Nvision Blog

Which Is Better for Patients With Dry Eye: LASIK or SMILE?

Posted on February 16, 2020

Tears do more than help you express sadness. This precious liquid whisks away irritants before they attack the eye's delicate surface. Each tear also contains substances crucial for healthy eye tissue.

When you're recovering from surgery, your eyes need more tears than ever. But some operations can enhance dry eye symptoms. And if you have severe dry eye, you might not be a candidate for the procedure you want.

woman with dry eyes

How Does Surgery Cause Dry Eye?

LASIK and SMILE surgeries reshape your eye, so light and images focus on the retina in the back of your eye. The incisions necessary for that reshaping could interfere with your body's ability to produce tears.

During LASIK, your doctor:

  • Numbs your eye.
  • Uses a laser or scalpel to cut a small flap in the cornea.
  • Folds up that bit of tissue.
  • Uses a laser to reshape the tissue below.
  • Unfolds the flap and settles it in place.

During SMILE, your doctor:

  • Numbs your eye.
  • Uses a laser to reshape layers of tissue within the cornea.
  • Removes excess cells with suction.

SMILE surgery involves no flap. That means, experts say, that fewer nerves within your eye get cut. That's crucial, as those nerves both tell your eye when it's dry and trigger ducts to pump out fluids. If they're intact after surgery they could, in theory, produce fewer episodes of post-op dry eye.

patient receiving cataract surgery

Which Surgery Works Best?

Each eye is different, and a surgery that works best for your eyes might be terrible for your friend or neighbor. That said, doctors have dug into the data about LASIK and SMILE, and a winner is beginning to emerge.

Dry eye after both LASIK and SMILE is transient, researchers say. Anyone who has surgery will have eye discomfort, including cells that may feel:

  • Gritty
  • Blurred
  • Swollen
  • Painful
  • Irritated

These symptoms are usually mild, and they should fade quickly. But studies suggest they sometimes go away faster after SMILE. In one study, researchers found that LASIK came with more dry-eye complaints than SMILE at six months. But both groups had similar experiences at the 12-month mark.

In a second study, researchers found that 80 percent of SMILE patients didn't use artificial tears six months after surgery. Among LASIK patients, 57 percent didn't need these eye drops.

If you have dry eyes now, some surgeries could make your symptoms worse. Your doctor might recommend SMILE as your surgical choice to further reduce your risk of discomfort after the procedure is through.

But this surgery is only recommended for people with nearsightedness. If you have another form of vision loss, you'll need LASIK. That's true even if you have dry eye.

Treating Dry Eye Before Surgery

The healthier your eyes are before the surgery begins, the quicker your recovery will be. If your doctor identifies dry eye during your presurgical screening exam, there are plenty of treatment options you can try together.

Experts say doctors can treat dry eyes with:

  • Prescription eye drops. These solutions encourage your glands to make more tears. Your doctor can also use drops to reduce eyelid or cornea swelling.
  • Tear duct plugs. A tiny silicone stopper can keep your tears from leaving your eyes.
  • Warm compresses. Blocked glands in your eyes keep tears from flowing. Heat combined with massage can open them again.
  • Light therapy. Your doctor can use tiny pulses of light to open up blocked ducts yet more.

Doctors say pre-surgery dry eye treatment is crucial. That's true whether you need LASIK or SMILE. Your eyes will be healthier, and they will heal faster.

And the treatments work. In the past, people with serious dry eye problems couldn't get surgery. Now, with these treatment options, they can.

Your doctor must watch your progress carefully and advise you on surgery options. If you don't make enough progress, you may need to postpone or even halt your surgery plans.  

References

Lenticule May Beat LASIK in the Dry Eye Arena. (February 2012). EyeWorld.

Dry Eye After Small Incision Lenticule Extraction (SMILE) Versus Femtosecond Laser-Assisted in Situ Keratomileusis (FS-LASIK) for Myopia: A Meta-Analysis. (November 2016). PLoS One.

Dry Eye Disease Following Refractive Surgery: A 12-Month Follow-Up of SMILE Versus FS-LASIK in High Myopia. (2015). Journal of Ophthalmology.

