Which Suits You Best SMILE vs LASIK?

Refractive error is the most common cause of decreased vision all over the world in all age groups.  Spectacles as a mode of treatment have been there for long. Contact lenses are an option for those who can take care of them and are not comfortable with glasses. But these two viz. spectacles and contact lenses are temporary measures i.e. you have to wear them daily and spare it at night. The permanent treatment to correct refractive error is laser procedures.

Laser treatment can be of different types like PRK(photorefractive keratectomy), LASIK and the latest addition is SMILE.

All the 3 procedures are safe, effective, and predictable but also have some limitations. Laser procedures should only be done in  patients who

  1. More than 18 years of age
  2. Stable refraction
  3. The corneal thickness should be adequate to do laser procedures.
  4. Should not have underlying eye diseases such as diabetic retinopathy or autoimmune diseases which hinders wound healing.
  5. Should be avoided in patients with moderate to severe dry eyes.
  6. Not to be done in pregnant and breastfeeding patients.

PRK is a procedure in which we remove the upper layer of the cornea( epithelium) and then treat the corneal bed with an excimer laser and post-laser we put a contact lens for 4-5 days for epithelium to heal. PRK can be done in patients with myopia, hypermetropia, and astigmatism. PRK is preferred in patients who are into contact sports and risk of flap dislocation is there, chronic dry eye patients, thin corneas. PRK takes a higher recovery time of about a week.

LASIK is the most common refractive surgery performed.

In LASIK a thin flap of cornea is made by microkeratome or femtosecond laser, then we use an excimer laser as in PRK. Then the flap is repositioned. Lasik can be done to treat myopia, hypermetropia, and astigmatism

Lasik is unsuitable in patients with thin corneas and those suffering from chronic eye diseases. In these patients PRK /SMILE is suitable.

SMILE is a newer addition to the armamentarium of refractive surgeons. Small incision lenticule extraction (SMILE) is a one-step laser procedure in which a femtosecond laser creates a lenticule in the stroma(middle part of cornea) and a small corneal incision is created through which the lenticule is taken out. SMILE is only suitable for myopia and a lesser degree of astigmatism.

So which process is more suitable for a particular person depends on his eye profile,  refractive status, and professional demand. Both LASIK and SMILE are FDA approved and have similar cost implications. Both surgeries are very safe and predictable. But there are some differences in both the procedures.

Both surgeries are day procedures and take equal time to do the procedure (~15-20 min). Although the early visual recovery is fast in LASIK. The ultimate result at the end of 1 month in both is the same.

LASIK can be done in all kinds of refractive conditions but SMILE is suitable mainly for myopia and moderate astigmatism. Since myopia is the most common refractive error,  both the procedures can cater a major patient profile.

Both have very few complications and most of them recover if treated in time, SMILE being safer as it is devoid of any flaps and the majority of complications are flap related.

SMILE has a less postoperative dry eye as corneal nerves are mostly preserved as it is a no flap surgery.

SMILE is a one-step process as it involves only a femtosecond laser. Lasik is a two-step process and involves creating a flap and reshaping the cornea.

SMILE is a less invasive surgery than LASIK as there is no flap.

As no excimer laser is used in SMILE, patients are more comfortable intraoperative as there is no smell and noise of excimer laser.

Both the processes are equally safe and early visual rehabilitation is noted somewhat faster in LASIK than SMILE.

To know which laser procedure is best suited, you should visit a laser center equipped with both the surgical procedure and your eye doctor after examining your eyes would recommend which one is best suited for you.

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