatism and slow recovery. We are just not convinced that there has been enough testing of the SMILE procedure to demonstrate that it is completely safe long term or better than LASIK. We don’t believe in trying something because it is ‘different’ or ‘new’ rather we prefer to offer our patients the reliable, safe and accurate procedure LASIK. In our opinion LASIK is still the gold standard in Laser Eye Surgery due to its precision, safety record, range of treatments, ease of re-treatments, and minimal side effects.

Call 0800 692020 to book your free assessment for laser eye surgery with Dr Reece Hall.