The FDA approved SMILE, the latest advance in laser vision surgery, in 2016. It has been shown to be as effective and safe as LASIK, and it is currently available for the treatment of myopia and myopic astigmatism. SMILE combines advantages of PRK and LASIK: it requires only a small incision, does not require a flap, and has a quick, LASIK-like recovery, with the additional benefit of no postoperative restrictions.
With one laser and in approximately 8 seconds, a thin contact lens-shaped layer just beneath the surface of the cornea is created with the laser. This layer is then removed through a tiny 2–3 mm opening, and the surrounding tissues heal together. The procedure is extremely comfortable, with a quick recovery, and requires no postoperative restrictions (unlike LASIK and PRK). It also avoids any potential risk of flap complications, in contrast to LASIK. The SMILE procedure is growing in popularity, but it is currently not as widely available as LASIK and PRK in the US. As surgeons and laser centers continue to adopt the technology, the volume of procedures is expected to grow.
On the day of the SMILE procedure, as with LASIK, most patients experience a sensation that they have something in their eye, as well as tearing and burning for several hours afterward. Visual recovery is quite rapid, and after one to two days most patients have 20/20 vision. With no postoperative restrictions after SMILE, patients are back to all normal activities, including wearing makeup and working out, the next day. One downside of SMILE is that certain prescriptions, including farsightedness, cannot be treated.
