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A newer type of laser refractive surgery known as Small Incision Lenticule Extraction (SMILE) makes use of laser to treat myopia (nearsightedness) and astigmatism (irregularly shaped cornea).

A newer type of laser refractive surgery known as Small Incision Lenticule Extraction (SMILE) makes use of laser to treat myopia (nearsightedness) and astigmatism (irregularly shaped cornea).

Learn about SMILE Eye surgery

What is Smile surgery?

A newer type of laser refractive surgery known as Small Incision Lenticule Extraction (SMILE) makes use of laser to treat myopia (nearsightedness) and astigmatism (irregularly shaped cornea). It is similar to LASIK Surgery. To see clearly, light rays must travel through cornea and lens. The cornea and lens refract (bend) the light so it lands on the retina. With a refractive error, the shape of your cornea or lens maintains light from bending properly. When light is not focused on the retina as it need to be, your vision gets blurred. In SMILE surgery, ophthalmologist changes the shape of cornea by using laser. This improves the way light rays are focused on the retina. SMILE is FDA-approved to treat mild near-sightedness and astigmatism.

Goal of the surgery

The goal of SMILE is to correct your near sightedness, astigmatism, or both, to improve your vision. SMILE can also reduce your need for eyeglasses or contact lenses. In many cases, it could even can help you do without them absolutely.


To have SMILE, you need to meet certain requirements. Here are some of them:

  • * You should be 18 years or older.
  • * Your eye prescription should not have changed by more than 0.5 in the last year.
  • * You should have nearsightedness between -1 and -10, and up to 3 diopters of astigmatism.
  • * Your corneas need to be healthy, and your overall eye health must be generally good.
  • * You need to have realistic expectations about what SMILE can and cannot do for you.

Before surgery

Before surgery ophthalmologist will examine your eyes and make sure you are a candidate for SMILE. Here is what he or she will do:

  • * Test your vision- This is to make sure that your vision has not changed. Also, it shows how high the nearsightedness is and whether SMILE is the right choice to correct your vision.
  • * Check for other eye problems- Your ophthalmologist will make sure that you do not have eye problems because other problems could affect the surgical process, or SMILE surgery could make those other problems worse.
  • * Measure and map the surface of your cornea- Your ophthalmologist will check the thickness of your cornea and make precise measurements of the cornea's surface. Your eye surgeon makes use of these measurements to program the computer-based laser used in the surgical procedure .
  • * Measure your pupil size

During surgery

  • * The laser is programmed with specific measurements for your eye.
  • * Your eye will be numbed with eye drops.
  • * Your eye surgeon will place an eyelid holder on your eye so that it doesn’t blink.
  • * A suction ring gently holds the cornea and helps to keep the eye from moving.
  • The laser sculpts a disc-shaped piece of cornea below the surface of your eye. It is the lenticule.
  • The laser then makes a small incision in your cornea. Then your surgeon separates the disc that the laser formed. The laser treatment is completed within 30 seconds.
  • Your surgeon removes the disc-shaped piece of cornea through the incision. This reshapes your cornea.

After surgery

  • * You will need to have someone drive you home after surgery.
  • * You should plan to take a nap or just relax for the rest of the day.
  • * You should take your eye-drop medicine as prescribed by your surgeon.
  • * Your vision may be blurry right after SMILE surgery. As you heal over the following few days , your vision will progressively improve.
  • * You can do most normal activities after a day or two.
  • * Avoid getting water in your eyes for a few days.


Small incision lenticule extraction (SMILE) carries the risk of problems or complications one should consider. These include:

  • * glare and halos around lights, particularly at night
  • * debris where the corneal disc was removed
  • * inflammation within the treated area
  • * infection
  • * retreatment which must be done with surface PRK

Very rare problems may include:

  • * having worse vision than before SMILE, even with glasses or contacts (called loss of best-corrected vision)
  • * weakening of the cornea(Less risk than LASIK)


Small incision lenticule extraction (SMILE) is a newer refractive surgery. Ophthalmologists expect that it will have a couple of advantages over LASIK and have similar good outcomes.

  • * No corneal flap is made during SMILE. There should not be any problem with the flap that occur with LASIK. Injuries in future will also not be dangerous.
  • * The corneal disc is removed through a very small incision. Since the surface of the cornea is not much disturbed, long-term dry eye is found to be much less common with SMILE.

Dr. Prashaant Chaudhry
Senior Consultant & HOD
Ophthalmology & Refractive surgery

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