Yes, SMILE Pro can treat more complex refractive errors than traditional SMILE, especially because it’s the first lenticule extraction solution to effectively treat hyperopia in addition to myopia and astigmatism.
SMILE Pro’s expanded capabilities, advanced technology, and improved safety features mean more patients—including those with challenging prescriptions—can benefit from laser vision correction.
If you’ve been told your vision is “too complex” for traditional SMILE, or you’re curious about the latest options in refractive surgery, this guide will help you understand how SMILE Pro changes the game. We’ll break down what makes SMILE Pro different, the technology behind it, and why it’s now a leading choice for treating a broader range of refractive errors.
What Makes SMILE Pro Different for Complex Vision Problems?
SMILE Pro stands out because it’s not just a small upgrade—it’s a leap forward in what’s possible with lenticule extraction. Traditional SMILE has been a reliable option for correcting myopia and astigmatism, but it has clear limitations, especially for people with hyperopia (farsightedness) or those needing high-precision correction.
SMILE Pro, performed on the ZEISS VISUMAX 800 femtosecond laser, is the first of its kind to offer effective, safe correction for myopia, astigmatism, and hyperopia. Its treatment range extends up to +7 diopters for hyperopia, -10 diopters for myopia, and up to -5 diopters for astigmatism. This expanded range means more people can qualify for laser vision correction—even those who were previously told they weren’t candidates.
How SMILE Pro Expands Treatment for Hyperopia, Myopia, and Astigmatism?
Traditional SMILE: Reliable, But Limited
- Myopia and Astigmatism: Traditional SMILE is well-established for nearsightedness and moderate astigmatism.
- Hyperopia: Early attempts to treat hyperopia with SMILE (like the FLEx prototype) struggled with poor visual quality and regression. The small optical and transition zones simply weren’t enough to deliver stable, high-quality results.
SMILE Pro: A Broader, More Effective Solution
- Expanded Range: SMILE Pro treats myopia up to -10D, astigmatism up to -5D, and hyperopia up to +7D.
- Redesigned Lenticule Geometry: By increasing the optical zone to 6.3 mm and adding a 2 mm transition zone (total diameter 8.3 mm), SMILE Pro delivers better refractive stability and visual quality for hyperopic patients.
- Minimum Lenticule Thickness: Maintained at approximately 30 µm to reduce interaction between the lenticule and corneal cap, lowering the risk of surgical complications and ensuring smoother removal.
The VISUMAX 800: The Technology Powering SMILE Pro’s Precision
Faster, Safer, and More Comfortable Procedures
- Laser Speed: The VISUMAX 800 operates at a pulse frequency of 2 MHz—four times faster than the previous VISUMAX 500. This means lenticule creation takes less than 10 seconds per eye, compared to 22 seconds before.
- Reduced Risk of Suction Loss: Shorter treatment times lower the risk of suction loss, which can be a problem during longer procedures, especially for anxious or uncooperative patients.
- Enhanced Patient and Surgeon Experience: The device is smaller, mobile, and features two screens—one for surgery, one for data management—making the whole process smoother.
Advanced Centration and Cyclotorsion Control
- CentraLign: This computer-assisted function ensures the treatment is perfectly centred on the corneal vertex, not just the pupil. Accurate centration is critical for optimal outcomes, especially in hyperopic and high-astigmatism cases.
- OcuLign: This tool allows for digital rotation of the cutting pattern, compensating for any eye rotation (cyclotorsion) during surgery. This is especially important for precise astigmatism correction.
Why does this matter?
Manual centration and axis alignment in traditional SMILE (VISUMAX 500) depends on the surgeon’s skill and can lead to decentration or under-correction, especially for complex cases. SMILE Pro automates these steps, reducing the risk of operator error and improving consistency.
