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.


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.

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