SMILE Surgery

Q: Is SMILE surgery painful?

Topical numbing drops are used, so significant pain during the procedure is not expected, although some pressure or other sensations may occur during the suction step. Temporary irritation, grittiness, tearing, or light sensitivity can occur during early recovery.

Q: How is SMILE different from LASIK?

SMILE does not create a large corneal flap. Instead, a femtosecond laser shapes a small disc of tissue (the lenticule) within the cornea, which is removed through a small incision. LASIK, by contrast, creates and lifts a hinged flap before reshaping the cornea with a separate excimer laser.

Q: Can SMILE correct hyperopia?

SMILE, in its current, widely approved form, is used for myopia and myopic astigmatism. Hyperopia (farsightedness) is generally treated with other techniques such as LASIK or PRK; your surgeon can confirm which option fits your prescription.

Q: How long do SMILE results last?

SMILE corrects the existing refractive error, and results are generally long-lasting. However, age-related changes such as presbyopia (difficulty focusing up close, typically after age 40–45) or cataracts can still develop independently over time.

Q: Can both eyes be treated on the same day?

Yes, SMILE is commonly performed on both eyes during the same session, though your surgeon may recommend otherwise based on individual factors.

Q: Is there an age limit for SMILE?

SMILE is generally considered for adults with a stable prescription, often required to be unchanged for at least one to two years. The exact age and candidacy requirements depend on regulatory requirements, eye health, and the specific laser system your surgeon uses.

Q: When can I fly or travel after SMILE?

Travel timing should be confirmed with your surgeon. Flying may be possible soon after an uncomplicated procedure, but scheduled follow-up and individual recovery factors can affect the recommendation.

SMILE (Small Incision Lenticule Extraction) is an advanced, flapless laser refractive surgery that corrects nearsightedness (myopia) and astigmatism. Using a high-precision femtosecond laser, a micro-thin, disc-shaped piece of tissue (lenticule) is shaped within the corneal stroma and removed through a keyhole micro-incision. Because no corneal flap is created, SMILE preserves corneal structural integrity, minimises surface nerve disruption, and significantly reduces daily dependence on glasses or contact lenses.

SMILE Surgery

Surgery Name
SMILE Surgery
Speciality
Ophthalmology (Refractive Surgery)
Duration
Usually 10–20 minutes for both eyes
Anaesthesia
Topical anaesthetic numbing eye drops
Hospital Stay
Same-day discharge; no hospital admission

Recovery Time
Routine activities in 1–2 days; vision stabilises over weeks
Procedure Type
Flapless femtosecond laser lenticule extraction (SMILE / SMILE Pro)
Insurance Coverage
Usually elective; coverage depends on policy criteria
Expected Outcome
Highly effective; outcomes depend on prescription and corneal anatomy

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Signs You May Need Vision Correction

Refractive errors occur when the eye cannot focus light directly onto the retina. SMILE is evaluated for adults with stable refractive errors who experience visual limitations such as:

Blurred distance vision: Inability to see distant road signs, television screens, whiteboards, or distant objects clearly (characteristic of myopia).
Distorted or ghosted vision: Visual blur, shadowing, or stretching of images at multiple distances (characteristic of astigmatism).
Frequent squinting and eye strain: Repeatedly narrowing the eyes to focus, frequently causing brow ache or tension headaches.
Sports and lifestyle hindrances: Inconvenience or risk of glasses fogging, slipping, or breaking during athletic, outdoor, or occupational activities.
Contact lens intolerance: Ocular dryness, foreign body sensation, or recurrent irritation caused by daily contact lens wear.

Understanding Refractive Errors

Clear vision occurs when the cornea and the natural lens bend incoming light rays to converge sharply onto the retina. When the corneal curvature does not match the physical length of the eyeball, light focuses incorrectly, causing blurred or distorted images.

Refractive Errors Corrected by SMILE

Myopia (Nearsightedness): The eyeball is slightly too long or the cornea is excessively curved, causing incoming light to focus in front of the retina rather than directly on it.
Myopic Astigmatism: The cornea has an asymmetrical, oblong curvature (resembling a rugby ball rather than a spherical football), creating multiple optical focal points.
Presbyopia Considerations: Natural age-related loss of near focusing power (typically developing after age 40). While standard SMILE corrects distance vision, monovision strategies may be discussed with your surgeon.

