ReLEx SMILE - Laser Vision Correction Beyond LASIK

ReLEx SMILE- Small Incision Lenticule Extraction is the 3rd generation of laser vision correction performed with the high precision femtosecond laser. It is the first and only bladeless and flapless minimally invasive 3D technique to visual freedom, which is beyond PRK & LASIK. First performed on a human eye some ten years ago and has already helped millions achieve freedom from glasses and contacts.

PRK, the 1st generation of laser vision correction, is characterized by surface ablation surgery of the cornea using an excimer laser.

LASIK, which was introduced as the 2nd generation of laser vision correction, also involves reshaping the cornea with an excimer laser. Using flap surgery, it enables quick visual recovery, which in part has made it a very popular treatment today.

SMILE, the 3rd generation of laser vision correction is entirely performed with the femtosecond laser, this minimally invasive, flapless surgery is redefining refractive surgery as we know it.

ReLEx SMILE is suitable for patients with drier eyes, contact lens intolerance and playing contact sports.

“ Anyone not offering SMILE in the future will simply not survive in highly competitive markets.”
Dr. Sri Ganesh Nethradhama, Bangalore, India, ESCRS 2015 Istanbul

The three steps of ReLEX SMILE
Find reasons to choose SMILE
ReLEx SMILE procedure is turning the world of refractive surgery on its head and it is described as: “LASIK without a flap and PRK without pain.”

ReLEx SMILE is a flapless procedure, which is the first and – until now – only femtosecond laser system to support this unique laser vision correction procedure. Thereby, a highly precise, precalculated lenticule is created inside the intact cornea and removed via a small incision – all without a flap.

The total procedure is done with a femtosecond laser using a gentle corneal interface/ treatment pack. There is low suction pressure and No vision loss during suction. Suction is only applied during actual laser procedure and the patient does not feel any pain during the procedure.
All-femto 3D laser

Performed entirely with femtosecond technology, no complex nomograms or fluence tests are required. The femtosecond laser corrects refractive errors in a three-dimensional way with utmost accuracy every time.
Minimally invasive

Minimally invasive means there is minimal corneal tissue intervention. It requires only a small incision (2-4 mm). The Side-cut length is 80 % shorter and cap incision area is 30 % smaller than Femto-LASIK flap. Smaller incisions improve epithelium healing.

Biomechanically stronger cornea:

The cornea surface is left untouched, which ensures better biomechanical strength and stability and fast healing.
Less Chance of Dry Eye & Regression:

SMILE preserves the corneal nerves better compared to Lasik. Many of the upper layers of the cornea are unaffected. Since no flap is created thereby lowering the chances of dry eye and related discomfort. It gives high stability in the long term with less chance of numbers coming back.
Quick, Simple & Less after care:

It takes only a few minutes from start to finish and laser to reshape the cornea is used only 20-30 seconds. It involves minimum intervention and therefore less after care is required. Visual recovery, in general, is fast. Patients can normally return to work, take a shower or apply makeup shortly after surgery. Driving and sports activities are possible within a few days. For those playing contact sports there is no risk of flap displacement.
Single-step solution

The refractive correction with ReLEx SMILE is performed-
- on one laser,
- with one treatment plan
- & only one laser process.
- Also, the patient doesn’t need to be moved.
That's what makes it a single-step solution.

Others advantages:

- Interesting treatment option also for athletes engaging in contact sports, flight crews, military and rescue personnel
- Odorless and noiseless, laser works silently
Not a Good LASIK Candidate? SMILE Could be for You
There are three common things that can cause a patient to not be eligible for LASIK:
  • Irregularly shaped or thin corneas
  • Predisposition to dry-eye or chronic dry eye syndrome
  • Patients who perform sports or jobs with a lot of direct contact to the eyes (ex: boxers, fighters, etc)
SMILE can possibly be an appropriate procedure for those who have been disqualified from LASIK candidacy due to these factors.

Who is eligible for SMILE?

To have the ReLEX SMILE procedure, you must:

• Be 18 years of age or older;
• Have healthy eyes free from retinal problems, corneal scars, and any eye disease;
• Have stable vision prescription for the last 6 months
• Be able to lie flat without difficulty;
• Be able to look directly at a blinking light during the whole VisuMax SMILE procedure;
• Be willing to sign an Informed Consent Form provided by your doctor;
• Be able to tolerate eye drops to numb your eye.

Laser vision correction is not advised for pregnant or lactating mothers.

ReLEX SMILE can correct the following powers:
Nearsighted ( Myopia )
-0.50 to -10.00 Diopters
-1.00 to -5.00 Diopters
Examination and Counseling before ReLEx SMILE

As with other Laser Vision Correction methods, you will first need to undergo a detailed eye examination to determine whether you are a suitable candidate.

Many factors play a role, including the nature and degree of the refractive error, the curvature and thickness of the cornea. Your profession and hobbies are also important. Your eye doctor will be happy to assist you in finding the best option for your vision needs.

Take your eye prescription records with you to the exams. Your doctor will

  • Dilate your pupils to fine-tune your prescription
  • Examine your eyes to make sure they’re healthy. This includes a glaucoma test and a retina exam
  • Take the following measurements:
    a) The curvature of your cornea and the size of your pupils
    b) The topography of your eyes to make sure you do not have an irregular astigmatism or a cone-shaped cornea — a condition called Keratoconus
    c) The pachymetry — or thickness of your cornea. You need to have enough tissue left after your corneas have been reshaped

Before coming for the tests a contact lens wearer must stop wearing lenses at least for one week earlier.