SMILE May Induce Less Dry Eye Than LASIK. (June 2015). American Academy of Ophthalmology.

Point-Counterpoint: SMILE vs. LASIK. (February 2019). Review of Ophthalmology.

Dry Eyes. (March 2019). Mayo Clinic.

Contact Lens Complications Compared to LASIK Complications

Posted on February 16, 2020

Are contact lenses safer for your eyes? Or should you opt for LASIK instead?

If these questions keep you up at night, you’re not alone. We all want to do what’s best for our eyes. And it’s sometimes hard to parse medical jargon and get at the truth.

It’s true that LASIK is a surgery, and all similar procedures come with at least some risk. But contact lens complications are more common than those seen with LASIK.

While your doctor can help to cut your LASIK complication risk, you’ll need to adjust your contact injury rate alone. That’s not always easy.

Orthokeratology contact lenses

Contacts and Complications

Contacts are medical devices, and they're tightly regulated by the U.S. Food and Drug Administration. That organization wouldn't automatically approve something that wasn't safe.

But to keep your risk of problems as low as possible, you need to follow detailed instructions carefully. Few people do that.

In a study of contact-lens wearers, a third had a lens problem that required a trip to the doctor. That means the majority of people who wear contacts will have some sort of complication.

Most of the time, experts say, problems stem from bacteria. In some cases, infections can cause blindness. They can develop quickly, and often, they start with an innocent decision.

You might choose to:

  • Expose your contacts to water. You might rinse them under the tap, or you might wear them while swimming or showering.
  • Skip a cleaning step. You know you should clean your contacts before storing them. But you're tired, and you don’t. Bacteria can grow in just one night.
  • Reuse solutions. The liquids you need to care for contacts are expensive. But reusing solutions instead of replacing them can be dangerous.
  • Hold on to cases. You should replace your case regularly. If you hold onto it for too long, bacteria can grow.

The type of lens you use plays a role in complication rates. In one study, for example, researchers found that 86.84 percent of people wearing extended-use lenses had a problem. Only 67.85 percent of those who chose daily wear versions had the same issue.

Your doctor plays a role in the lenses you choose, but all the other complication risk factors stem from your choices. And global problem rates remain consistent over time. People don’t seem to change the way they care for contacts, even as the risks of improper contact use become clear.

lasik eye

LASIK and Complications

Every surgery comes with risks. You could have a reaction to the anesthetic drops, or the machine your doctor uses could malfunction. When you're preparing for surgery, it's easy for your mind to dream up plenty of scenarios that end with long-lasting blindness. In reality, LASIK comes with very few complications.

Industry records suggest that the LASIK complication rate sits at below 1 percent. Some people experience transient issues, such as:

  • Blurred vision.
  • Trouble with night vision.
  • Light sensitivity.
  • Mild pain or discomfort.
  • Dry eyes.

But often, these problems go away when the eye heals. It's very rare for them to persist.

Experts say LASIK technology is improving to reduce side effects. When compared to older surgeries, newer versions tend to come with fewer patient complaints. That means we can expect complication rates to drop even more.

To ensure the best outcome, you'll need to choose your surgeon carefully and work with a partner with plenty of experience and skill. You'll also need to stick to the follow-up care instructions given by your doctor. Do that, and there's no reason to expect major problems.

What Should You Do Next?

It's good to understand the risks and benefits of any medical procedure you're considering. That's true whether you're thinking about contacts or surgery.

But remember that your eyes are unique and special, and what's right for you might be different than what's right for someone else. Talk with your doctor to get the best advice on what should work for your eyes. 

References

Complications of Contact Lenses. UpToDate.

Contact Lens Risks. (September 2018). U.S. Food and Drug Administration.

Prevalence of Contact Lens-Related Complications Among Wearers in Saudi Arabia. (2016). Sudanese Journal of Ophthalmology.

LASIK Complication Rate: The Latest Facts and Stats You Should Know. (October 2017). American Refractive Surgery Council.

Facts About LASIK Complications. (December 2018). American Academy of Ophthalmology.

What Is the SMILE Procedure?

