SMILE Eye Surgery

What is SMILE eye surgery?

In small incision lenticule extraction (SMILE) eye surgery, your surgeon uses a laser to reshape your cornea and treat astigmatism and nearsightedness.

SMILE is a minimally invasive surgery. Its name gives an idea of what happens. The laser creates a lenticule and a tiny incision — less than 4 millimeters long — into your eye to remove your lenticule. Lenticules are disc-shaped pieces carved into your cornea by the laser. (The shape of the tissue is like an M&M®.) Removing the piece of tissue is what changes the shape of your cornea.

What does SMILE eye surgery treat?

Your eye care professional may suggest SMILE surgery if you have refractive errors and want to be able to see without using eyeglasses or contact lenses.

They may recommend SMILE eye surgery over other types of corrective surgeries if you have a higher prescription or issues with dry eyes. People who are candidates for SMILE eye surgery:

• Are at least 22 years old.
• Haven’t had a significant change in their prescription in a year.
• Have prescription ranges that fall between specific parameters: nearsightedness that falls between -1 and -10 and astigmatism up to 3 diopters.
• Have healthy corneas.
• Are able to understand the benefits, risks and limitations of SMILE eye surgery.

Who shouldn’t have SMILE eye surgery?

Your eye care provider may not recommend SMILE eye surgery if you:

• Are pregnant or breastfeeding (chestfeeding).
• Have frequent changes in prescription for glasses or contacts.
• Have severe glaucoma.
• Have scars on your cornea.
• Have certain types of skin disorders.
• Have keratoconus.
• Have unmanaged diabetes.
• Have a cataract that’s affecting your vision.
• Have had certain kinds of eye surgeries, injuries or infections.

How common is SMILE eye surgery?

Throughout the world, surgeons have done 5 million SMILE eye surgeries. The procedure became available in the U.S. in 2016, but had approval elsewhere about 10 years before that.

How should I prepare for SMILE eye surgery?

In a pre-surgery appointment, your surgeon will examine your eyes to confirm you don’t have any other eye diseases or conditions that mean you shouldn’t have SMILE surgery. They’ll map out plans to remove the lenticule from your eye. For example, they’ll measure your cornea’s curvature and thickness.

Your provider will let you know how to prepare for surgery.

• They’ll ask you about the medications and over-the-counter supplements you take. They’ll let you know about medications you should stop taking before the surgery. They’ll also tell you when you should stop taking them before the surgery.
• Your provider will advise you if you need to stop drinking or eating the day before the procedure.

You should have an adult friend or family member with you to drive you home on the day of your surgery, too.

What happens during this procedure?

Your surgeon will numb your eye. They’ll use a femtosecond laser for the surgery.

The laser will create a small disc of tissue from your eye that looks much like a soft contact lens. It will be thicker in the middle and thinner along the edges. This disc is the lenticule.

Your surgeon will use the laser to make a small cut into your eye so they can remove the lenticule. By doing this, the surgeon changes the shape of your cornea and improves your vision.

Your eye doesn’t need stitches and will heal in about one or two days.

How long does a SMILE eye surgery take?

The SMILE surgery itself takes only minutes for each eye. The laser part only takes about 30 seconds.

What happens after a SMILE eye surgery?

After SMILE surgery, your friend or family member can take you home. You shouldn’t do anything strenuous that day. You’ll probably want to rest.

Your vision will get better over a matter of days or weeks. It may even be better right away. You’ll likely be able to return to your normal routine after one or two days. But you should be careful to avoid water in your eyes for a few days.

What are the benefits of the SMILE eye surgery?

People have corrective surgeries because they want to get rid of their contact lenses or glasses. If you have SMILE eye surgery, you’ll be able to see better and be less dependent on glasses or contact lenses.

SMILE may be better than LASIK eye surgery for people who:

• Tend to have dry eyes.
• Have a higher prescription.
• Are more active. You have more of a chance of the corneal flap moving around with LASIK. There isn’t a corneal flap created during SMILE.

SMILE surgery offers a chance for less tissue and nerve damage, quicker healing and less inflammation than other types of corrective eye surgeries. SMILE surgery is painless, too.

How successful is SMILE eye surgery?

One study of people who had SMILE surgery found that 99% of them had at least 20/40 vision six months after the surgery. The same study showed that 88% had 20/20 vision when they came in for their six-month check-up.

What are the risks or complications of SMILE eye surgery?

Any surgery comes with risks or the chance of complications. Even though SMILE surgery is very safe and effective, you may have issues:

• Finding a surgeon who has done this surgery a significant number of times.
• Having halos and glare with lights, especially when it’s dark.
• Dry eyes.
• Needing another surgery to handle debris in your eye or to smooth out your cornea.
• Loss of vision (very rare).

What is the recovery time for SMILE eye surgery?

You should be able to resume regular activities in a few days, but you’ll still need to avoid getting water in your eyes for at least that long. Your vision may seem better even at first. It will continue to improve in the coming days and weeks.

In addition, you should:

• Wear protective eyewear after the surgery (like sunglasses or safety glasses).
• Avoid using eye makeup until your provider says it’s OK.
• Use any eye drops or other prescribed medications as directed by your surgeon.
• Don’t go swimming or use hot tubs for the first few days, or as directed by your surgeon.

When should I call my healthcare provider?

Your surgeon will give you instructions after your procedure. These instructions will tell you when you need to call. But typically, you should call your provider or get emergency help if:

• You have extreme pain in your eye.
• You lose vision suddenly.
• You have signs of infection, such as swelling, changes in skin color or a fever.
• You have discharge from your eye.

Is SMILE eye surgery safer than LASIK?

Both SMILE eye surgery and LASIK eye surgery are very safe procedures. SMILE may have an advantage because it is less invasive than LASIK. There’s also less chance of nerve or tissue damage.

What is the downside of SMILE eye surgery?

SMILE eye surgery only treats astigmatism and myopia (nearsightedness). Other corrective surgeries can treat other eye conditions, like presbyopia or farsightedness (hyperopia).

The SMILE procedure is a little newer than other eye surgeries. There may be fewer surgeons familiar with doing SMILE surgery than LASIK or photorefractive keratectomy (PRK). There may also be fewer research studies on SMILE surgery.

A note from Cleveland Clinic

Many people who wear contact lenses or glasses decide they don’t want to wear them any longer. Your eye care provider is your partner in sight. Ask them if they would recommend any type of corrective surgery, like SMILE eye surgery. They’ll direct you to the safest option for you. If you have SMILE surgery, be sure to do what your surgeon tells you so you have the best results.