SMILE (Small Incision Lenticule Extraction) is a modern laser vision correction procedure designed to reduce dependence on glasses or contact lenses by reshaping the cornea. Unlike LASIK, SMILE does not require the creation of a large corneal flap, making it an attractive option for selected patients.
Although SMILE is often promoted as a minimally invasive laser procedure, successful treatment depends on careful patient selection rather than the technology alone. Prescription stability, corneal thickness, corneal shape, tear film quality, overall eye health, and realistic expectations are all essential factors when determining whether SMILE is appropriate.
How SMILE Works
SMILE uses a femtosecond laser to create a small disc-shaped piece of tissue (called a lenticule) within the cornea. The surgeon removes this lenticule through a very small incision, changing the shape of the cornea so that light focuses more accurately on the retina.
Because there is no large corneal flap, SMILE may preserve more corneal biomechanics and may reduce some flap-related complications. Some patients also experience less postoperative dry eye, although results vary between individuals.
SMILE is not simply a better version of LASIK. It has its own advantages, limitations, learning curve, enhancement strategies, and recovery pattern. It is most commonly used to treat myopia (short-sightedness) and myopic astigmatism.
Who May Be a Suitable Candidate?
Suitable candidates generally have:
- A stable glasses prescription
- Healthy corneas
- Adequate corneal thickness
- Healthy tear film
- Healthy retina and optic nerve
- Realistic expectations
Additional assessment may be required for patients with:
- Thin corneas
- Keratoconus or ectasia risk
- Significant dry eye disease
- Active eye inflammation
- Autoimmune disease
- Pregnancy-related refractive changes
- Unstable prescription
- High retinal risk associated with severe myopia
Patients who are not suitable for SMILE may still be candidates for LASIK, PRK, phakic intraocular lenses, refractive lens exchange, or non-surgical vision correction.
Comprehensive Preoperative Assessment
Successful laser vision correction depends on detailed preoperative testing.
Assessment may include:
- Manifest refraction
- Cycloplegic refraction when appropriate
- Best-corrected visual acuity
- Corneal topography or tomography
- Pachymetry
- Epithelial thickness mapping when available
- Tear film evaluation
- Pupil size assessment
- Intraocular pressure measurement
- Dilated retinal examination
- Review of previous contact lens use
Because contact lenses can temporarily change corneal shape, patients are often advised to stop wearing them before their final measurements.
Planning the Procedure
Patients should clearly understand:
- Which refractive error is being corrected
- The expected visual outcome
- Whether both eyes will be treated on the same day
- Alternative treatment options
- The possibility of requiring enhancement treatment in the future
Informed consent should include discussion of potential risks such as dry eye, glare, halos, residual refractive error, undercorrection, overcorrection, regression, infection, inflammation, corneal ectasia, and the possible need for glasses or additional procedures.
Like all laser vision correction procedures, SMILE does not prevent future age-related eye conditions such as presbyopia, cataracts, glaucoma, or retinal disease.
The Procedure
SMILE is usually performed under topical anaesthetic eye drops and typically takes only a few minutes per eye.
During the procedure, the femtosecond laser creates the lenticule inside the cornea, which is then removed through a small incision without creating a large flap.
Most patients return home shortly after treatment.
Recovery After SMILE
Many patients notice improved vision within the first few days, although complete visual stabilisation may take several weeks.
During recovery, patients may experience:
- Dryness
- Fluctuating vision
- Mild discomfort
- Light sensitivity
- Glare or halos
- Foreign body sensation
Patients should use prescribed eye drops, avoid rubbing their eyes, protect them from contamination, and attend scheduled follow-up appointments.
Risks and Possible Complications
SMILE has an excellent safety profile when appropriate patient selection is performed, but complications remain possible.
Potential risks include:
- Dry eye symptoms
- Residual refractive error
- Regression
- Infection
- Inflammation
- Corneal ectasia
- Visual disturbances such as glare or halos
- Reduced contrast sensitivity
- Need for enhancement treatment
Although flap-related complications are avoided, careful postoperative monitoring remains important.
SMILE Surgery Abroad
Patients travelling abroad for SMILE should allow enough time for consultation, detailed measurements, surgery, and early postoperative review before flying home.
Treatment plans may need to change if preoperative testing identifies dry eye disease, unstable measurements, borderline corneal findings, or other factors affecting safety.
Laser vision correction should never be planned solely around travel dates.
Medical Records Before Travelling
Useful records may include:
- Recent ophthalmology examination
- Glasses prescription
- Best-corrected visual acuity
- Corneal topography or tomography
- Pachymetry
- Retinal examination findings
- Intraocular pressure measurements
- OCT scans when indicated
- Previous eye surgery reports
- Medication list
- Relevant medical history
These records help determine whether SMILE is appropriate before travel begins.
Follow-Up After Surgery
Postoperative follow-up is an important part of treatment.
Patients should know:
- When postoperative examinations will take place
- Which symptoms require urgent assessment
- How long they should remain near the clinic
- How follow-up will continue after returning home
Severe pain, sudden vision loss, increasing redness, discharge, eye injury, or worsening vision should always be assessed urgently by an ophthalmologist.
How Healing Journey Supports Patients
Healing Journey assists patients by coordinating ophthalmology consultations, collecting medical records, arranging diagnostic testing, preparing discharge documentation, and helping ensure continuity of care after returning home.
The objective is not simply to arrange laser surgery, but to ensure that the chosen treatment is medically appropriate, expectations are realistic, and follow-up is properly organised.
Responsible communication should avoid promising perfect vision or lifelong freedom from glasses.
Successful outcomes depend on appropriate patient selection, accurate measurements, careful surgical planning, and realistic expectations.
What Patients Should Ask Before SMILE Surgery Abroad
- Am I a suitable candidate for SMILE?
- Would LASIK or PRK be more appropriate for my eyes?
- Is my cornea healthy enough for laser surgery?
- Do I have any signs of keratoconus or corneal weakness?
- What visual side effects should I expect?
- Will I still need reading glasses later in life?
- How long should I remain near the clinic after surgery?
- What follow-up appointments will I require?
- What symptoms require urgent medical attention?
- What happens if enhancement treatment becomes necessary?
References
- National Institute for Health and Care Excellence (NICE). Photorefractive Laser Surgery for the Correction of Refractive Errors (IPG164).
- American Academy of Ophthalmology. Refractive Errors and Refractive Surgery Preferred Practice Pattern®.
- U.S. Food and Drug Administration (FDA). LASIK and Laser Vision Correction Information.
- Royal College of Ophthalmologists. Refractive Surgery Clinical Guidance.
- European Society of Cataract and Refractive Surgeons (ESCRS). Clinical Guidelines.
- American Society of Cataract and Refractive Surgery (ASCRS). Refractive Surgery Resources.
- Cochrane Eyes and Vision. Laser Vision Correction for Refractive Errors.
- National Eye Institute (NEI). Refractive Errors.
- World Health Organization (WHO). Blindness and Vision Impairment.
- Mayo Clinic. LASIK Eye Surgery and Laser Vision Correction.
Is SMILE better than LASIK?
Not automatically. SMILE may be a good option for selected myopic patients, but LASIK or PRK may be more suitable depending on prescription, corneal shape, enhancement needs, and surgeon assessment.
Can SMILE treat every prescription?
No. The range depends on available technology, approval, clinical judgement, and the patient’s eye measurements.
Why does follow-up matter after SMILE?
Interface healing, residual refractive error, dry eye, inflammation, and visual quality should still be checked even though the procedure is flapless.