Posted on November 18, 2019

You probably associate the word smile with orthodontia, not ophthalmology. But if you're nearsighted, this term could take on a whole new meaning for you.

SMILE, otherwise known as small-incision lenticule extraction, is a surgical procedure that could help you to reduce or eliminate your need for glasses or contact lenses.

 

How Does SMILE Work?

SMILE is a refractive surgery that involves reshaping your eye. After surgery, light should pass directly through the center of your eyeball and focus on the perfect spot on your retina. LASIK and other laser-based surgeries have the same goal, but they achieve it in a different way.

In a LASIK surgery, your doctor cuts a small flap in the front of your eye, and that gets lifted up. A laser moves in and corrects the exposed tissue, and the flap settles back into place when the work is done.

SMILE surgeries involve no flaps. Doctors use lasers to reshape layers within the cornea while leaving the surface untouched. Excess tissue is suctioned away.

Experts say the innovation is similar to one seen in general surgery. You could have:

  • Open surgery, in which doctors make big cuts to see the field and make revisions
  • Laparoscopic surgery, in which the cuts are smaller, but the surgical outcome is similar

SMILE fans say recovery times are quicker. And you might be less susceptible to injuries later.

People who go through LASIK retain that cornea flap for the rest of life. A hit to your eye (from an errant soccer ball or a flapping branch, for example) could theoretically push it out of place. That could require surgery. The chances of such a complication from LASIK are incredibly slim, but with no flap, you have no similar risk.

Research suggests SMILE is effective. In one study of 328 people, 99 percent had 20/40 or better vision six months after surgery. At the six-month mark, 88 percent of people had 20/20 vision.

Many refractive surgeries are designed to amend all sorts of vision problems. SMILE is different.

Experts say the FDA has approved this surgery for nearsightedness, but at this point, you can't use it for anything else. You'll also need to meet surgical requirements.

To sign up for SMILE, experts say, you'll need to demonstrate that you are:

  • 22 or older.
  • Living with a stable eye prescription that hasn't changed within the last year.
  • Holding a prescription measuring between -1 and -8 diopters.
  • Healthy, with acceptable corneas and no history of eye disease or eye surgery.

 

Preparing for Surgery

SMILE is a precise procedure, and doctors like to ensure their patients are good candidates long before the work begins. Expect to go through a thorough eye exam, and be prepared to pay for the procedure.

Your doctor will:

  • Perform an exam to check your vision, measure the size of your pupils, assess the thickness of your corneas, and more.
  • Discuss your options so you can make an informed choice about SMILE or another refractive surgery.
  • Address your recovery so you'll be prepared to care for your eyes and heal.
  • Outline the cost as SMILE isn't often covered by insurance. Expect to pay $2,000 or more per eye.

Recovering From SMILE

Your surgery will be over in minutes, and you won't feel a thing. Your eyes will be numb, and if you feel nervous, your doctor can use medications to soothe your nerves. But you'll need to take several steps at home to protect your vision.

You'll use eye drops to combat infection, reduce swelling, and ease pain. As reporters point out, you'll need to use them every few hours, even at night. So you might lose a bit of sleep while your tissues knit together.

You'll also wear goggles while you sleep and in the shower, to protect your eyes from water and pokes.

After surgery, you'll have plenty of eye appointments. Your doctor will check your healing and your vision. If you don't achieve a 20/20 score (or something you deem acceptable in consult with your doctor), you might need another correction.

Some doctors use LASIK to fine-tune vision after SMILE, but others choose another solution. Your doctor can explain your options to you if the need arises.

References

Small Incision Lenticule Extraction SMILE—The Future of Refractive Surgery is Here. (January 2018). Missouri Medicine.

SMILE Procedure Expands Laser Vision Correction Options. (May 2017). American Refractive Surgery Council.

What Is Small Incision Lenticule Extraction? (June 2019). American Academy of Ophthalmology.

Who Is a Good Candidate for SMILE? (June 2019). American Academy of Ophthalmology.

I Had Laser Eye Surgery, and Here's How It Went. (April 2019). Independent.

