Can Smile Damage Optic Nerve?

The pursuit of perfect vision has sparked a rise in refractive surgery, with SMILE (Small Incision Lenticule Extraction) emerging as a popular alternative to LASIK.

However, concerns about potential risks, particularly regarding the optic nerve, have caused anxiety among prospective patients. So, does SMILE pose a genuine threat to your optic nerve? Let’s explore the facts and debunk the myths surrounding this groundbreaking procedure.


Understanding the Optic Nerve

The optic nerve, comprising millions of delicate nerve fibers, carries visual information from the eye to the brain.
Any impairment to this intricate structure can result in vision loss, underscoring the understandable apprehension regarding its susceptibility during SMILE.


SMILE vs. LASIK: A Different Approach

Both SMILE and LASIK are aimed at reshaping the cornea to correct refractive errors. However, their methods differ significantly.
LASIK: This procedure involves creating a corneal flap using a laser, lifting it, and reshaping the underlying tissue before replacing the flap. It should be noted that this process may result in the severing of some corneal nerves.

  • SMILE:
    In contrast, SMILE utilizes a femtosecond laser to create a lenticule, a small, disc-shaped piece of corneal tissue, within the cornea. This lenticule is then extracted through a tiny incision, minimizing disruption to the surrounding tissue and nerves.
  • The Nerve Factor:
    The primary distinction in nerve involvement lies in the creation of the flap. During LASIK, the flap creation severs certain sub-basal nerves that play a role in corneal sensation and tear production. However, with SMILE, this disruption is avoided, potentially resulting in quicker nerve recovery and fewer instances of dry eye problems.
  • Research and Evidence:
    Multiple studies have delved into the impact of SMILE on the optic nerve. While initial research hinted at potential alterations in optic nerve parameters following SMILE, subsequent, more comprehensive studies have revealed no significant adverse effects on optic nerve health or function. These studies, encompassing larger sample sizes, have likewise shown no statistically significant rise in intraocular pressure (IOP)—a critical risk factor for glaucoma. Furthermore, another study has found no indication of optic nerve damage or vision loss associated with SMILE, ultimately concluding that the procedure is both safe and effective.


Potential Risks and Considerations

Although the risk of optic nerve damage is minimal, it is important to acknowledge that no surgery is completely without risk. SMILE surgery, while generally safe, can have potential complications including:

  • Transient Increase in IOP:
    Although this does not directly affect the optic nerve, there may be a temporary rise in intraocular pressure after SMILE. Nevertheless, this issue usually resolves itself without intervention.
  • Loss of Corneal Sensation:
    Temporary loss of corneal sensation is common after SMILE due to the disruption of nerve fibers. Fortunately, the sensation usually returns within a few months.
  • Rare Complications:
    As with any surgical procedure, SMILE carries a small risk of rare complications such as infection, corneal ectasia (thinning), and dry eye syndrome.


The Bottom Line

According to current research, the chances of SMILE causing damage to your optic nerve are extremely low. This flapless procedure minimizes any disruption to the nerve, and studies have not shown any significant negative impact on the health or function of the optic nerve.

However, as with any surgical decision, it is crucial to have a thorough consultation with a qualified ophthalmologist. They can evaluate your individual suitability for SMILE, discuss the potential risks and benefits, and address any concerns you may have.


  • SMILE is a proven and reliable procedure for correcting refractive errors effectively and safely.
  • The risk of optic nerve damage is extremely low.
  • It is important to have a thorough discussion with your ophthalmologist about your medical history and concerns.
  • Select a skilled and experienced surgeon.
  • By making well-informed decisions based on expert guidance and evidence, you can confidently pursue improved vision without unnecessary worries about your optic nerve.

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