Turned Down for LASIK? Consider SMILE for Nearsightedness


Learn about small-incision lenticular extraction

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

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 ultrashort pulses), but SMILE creates a much smaller incision.

During a SMILE procedure, the laser is used to create a lenticule, a disc-shaped piece of corneal tissue. The surgeon then removes this corneal tissue through a small incision using a special tool.

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. Afterwards, the flap is put back into place to heal.

“Some of the most ideal SMILE candidates are the ones that require high nearsighted correction and have little or no astigmatism,” says ophthalmologist Ronald Krueger, MD.

Changes in the cornea that might make someone a poor candidate for LASIK won’t prevent someone from having SMILE, he says.

Dr. Krueger identifies a number of benefits of SMILE when compared with LASIK:

  • SMILE cuts fewer nerves on the surface of the eye, which may reduce problems with dry eye after the procedure.

  • The smaller incision makes the eye less vulnerable to trauma.

  • The procedure tends to involve faster healing and less discomfort.

  • SMILE can produce more accurate results than LASIK for patients who need a high level of correction. 

What happens during and after the procedure?

SMILE starts with a local anesthetic, which the surgeon uses to numb the eye. “We couple a small suction ring to the surface of the eye, and then we link it to the laser. The suction holds the eye still during laser treatment,” explains Dr. Krueger.

The surgeon then applies it to the cornea of the eye for about 30 seconds. “Once we remove the suction ring from the eye, we use a small instrument that allows us to separate the layers that we created and remove them through the incision,” he says.

The procedure typically takes 20 to 30 minutes for each eye.

LASIK tends to result in more immediate vision correction, but SMILE generally creates less discomfort and faster healing, given the smaller size of the incision.

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. Krueger. “It’s become very popular in Asia and in some places is becoming the preferred procedure.” Physicians have performed approximately 750,000 SMILE procedures worldwide so far, he says.

Is it safe?

Studies show that SMILE is just as safe as LASIK, Dr. Kreuger 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.

-By Family Health Team, Courtesy of Cleveland Clinic HealthEssentials