Causes and Contributing Factors

Genetic Predisposition and Eye Growth: Most refractive errors are inherited and stabilize once physical growth finishes in early adulthood.

Preparing for SMILE Surgery

Treatment Option	Best For	Procedure Method	Recovery
SMILE	Myopia and myopic astigmatism with active lifestyles or dry-eye concerns	Flapless femtosecond lenticule extraction through a 2–4 mm micro-incision	Rapid visual recovery; light activities in 1–2 days; healing continues for weeks
Femto-LASIK	Myopia, hyperopia, and astigmatism seeking immediate visual clarity	Femtosecond laser corneal flap + excimer laser ablation	Rapid visual recovery; light activities in 1–2 days; healing continues for weeks
PRK / Surface Ablation	Thin corneas, surface irregularities, or high trauma risk occupations	Surface epithelial removal + excimer laser ablation (no flap)	Gradual visual recovery over 1–2 weeks; bandage contact lens worn 3–5 days

A comprehensive pre-operative evaluation is conducted to verify candidacy and calculate exact laser programming dimensions:

Corneal Tomography & Topography (e.g., Pentacam): High-resolution 3D mapping of anterior and posterior corneal surfaces to exclude subclinical keratoconus.
Corneal Pachymetry: Precision ultrasound or optical thickness measurements to ensure sufficient residual stromal bed depth.
Cycloplegic Refraction: Measuring true refractive error after relaxing eye focusing muscles with drops.
Pupillometry & Higher-Order Aberrometry: Measuring pupil size in dim light to determine optimal optical and transition zone diameters.
Tear Film & Ocular Surface Evaluation: Assessing tear break-up time and meibomian gland health.
Dilated Fundus Examination: Detailed inspection of the peripheral retina to detect and treat any retinal thinning or tears prior to surgery.

What Happens on the Day of Surgery?

The outpatient surgical process is designed to ensure maximum patient comfort and safety:

Verification of patient identity, surgical consent, and final laser parameter calibration.
A mild oral relaxing medication may be provided if prescribed to help you stay calm.
Instillation of topical anaesthetic (numbing) eye drops to eliminate ocular sensation.
The eyelids and periocular area are disinfected with an antiseptic solution, and you are positioned comfortably under the femtosecond laser.

Risks and Complications of SMILE Surgery

Before Surgery	After Surgery
Blurred Distance Sight: Significant blurring and distortion caused by uncorrected myopia and astigmatism.	Clear Distance Vision: Functional uncorrected vision often achieved within 24 to 48 hours, with progressive stabilization over weeks.
Constant Eyewear Constraints: Reliance on glasses or contacts that restrict sports, travel, and daily convenience.	Flap-Free Athletic Freedom: Full participation in sports, swimming, and outdoor pursuits without concern for flap displacement.
Contact Lens Fatigue: Ocular dryness, irritation, and redness from continuous contact lens wear.	Minimal Dryness Symptoms: Temporary mild dryness that resolves quickly due to preserved corneal sensory nerves.
Daily Inconvenience: Regular expenditure and routine maintenance for spectacles and contact lenses.	High Long-Term Visual Quality: Excellent contrast sensitivity and lifestyle satisfaction.

