Correcting Myopia: Is SMILE a Better Choice?

Myopia, commonly known as nearsightedness, is a widespread visual impairment affecting millions worldwide. At its core, myopia is a refractive error that results in difficulty seeing distant objects clearly. Over the past several decades, myopia has seen a significant rise in prevalence, making its correction a pressing concern. Among the most advanced solutions to this challenge are two innovative surgical techniques: SMILE (Small Incision Lenticule Extraction) and LASIK (Laser-Assisted In Situ Keratomileusis). Both have revolutionized the approach to myopia correction, offering distinct methodologies and benefits. As these procedures gain popularity and evolve through technological advancements, they represent the forefront of combating myopia, promising improved vision and quality of life for countless individuals.

Understanding High Myopia and Its Challenges

Myopia is a condition where the eye’s shape causes light rays to bend (refract) incorrectly, focusing images in front of the retina instead of on it. This results in blurred vision for distant objects while close objects remain clear. A more advanced version of the condition, high myopia, takes this a step further and causes an elongation of the eyeball. High myopia can lead to thinning of the retina, making it more susceptible to issues like retinal detachment and other complications.

Individuals with high myopia are at an increased risk of developing other eye-related problems such as glaucoma, which can damage the optic nerve, and cataracts, which cloud the eye’s lens. As a result, tasks that others might take for granted, such as driving, reading, or recognizing faces from a distance, become challenging and can lead to a reliance on corrective lenses or other visual aids.

For managing high myopia, the first line of treatment often includes glasses or contact lenses, tailored to correct the refractive error. However, other more-permanent solutions exist in the form of corrective surgeries. Among these, advanced techniques such as LASIK and PRK have been prominent, but newer methods like SMILE are also gaining traction with similar patient outcomes and a less-invasive nature.

SMILE: A Modern Approach to Myopia Correction

SMILE is a modern leap in the field of refractive eye surgery, particularly in the correction of myopia. Unlike LASIK, which involves creating a flap on the cornea (surface of the eye), SMILE is performed through a small 4 mm incision and creates no flap. This key difference not only reduces the risk of corneal weakening but also minimizes post-surgery complications like dry eyes and other flap-related issues. At the heart of the SMILE procedure is the use of cutting-edge femtosecond laser technology. This laser precisely forms a lenticule (a small lens-shaped piece of tissue) within the cornea, which is then removed through the small incision, thereby altering the eye’s refractive power and correcting the myopia. 

The accuracy and precision offered by these laser are unparalleled, ensuring a high degree of control and predictability in the procedure. The laser’s rapid and focused energy delivery allows for a smooth, gentle process, contributing to a quicker recovery time and less discomfort for patients post-surgery. The technological advancements in SMILE make it an attractive option for patients with myopia, especially those who are not ideal candidates for LASIK due to various factors like thin corneas or active lifestyles.

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LASIK: The Traditional Standard

LASIK (Laser-Assisted In Situ Keratomileusis) has long been the gold standard in refractive eye surgery. The procedure involves creating a thin flap in the cornea and using an excimer laser to reshape the underlying corneal tissue, thereby correcting refractive errors like myopia. The precision of the laser, combined with the skill of the surgeon (like Dr. Dan Haddad), allows for a high degree of accuracy in vision correction. While LASIK is still a great option, it can often be contraindicated for people with Myopia given the likelihood of complications. Furthermore, LASIK is still somewhat more invasive than SMILE since it requires the creation of a flap on the cornea. For those with active lifestyles or other complicating factors, LASIK may not be the right solution.

Comparative Efficacy: SMILE vs. LASIK for Myopia

SMILE and LASIK have frequently been compared, particularly in their efficacy in treating high myopia. While LASIK has been a well-established and widely trusted method for many years, SMILE is begging to emerge as a better option for correcting myopia. Regarding visual outcomes and success rates, both SMILE and LASIK have demonstrated high levels of efficacy in correcting myopia. However, studies have shown that SMILE can offer comparable, and in some cases, superior outcomes in high myopia correction. 

In terms of safety and potential complications, each procedure has distinct considerations. LASIK’s flap creation can lead to specific flap-related complications, although these complications have become increasingly rare with modern techniques and equipment. On the other hand, SMILE uses a smaller corneal incision, significantly reducing the risk of dry eyes post-surgery. 

This smaller incision is also beneficial in preserving the structural integrity of the cornea, making SMILE an appealing option for individuals with thinner corneas or active lifestyles. The procedure’s minimal invasiveness preserves the surface integrity of the cornea, reducing the risk of corneal ectasia. This rare but serious complication occurs when the cornea progressively thins and bulges outward. This aspect of SMILE is especially crucial in the context of high myopia where corneal integrity is a key concern.

Patient Outcomes and Satisfaction

The evaluation of patient outcomes and satisfaction following SMILE and LASIK surgeries provides a comprehensive view of their effectiveness in real-world scenarios. Data on post-surgery vision acuity exams reveal that a significant majority of patients from SMILE achieve 20/20 vision or better. Patient satisfaction rates are similarly high for both procedures, underlining their success in meeting or exceeding patient expectations for vision correction. In terms of long-term effectiveness and stability, both SMILE and LASIK demonstrate excellent results. Studies tracking patients for several years post-surgery show that the vast majority retain stable and high-quality vision over time. 

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Limitations and Considerations

While SMILE represents a significant advancement in refractive surgery, it’s applications relative to LASIK are somewhat narrow. SMILE is primarily designed for myopia and astigmatism, and unlike LASIK, it currently cannot treat hyperopia (farsightedness) and other diseases. Additionally, patients with certain corneal conditions may not be ideal candidates for SMILE.

When deciding between SMILE and LASIK, the choice should be tailored to the individual’s specific needs, eye health, and lifestyle factors which you can discuss with Dr. Haddad. Dr. Haddad will work with you to consider the degree and type of refractive error, corneal thickness, and the overall health of the eye as well as which procedure is most appropriate for your situation. For patients with active lifestyles or those in professions at higher risk of physical contact with the eyes, SMILE’s flapless approach might be more advantageous. Conversely, LASIK’s broader applicability and the ability to retreat or enhance the procedure make it a versatile choice for many.

Final Thoughts

SMILE is a great option for those living with myopia and can help to improve vision as well as quality of life. While SMILE has some real benefits, nobody but you and your doctor can decide if this is the best procedure for you. A number of factors, such as other underlying conditions, lifestyle, and more will play a role in determining if SMILE is right for you. If you or a loved one is living with myopia, SMILE may be an excellent option to improve your vision. The first step to determining your candidacy for SMILE or LASIK is to schedule an appointment with Michigan’s #1 laser-eye doctor. Get started by scheduling a consultation with a LASIK coordinator OR take this quick quiz to find out if LASIK, PRK or SMILE is right for you.

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David Lemieux, BA from Oakland University is a LASIK expert and marketing professional that has worked with Dr. Dan Haddad and the Laser Eye Institute since 2017. David believes in education and cutting through the noise to deliver facts and opinions about LASIK, SMILE, and all things Laser Vision Correction.