Smile Eye Surgery Requirements

For lots of people, always needing glasses or contacts can be a hassle. SMILE, an innovative laser eye surgery, offers to get rid of this nuisance by reshaping the cornea permanently and enhancing eyesight.

But before you start imagining a specs-free life, it’s vital to grasp the prerequisites, eligibility criteria, and important factors for SMILE.


Demystifying SMILE

SMILE, short for Small Incision Lenticule Extraction, runs on a femtosecond laser to craft a tiny lenticule in the cornea, tailored precisely to correct refractive errors. This procedure, conducted in a near-silent manner, allows the patient to maintain a comfortable position throughout.

Following lenticule creation, it is gently removed through a small incision, reshaping the cornea to address issues like nearsightedness and astigmatism.

SMILE boasts advantages over LASIK

  • Preservation of Tissue:
    By minimising disruption, it enhances biomechanical stability, accelerates healing, and lowers the risk of dry eye symptoms.
  • Incision Size:
    A smaller incision reduces the likelihood of post-operative complications.
  • Speedy Recovery:
    Many patients notice improved vision in just a few days.


Candidate Criteria: A Checklist for Suitability

While SMILE boasts numerous benefits, it’s not a blanket solution for everyone.

Here’s a detailed checklist to evaluate your suitability:

  • Age:
    Candidates should be at least 22 years old, with no specified upper age limit. Typically, vision stabilises around this age, ensuring optimal results from the procedure.
  • Vision Stability:
    Prior to considering SMILE surgery, patients should maintain consistent refraction within +/- 0.5 D for at least a year. Fluctuations in refraction may indicate potential vision changes, affecting the predictability of SMILE outcomes.
  • Central Corneal Thickness (CCT):
    Adequate corneal thickness is crucial for successful surgery. Thinner corneas are more susceptible to complications, such as post-operative ectasia. A minimum thickness of 475 micrometres is generally recommended. These precise measurements will be fed into the computer that controls the SMILE laser.
  • Eye Health:
    Candidates should have healthy eyes without pre-existing conditions like cataracts, corneal issues, excessive scarring, advanced or uncontrolled glaucoma, active eye inflammation, ocular allergy, epithelial basement membrane dystrophy, keloid formation, functional monocularity, corneal thinning disorders or significant corneal abnormalities. These conditions can impact the safety and effectiveness of the procedure.
  • Refractive Error:
    SMILE is effective for treating nearsightedness (-1 to -10 diopters) and astigmatism (up to 5 diopters). Notably, SMILE is not suitable for farsightedness or presbyopia.


Additional Considerations

  • Pregnancy and Breast-Feeding:
    These conditions are contraindications due to hormonal changes that impact vision.
  • Certain Medical Conditions:
    Conditions such as uncontrolled diabetes, hepatitis C, autoimmune disorders, herpes, and uncontrolled chronic illnesses can heighten risks and hinder corneal wound healing.
  • Previous Eye Surgery:
    Previous eye surgeries may influence suitability for the procedure.
  • Severe Dry Eye:
    While SMILE generally presents a lower risk of dry eye compared to LASIK, existing dry eye conditions should be addressed with your physician.
  • Immunosuppressant Drugs:
    The same caution applies if you are using immunosuppressant medications.


Beyond the Checklist: A Deeper Dive into Suitability Factors

Seeking guidance from a proficient ophthalmologist with expertise in SMILE is crucial. They will conduct a comprehensive eye examination, encompassing:

  • Detailed Vision test:
    Evaluate your current prescription and its stability.
  • Comprehensive Corneal Assessment:
    Utilise advanced imaging technologies to measure corneal thickness and topography.
  • Tear Film Assessment:
    Adequate tear production and quality are vital for post-surgery healing and comfort.
  • Pupil Size Measurement:
    Utilising a pupillometer, pupil size is measured by laser to ensure precise targeting of the lenticule. Larger pupils can present challenges during the laser procedure.
  • Holistic Eye Health Evaluation:
    Identify any underlying conditions that could affect the procedure.
  • Detection of Corneal Irregularities:
    Utilise slit-lamp examination to identify abnormalities like keratoconus, neovascularisation, scarring, or cataracts.
  • Identification of Corneal Thinning Conditions:
    Corneal pachymetry serves as a valuable screening tool for patients with corneal thinning disorders.
  • Additional Tests:
    Intraocular pressure measurement is crucial for detecting uncontrolled glaucoma. Fundoscopy helps exclude retinal holes, degenerative retinas, and various macular diseases. Computed video keratography is effective in detecting early signs of keratoconus, corneal warpage, as well as asymmetrical or irregular astigmatism.
  • Personalised Discussion:
    Address your lifestyle, expectations, and concerns to ensure an informed decision-making process.


Preparing for Surgery: Ensuring a Smooth Journey

If you meet the requirements and decide to move forward, your doctor will offer precise pre-surgery guidelines, including:

  • Ceasing contact lens use for a specified time (typically weeks) to avoid interfering with preoperative tests.
  • Refraining from applying makeup and lotions near the eyes on the surgery day to prevent debris accumulation that could cause infections.
  • Organising transportation to and from the surgery, as you may not be fit to drive immediately afterwards.
  • Reviewing all medications and supplements you are taking, as some may require adjustment before or after the surgery.


The Final Word: Knowledge Empowers Choice

SMILE presents an appealing laser vision correction option, yet it’s not universally suitable. Understanding the prerequisites, eligibility criteria, and key factors allows you to decide if it aligns with your vision needs and lifestyle. Remember, consulting a proficient ophthalmologist specialising in SMILE is vital. They can evaluate your suitability, address queries, and alleviate any concerns you may harbour.


Consider these key reminders

  • The Choice is Yours:
    Although your doctor offers advice, the final decision to undergo SMILE is yours to make.
  • Seek Diverse Opinions:
    Consulting multiple ophthalmologists can offer varied perspectives and boost confidence in your chosen provider.
  • It’s an Investment in Your Vision:
    Despite the upfront cost, weigh it against the long-term advantages of potentially reducing reliance on glasses or contacts. Empower yourself with the knowledge to make informed choices regarding your vision and eye well-being. By carefully reviewing the insights provided and seeking counsel from qualified experts, you can determine if SMILE leads you to a clearer future, free from glasses and contacts.

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