Complication	Risk Level	What It Is	How We Prevent / Treat It
Dry Eye Symptoms	Common (mild, temporary, usually 1–2 months)	Temporary decrease in tear film stability causing mild dryness or grittiness	Preservative-free lubricating eye drops; significantly lower incidence and faster recovery compared to flap-based surgeries
Night Vision Symptoms (Glare & Halos)	Common in early recovery; usually improves	Visual glare, halos, or starbursts around bright lights in low-contrast night conditions	Optimized optical zones and aspheric lenticule geometry; symptoms diminish as corneal remodeling completes
Under-correction / Over-correction	Uncommon (approx. 1–3%)	Slight residual refractive error (under-correction or over-correction) after full healing	Managed with corrective glasses or surface laser enhancement (PRK) once refraction is stable (after 3–6 months)
Suction Loss during Laser Delivery	Rare (less than 1%)	Inadvertent loss of suction contact during femtosecond laser firing	Managed immediately according to standard clinical algorithms (re-docking, converting to LASIK/PRK, or rescheduling)
Incision Tear / Retained Lenticule Remnant	Rare (less than 0.5%)	Tear at the micro-incision edge or retention of a microscopic lenticule fragment	Gentle surgical dissection, meticulous visual inspection of extracted lenticule, and micro-irrigation if needed
Inflammation (DLK) / Infection	Very rare (less than 0.1%)	Non-infectious corneal inflammation (Diffuse Lamellar Keratitis) or microbial infection	Strict operating room asepsis and prompt treatment with topical antibiotic and corticosteroid eye drops
Corneal Ectasia	Extremely rare (less than 0.05%)	Progressive structural thinning and steepening of the cornea in biomechanically susceptible eyes	Rigorous pre-operative tomographic screening; managed with Corneal Collagen Cross-Linking (CXL) if ever detected
Refractive Regression	Uncommon (months to years later)	Gradual minor drift in refractive error over long-term follow-up	Monitored at routine annual check-ups; may be addressed with enhancement if clinically appropriate

Recovery Timeline After SMILE Surgery

Time Period	Expected Recovery Milestones
First 24 Hours	Vision is initially misty or hazy. Mild tearing, light sensitivity, and foreign body sensation are common for 3–5 hours. Rest with eyes closed; wear protective eye shields.
Days 2 to 7 (First Week)	Vision sharpens significantly, allowing return to routine office work and light activities. Use prescribed eye drops as scheduled; avoid rubbing the eyes.
Weeks 2 to 4	Micro-incision is fully healed. Visual acuity and contrast sensitivity continue to refine. Moderate exercise, gym workouts, and non-contact sports can safely resume.
Months 1 to 3	Complete corneal remodeling and refractive stabilization. Any transient night glare or dry-eye symptoms largely resolve.

Postoperative Care

Immediate post-procedure care at the surgical center ensures proper ocular recovery before discharge:

Rest comfortably in a dimly lit recovery lounge for 20 to 30 minutes.
A detailed slit-lamp examination is performed to confirm micro-incision sealing and absence of stromal debris.
Clear protective eye shields are taped over the eyes.
The clinical team provides your eye drop medication kit, instructions, and confirms your Day-1 follow-up appointment.

Frequently Asked Questions about SMILE Surgery

Is SMILE surgery painful?

SMILE is virtually painless. Numbing anaesthetic drops are applied before the procedure to thoroughly anaesthetize the eye. You will feel a sensation of slight pressure for 10–25 seconds during laser docking, but sharp pain is minimised. Mild foreign body sensation, tearing, or scratchiness may occur for 3–5 hours after surgery.

How is SMILE different from LASIK?

SMILE is a flapless procedure that removes a small disc of tissue (lenticule) through a 2–4 mm micro-incision using a single femtosecond laser. Femto-LASIK creates a larger 20 mm circular hinged flap and uses an excimer laser to ablate tissue. SMILE offers greater biomechanical preservation and fewer flap-related concerns.

Can SMILE correct hyperopia (farsightedness)?

SMILE is widely approved for myopia (nearsightedness) and myopic astigmatism. Hyperopia (farsightedness) is generally treated with Femto-LASIK or PRK, though hyperopic lenticule extraction protocols are under clinical evaluation and regulatory rollout on select advanced platforms.

How long do SMILE results last?

The corneal reshaping achieved by SMILE is permanent. However, SMILE does not prevent natural age-related ocular changes, such as presbyopia (gradual loss of near focus after age 40) or cataracts later in life.

Can both eyes be treated on the same day?

Yes. In the vast majority of cases, bilateral SMILE surgery (both eyes treated during the same surgical session) is standard clinical practice worldwide, providing rapid and balanced visual recovery.

