For patients seeking to improve their eyesight through refractive surgery, the most popular option is LASIK (laser-assisted in situ keratomileusis). SMILE (small incision lenticule extraction) surgery has also been introduced in the past few years. While both procedures have highly successful track records, our team at DLV Vision strongly prefers LASIK surgery, for a few important reasons. We’ll share those reasons here and let you know why we think LASIK is the superior refractive surgery option.
In order to understand why we strongly prefer LASIK over SMILE at DLV Vision, it’s important to know how both procedures actually work. During LASIK surgery, our surgeons use a femtosecond laser to create a thin flap on the cornea, which we then lift to access and reshape the underlying tissue. By reshaping the eye with the excimer laser, we can correct refractive errors such as nearsightedness, farsightedness, and astigmatism, before repositioning and closing the tissue. Conversely, for SMILE surgery, a surgeon creates a small incision in the cornea to access and remove a tiny, disc-shaped piece of tissue, called a lenticule. This tissue is removed by hand with surgical instruments rather than by the precise excimer laser.
In terms of visual outcomes, the results from LASIK are consistently superior to those provided by SMILE for myopia (nearsightedness) and astigmatism. As technology has advanced and LASIK procedures have been refined over the years, the results have become more predictable, precise, and successful. In contrast, SMILE technology, which is technology that has existed for years but only has gained approval recently, in our opinion, still lacks the same level of precision, despite the improvement in technology. As a result, we have abandoned this procedure in our practice.
While SMILE has gained modest popularity as a corrective solution, it’s essential to understand that it has severe limitations. Unlike LASIK, SMILE does not currently offer pupil tracking and potentially cannot be centered as well as LASIK can. Finally, while LASIK is a completely laser-based surgery, SMILE involves manual removal of a piece of corneal tissue manually with a surgical instrument and as a result, does not match the precision or speedy visual recovery seen with LASIK involves manual removal of a piece of corneal tissue with a precise blade.
Right now, SMILE also lacks an option to adjust the procedure to specific corneal profiles (known as custom or topography guided treatments) based on the unique shape of each patient’s eye. This means that LASIK is often a more suitable choice for patients who need a more personalized custom approach. LASIK is also able to treat higher levels of myopia, astigmatism and hyperopia (farsightedness), both of which SMILE is unable to address.
SMILE is modestly increasing in popularity due to manufacturer marketing of this laser, particularly in parts of the world such as Asia. Despite the fact that this surgery may have a slightly higher price point and the manufacturer’s claims of technical superiority, LASIK provides better outcomes in and faster vision recovery in our (and other surgeon’s) hands than SMILE. While there is typically less likelihood of the dry-eye-like symptoms of surgical temporary ocular discomfort syndrome after SMILE surgery, these symptoms are temporary, and the precise benefits of LASIK are much longer-lasting.
While it’s advertised as a corrective solution for patients with astigmatism, SMILE can lead to unpredictable outcomes and isn’t customizable for a patient’s needs with topography-guided or wavefront treatments. Some patients with mild astigmatism may see success with SMILE, but it’s not as easily predicable. LASIK, on the other hand, has a longer history and is more reliably effective at enhancing vision.
When it comes to choosing between LASIK and SMILE, understanding the differences and considering the limitations of each procedure is essential. While SMILE may offer certain advantages such as temporary relief from dry eye-like symptoms, LASIK currently provides more precise outcomes, greater customization options, and has an established record of success. Schedule a visit to your nearby DLV Vision office and speak with one of our eye surgery experts about the life-changing benefits of improved eyesight with LASIK.