If it is determined that you are not a good candidate for ReLEx SMILE surgery:
• You will be given an explanation as to the reasons why you are not a good candidate.
• You may want to consider an alternative method of refractive surgery, or stay with your glasses or contact lenses for the time being.
How do I prepare?
If you wear contact lenses, most surgeons recommend switching to glasses a few weeks before surgery. You are advised not to apply makeup, lotions or perfume the day you have surgery. Also, it is suggested that you arrange to have someone bring you home afterward.

You will be asked to sign an informed consent form after a thorough discussion of the risks, benefits, alternative options and possible complications.
How SMILE is done?
  • On the actual day of surgery, you will be given some numbing drops in your eye(s).
  • Upon entering the surgery room, you will be asked to lie down on the laser bed.
  • Anesthetic eye drops are applied to the eye.
  • An eyelid holder is used to prevent the eye from blinking during the procedure.
  • The eye not having surgery may be covered with a temporary shield.
  • The laser system uses a disposable, single-use Treatment Pack that will be attached to your cornea by light suction on the eye but you will be able to see the blinking light and your doctor will ask you to keep looking right at a blinking light.
  • The light will be visible throughout the entire procedure, though at times it could get slightly blurry.
  • Your doctor will guide you to follow the steps. You will hear a voice instruction (Suction-On) and at this point you have to be calm and quiet because the actual laser is about to start now.
Creating the lenticule
  • The femtosecond laser will then create a thin contact-lens-shape layer (lenticule) just beneath the surface of the eye corresponding to the refractive numbers and a small incision are created inside the intact cornea.
  • The laser portion of the surgery takes about 30 to 60 seconds (Lenticule: A small piece of tissue that is removed from the cornea during the SMILE procedure to correct your vision.) Removing the lenticule
  • Once the laser has created the disc-shaped piece of tissue, the doctor will then utilize surgical instruments to safely remove this tissue.
  • You may feel some sensation during this part of the procedure, but you should not feel pain due to the numbing drops applied prior to and during the procedure.
  • The entire procedure, including the removal of the corneal tissue, generally takes 8 to 10 minutes in total.

Removing the lenticule -

  • Once the laser has created the disc-shaped piece of tissue, the doctor will then utilize surgical instruments to safely remove this tissue.
  • You may feel some sensation during this part of the procedure, but you should not feel pain due to the numbing drops applied prior to and during the procedure.
  • The entire procedure, including the removal of the corneal tissue, generally takes 8 to 10 minutes in total.

Correcting the refractive error - Removing the lenticule changes the shape of the cornea, correcting the refractive error

What happens after surgery?
  • After the surgery, your doctor will put some medication drops into your eye.
  • The nursing staff will take you to a recovery room where you will take rest for around 15 minutes.
  • Your doctor will examine your eyes with a Slit-Lamp
  • After a brief instruction about medications you will be discharged from the clinic.
  • Your eye may experience some discomfort. If necessary, your doctor may prescribe oral pain medicine for use as necessary.
  • You may be mildly sensitive to light and glare. Wear sunglasses to ease your discomfort. You may also have the feeling that something is in your eye. Do not rub your eye if you feel this sensation.
  • Your vision should stabilize within a few weeks.
  • Use all medication eye drops and lubricants your doctor prescribes as directed. These are necessary for the proper healing of your eye(s).
  • We recommend our patients to remain at home for the first one or two days following the surgery to avoid dust while they can perform their daily routine like reading, watching TV, Computer work etc. from next day. In most cases patients can return to work on the following day of SMILE surgery.

It is customary to have a post-op examination the next day. Further examinations are usually scheduled for the following weeks or months. It is important for you to keep these appointments to monitor your healing process.

Possible Complications
These are the few complications one can face:
  • The most likely being loss of suction during the lamellar cuts. In this event, the procedure can simply be aborted with no risk to the patient’s vision. Surgeon can plan procedure at a later date, or the patient can be switched to LASIK or PRK.
  • The other risk unique to ReLEx SMILE is incomplete lenticule removal; for re procedure surgeon has to sift to conventional Lasik.
  • In the event that ReLEx SMILE patients do not achieve target refraction and require enhancement, options include PRK or, ideally, thin-flap LASIK. The latter is feasible so long as:
    - The original ReLEx SMILE procedure was done with a thick enough cap to leave space for a new flap plus the ablation,

    - The maximum epithelial thickness is confirmed before making the new flap to avoid a buttonhole, and the residual stromal thickness below the lenticule is above the standard LASIK safety limits (which is not necessary for a primary ReLEx SMILE procedure).

    - Despite its proven predictability, a retreatment may be necessary in rare cases. If so, the initial SMILE incision can be extended into a flap with the option CIRCLE from ZEISS.

  • Go home with a driver or someone to escort you.
  • Sleep for several hours, your eyes need rest
  • Carefully follow all the instructions given by your doctor.
  • Go into smoky or dusty surroundings for some days
  • Indulge in hot showers or swimming activities till instructed
  • Rub or itch your eyes unnecessarily
  • Wear eye make up for 2-3 weeks