Is there an age limit for SMILE surgery?

Candidates must be at least 18 years of age with a stable prescription for at least 12 months. There is no upper age limit as long as your eyes are healthy, free from significant cataracts, and have normal corneal topography and tear film health.

When can I fly or travel after SMILE?

Most patients can safely fly 2 to 3 days after surgery following their Day-1 follow-up examination. Because aircraft cabin air is very dry, using preservative-free lubricating drops frequently during the flight is strongly recommended.

Will I still need reading glasses after SMILE?

Standard SMILE corrects distance vision. If you are under 40, your natural lens will focus comfortably at near distances. After age 40–45, presbyopia naturally develops, and reading glasses may eventually be needed for close tasks unless monovision strategies are used.

What happens if I need an enhancement after SMILE?

If residual refractive error persists after full healing, an enhancement procedure can be safely performed using surface PRK or converting the SMILE cap into a flap (Circle technique), provided corneal thickness permits.

Study / Guideline	Core Metric Settled	Direct Impact on Surgical Practice	Link to Study / Summary
American Academy of Ophthalmology (AAO) Refractive Surgery PPP	Preferred Practice Pattern guidelines affirming SMILE as a safe, effective, and predictable flapless procedure for correcting myopia and myopic astigmatism.	Standardized worldwide clinical indications, pre-operative tomographic screening, and post-operative safety guidelines for lenticule extraction.	https://www.aao.org/preferred-practice-pattern/refractive-surgery-ppp
Cochrane Systematic Review & Meta-Analysis - SMILE vs LASIK for Myopia	Demonstrated equivalent uncorrected visual acuity (UCVA) and refractive predictability between SMILE and LASIK, with SMILE showing superior corneal nerve preservation and lower post-operative dry eye scores.	Provided robust, evidence-based confirmation of long-term visual equivalence and ocular surface benefits for myopic patients.	https://www.cochranelibrary.com/
US FDA Premarket Approval (PMA) & International Multi-Center Clinical Trials	Reported >95% of patients achieving 20/20 or better uncorrected visual acuity with excellent refractive stability and high overall patient satisfaction.	Established safety thresholds and parameters for treating myopia up to -10.00 D and astigmatism up to -5.00 D.	https://www.fda.gov/medical-devices/recently-approved-devices/visumax-femto-laser-system-p150040

SMILE Surgery

SMILE Surgery

Free Second Opinion

Signs You May Need Vision Correction

Understanding Refractive Errors

Refractive Errors Corrected by SMILE

Causes and Contributing Factors

Understanding Refractive Errors

Refractive Errors Corrected by SMILE

Causes and Contributing Factors

What is SMILE Surgery?

When is SMILE Surgery Recommended?

What Happens if You Delay Treatment?

Know Your Insurance Benefits

When to Seek Prompt Eye Evaluation

Types of Laser Vision Correction Procedures

SMILE / SMILE Pro (Small Incision Lenticule Extraction)

Femtosecond (Bladeless) LASIK

Photorefractive Keratectomy (PRK / TransPRK)

Comparing SMILE with Other Options

Doctor's Recommendation

Preparing for SMILE Surgery

What Happens on the Day of Surgery?

What to Expect Before and After SMILE Surgery

How is SMILE Surgery Performed?

Anaesthesia and Eye Docking

Femtosecond Lenticule Creation

Lenticule Dissection

Lenticule Extraction and Completion

How Long Does SMILE Surgery Take?

Expert Guidance, Every Step of the Way

Risks and Complications of SMILE Surgery

Recovery Timeline After SMILE Surgery

Postoperative Care

Eye Drops & Protection

Hygiene & Environmental Precautions

Activity Guidelines

Follow-Up Visits After SMILE Surgery

Warning Signs After SMILE: When to Seek Urgent Care

Questions to Ask Your Surgeon

Frequently Asked Questions about SMILE Surgery

Find the Right Specialist for SMILE Surgery

Why Choose SPEROW?

Find a Surgeon You Can Trust

Clinical Guidelines and Evidence

Related Conditions

Related Procedures

Related Specialty

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