Skills and Know-How Necessary for Successful SMILE Outcomes. (March 2016). EyeWorld.

Why Is LASIK More Affordable Than Contact Lens Wear?

Posted on November 18, 2019

You've told yourself you couldn't have LASIK, even though you desperately want to stop wearing contact lenses all the time. You think you'll save money by sticking with the tried and true.

Do the math, and you might discover that you're paying more for contacts than you would for a LASIK surgery.

 

How Much Does LASIK Cost?

During a LASIK procedure, your doctor numbs your eyes, creates a corneal flap, and amends the tissue within your eye with a laser. The flap is replaced, and you're sent home with drops to help you heal. The procedure is sophisticated, and it can come with a high price tag.

Analysts say LASIK can cost between $1,000 to more than $3,000 per eye. That price includes your:

  • Eye exam. Your doctor needs to assess your vision loss and eye health before the work begins.
  • LASIK procedure. The doctor's time, the equipment, anesthesia, and all other details are included in this price.
  • Post-operative care. Drops you need to heal your eyes and your return visits with the doctor are included here.
  • Follow-up care. If you don't achieve the vision correction you want, a second surgery can be included in the fee.

Bargain-basement prices often come with loopholes. Your follow-up care might cost extra, for example, or you won't get a second surgery for free. You'll need to understand the price carefully before you sign on.

How Much Do Contacts Cost?

You don't need surgery to wear contacts, but you do need a special type of eye exam. And you'll need to pay for both your contacts and their upkeep. This is an expense you'll always see in your budget.

In 2012, researchers dug into eye health prices all across the country. These are some of the fees you can expect to pay as a person who wears contact lenses:

  • Contact exam: Fees range between $85 and $215.
  • Contact lenses: These fees vary widely, depending on the kind of contact you need. Expect to pay about $90 for a three-month supply.
  • Glasses exam: You'll also need glasses to wear when you're resting your eyes from your contacts. This demands a different exam. Expect to pay between $20 and $140.
  • Glasses: You'll pay between $50 and $300 or more, depending on your prescription.

You'll also need cases and solution to store your contacts when they're not in your eyes. Fees can vary, but it’s not unusual to pay $200 per year to maintain your contacts.

What About Insurance?

We use insurance policies to offset the cost of medical care and keep our expenses low. While some plans help to pay for vision care, it's rare to have full coverage. And even if you do, some of your fees won't be included in your benefits package.

LASIK is not covered by insurance plans. Officials consider this an elective procedure that you could skip by wearing glasses or contacts. It's rarely, if ever, covered.

Vision insurance programs offer benefits, but they can be lean. In one typical program, you'll get coverage for:

  • Eye exams.
  • Contact lens fittings.
  • One set of contact lenses annually.

You'll have to pay out of pocket for your glasses. And this plan won't cover the cost of your solutions and maintenance materials.

Vision insurance can be helpful, but it's rare. Analysts say just 35 percent of employers offer this kind of coverage to their employees. And Medicare doesn't cover routine eye exams at all, reporters point out.

If you don't have vision insurance, you're not alone. But it means you'll pay your bill on your own, regardless of whether you choose LASIK or contact lenses.

What's the Final Tally?

 

To determine if LASIK is truly more affordable than contact lenses, we'll have to do some comprehensive math.

We know LASIK will cost, on average, $4,000 for both eyes. That's a lifetime cost, as you won't need to repeat the experience every year.

Per year, contacts will cost:

  • $100 for an exam.
  • $300 for the lenses.
  • $200 in solution.
  • $115 for glasses (since glasses cost about $350, and they last for about three years).

That brings your yearly contacts price to $715. After about five years, you'll pay more for contacts than you would for LASIK.

References

How Much Does LASIK Cost? VSP.

How Much Do Glasses Cost? How Much Do Contacts Cost? (October 2012). Clear Health Costs.

Vision Insurance FAQ: Frame, Lens, and Contact Lens Benefits. (April 2016). VSP.

What Percentage of Companies Offer Vision Insurance? (January 2017). Zenefits.

Vision Care Lags, With Blind Spots in Insurance Coverage. (May 2018). National Public Radio.

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