June 12, 2019

Turned Down for LASIK? Consider SMILE for Nearsightedness

Learn about small-incision lenticular extraction

Patient discussing SMILE surgery with optometrist

Most people have heard of LASIK, one of the most popular forms of laser vision correction. But have you heard about SMILE?


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This procedure is similar to LASIK but also holds some distinct advantages — especially if you’re very nearsighted and need a high correction. Some people who aren’t candidates for LASIK can undergo SMILE.


SMILE stands for Small-Incision Lenticular Extraction. SMILE is similar to LASIK, or Laser-Assisted In Situ Keratomileusis.

They both involve the use of a femtosecond laser (which does its work with ultra short pulses), but SMILE creates a much smaller incision and performs the entire procedure on a single laser system.

During a SMILE procedure, the laser is used to create a lenticule, a disk-shaped piece of corneal tissue. The surgeon then removes this corneal tissue through a small incision without having to create and lift a flap.

Once this tissue is removed, it changes the curvature of the cornea to improve your vision.


This method differs from LASIK, which involves creating a corneal flap that exposes the cornea so that the surgeon can reshape it with the laser. Afterward, the flap is put back into place to heal.

Ophthalmologist William Dupps, MD, PhD, says there are a number of benefits of SMILE when compared with LASIK:

  1. SMILE cuts fewer nerves near the surface of the eye, which may reduce problems with dry eye after the procedure.
  2. The lack of a flap eliminates the possibility of flap-related complications during or after surgery.
  3. Dr. Dupps’ lab and other investigators have demonstrated a tendency toward better preservation of corneal strength in SMILE than in LASIK.

What happens during and after the procedure?

SMILE starts with a local anesthetic, which the surgeon uses to numb the eye. “We dock a small contact lens with gentle suction to the front surface of the eye, which maintains the alignment of the eye with the laser and prevents eye movement,” explains Dr. Dupps.

The surgeon then applies the laser treatment for about 30 seconds. “Suction is released. Then we use a small instrument to separate the layers that we created and remove the lenticule through the small incision,” he says.

The procedure typically takes about five minutes for each eye.

SMILE may take a day or two longer than LASIK to yield 20/20 or better vision, but it is usually more comfortable and ultimately produces visual results comparable to LASIK.

Most patients are able to resume all normal activities five days after the procedure.

Is SMILE a new procedure?

It is relatively new in the United States.

“SMILE has been around since 2009 and has grown exponentially since then,” says Dr. Dupps. “It’s become very popular in Asia and in some places is becoming the preferred procedure.” Physicians have performed approximately 2 million SMILE procedures worldwide so far, he says.

Is it safe?

Studies show that SMILE is just as safe as LASIK, Dr. Dupps says. Talk to your doctor to learn about any possible risks associated with your particular vision problems, and to make sure the SMILE procedure is right for you.

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