Comparing SMILE Pro and Traditional SMILE for Complex Refractive Errors
| Feature | Traditional SMILE (VISUMAX 500) | SMILE Pro (VISUMAX 800) |
| Myopia Correction | Up to -10D | Up to -10D |
| Astigmatism Correction | Up to -5D | Up to -5D |
| Hyperopia Correction | Limited/Not available | Up to +7D |
| Laser Speed | 500 kHz (22 seconds per eye) | 2 MHz (<10 seconds per eye) |
| Centration Control | Manual | Computer-assisted (CentraLign) |
| Cyclotorsion Adjustment | Manual | Digital (OcuLign) |
| Lenticule Geometry | Smaller, less stable | Larger, more stable |
| Risk of Suction Loss | Higher | Lower |
| Induction of HOAs | Higher | Lower |
Bottom line:
SMILE Pro’s technology not only expands who can be treated, but also improves the safety and predictability of outcomes for those with complex prescriptions.
Why SMILE Pro Is a Game-Changer for Hyperopia and High Astigmatism?
Solving the Hyperopia Challenge
- Early hyperopic SMILE treatments failed due to small optical zones and poor transition zones, leading to regression and poor visual quality.
- SMILE Pro’s larger optical and transition zones now make it a real alternative to LASIK for hyperopia.
- Studies show positive results, but accurate centration and the creation of a large lenticule are essential for success.
Tackling High Astigmatism with Precision
- Traditional SMILE lacked reliable cyclotorsion compensation, making high-astigmatism corrections tricky and prone to under-correction.
- SMILE Pro’s OcuLign system allows for precise digital axis alignment, reducing the risk of error and improving outcomes.
Addressing Surgical Challenges
- Shorter Procedure Time: The VISUMAX 800’s faster laser means less time under suction, reducing the chance of complications.
- Better Ergonomics: The new device is smaller, mobile, and allows for better workflow and comfort for both patient and surgeon.
- Digital Integration: Treatment planning is centralised and can be done remotely, reducing errors and saving time.
Real-World Results: What Do Studies Show About SMILE Pro for Complex Cases?
- Lower Induction of Higher-Order Aberrations (HOAs): The VISUMAX 800’s user interface and advanced software help surgeons achieve better centration and axis alignment, resulting in fewer HOAs and better visual quality.
- Improved Outcomes for Complex Prescriptions: Studies confirm that SMILE Pro delivers excellent results for patients with high myopia, astigmatism, and hyperopia—outcomes that were previously difficult to achieve with traditional SMILE.
- Reduced Complications: Faster procedures and digital controls mean lower rates of suction loss and decentration, both of which can negatively impact visual outcomes.
Who Should Consider SMILE Pro for Complex Refractive Errors?
SMILE Pro is especially suitable for:
- Patients with high myopia or astigmatism who want a minimally invasive procedure.
- Those with hyperopia who were not eligible for traditional SMILE.
- Patients seeking a procedure with a lower risk of dry eye and better biomechanical stability than LASIK.
- Individuals who want the latest, most precise technology for their vision correction.
What to Expect? The Patient and Surgeon’s Experience with SMILE Pro
- Comfort: Shorter laser times and improved ergonomics mean a more comfortable experience.
- Safety: Advanced controls reduce the risk of complications.
- Efficiency: Integrated software and digital planning streamline the process for both patient and surgeon.
Key Takeaways: Is SMILE Pro the Best Choice for Complex Refractive Errors?
SMILE Pro represents a major advancement in laser vision correction.
It’s the first lenticule extraction procedure to reliably treat hyperopia, while still excelling at myopia and astigmatism correction. Its advanced technology, faster treatment times, and digital controls mean safer, more predictable outcomes for patients with complex prescriptions.
If you’ve been told you’re not a candidate for traditional SMILE or want the most advanced option for your vision, SMILE Pro is worth considering. Consult with a refractive surgeon who offers SMILE Pro to see if it’s right for your needs.
Ready to take the next step? Explore your options with a SMILE Pro provider and see how modern laser vision correction can work for you.
