SMILE vs LASIK Surgery in Singapore: Which is Better?
Singaporeans have one of the highest rates of myopia in the world. Laser vision correction (LVC) procedures have been widely performed to help patients reduce their dependence on glasses and contact lens and improve their quality of life.
The commonest LVC procedure is LASIK surgery, because of its high success rate, predictability and fast recovery. It has been the main treatment of choice amongst refractive surgeons for decades. Other LVC procedures like Epi-LASIK / LASEK and more recently SMILE/SMILE Pro, have been added to the list of LVC procedures.
There is a lot of material regarding LASIK and SMILE and it can be difficult for patients to digest the multitude of information. Patients often ask whether LASIK or SMILE is better for their vision correction and which one should be chosen?
This article aims to compare the 2 procedures and provide an overview regarding both procedures and their relative differences and benefits.
What is LASIK and SMILE?
LASIK surgery involves the creation of a corneal flap, which is usually with a femtosecond laser, followed by – reshaping of the cornea tissue beneath the flap by an excimer laser. The flap is repositioned and seals down securely on its own.
In SMILE, a femtosecond laser carves out a piece of cornea tissue (lenticule) and the surgeon removes this piece of tissue using a blunt dissector through a small incision.
What are the key differences between LASIK and SMILE?
| LASIK has a longer history in terms of predictability, accuracy, effectiveness and safety. | SMILE was introduced internationally around 2011. |
| Treatment range and limitations
LASIK can treat all forms of refractive errors (myopia, hyperopia and astigmatism) and has a greater range of treatment. Because it uses an excimer laser to reshape the cornea, it is relatively more precise in the correction of refractive errors. |
Treatment range and limitations
SMILE has a more limited treatment range compared to LASIK. The correction of astigmatism is less precise compared to LASIK. |
| Treatment of presbyopia
LASIK can treat presbyopia because of its hyperopic treatment. |
Treatment of presbyopia
SMILE is unable to correct hyperopia and therefore cannot correct presbyopia. |
| Customised treatment and ability to correct higher order aberrations
Because LASIK utilises an excimer laser to correct the power without the need for a manual removal of the cornea tissue, it is able to correct very small refractive errors very accurately, and can reduce minute imperfections of the eye (i.e. higher order aberrations) through its customised Wavefront-guided treatment. This aims to improve the visual results of patients, with sharper vision and lesser haloes and starbursts at night. |
Customised treatment and ability to correct higher order aberrations
Because SMILE reshapes the cornea by using a femtosecond laser to create a cornea lenticle which has to be manually removed, it is less able to correct very small refractive errors and because it does not have a Wavefront-guided treatment, it is unable to correct higher order aberrations. |
| Rate of vision recovery
LASIK surgery generally recovers relatively faster compared to SMILE. |
Rate of vision recovery
SMILE’s recovery is relatively slower than LASIK surgery. |
| Tissue removal
LASIK surgery has relatively lesser tissue removal than SMILE. |
Tissue removal
SMILE has relatively more tissue removal than LASIK. |
| Ability to enhance
LASIK can be easily enhanced if there is any residual refractive error, to fine tune the result. LASIK can enhance small refractive errors accurately. |
Ability to enhance
SMILE cannot be enhanced with another SMILE procedure. If enhancement surgery is required, the surgeon will have to perform LASIK or Epi-LASIK to correct the vision. Because 2 different types of procedures are performed, the result tends to be more variable. |
| Side effects
LASIK can potentially result in relative more dry eyes compared to SMILE in the initial stages of recovery, but this generally improves over time and is rarely permanent and significant. |
Side effects
A common myth is that SMILE does not cause dry eyes because it is flapless. Because a certain amount of cornea tissue has to be removed to reshape the cornea, SMILE also causes dry eyes, which like LASIK, generally improves over time and is rarely permanent and significant. |
| Ability to engage in contact sports
A myth regarding LASIK is that because there is a flap, patients cannot engage in contact sports for fear of the flap being dislodged. This is untrue, because the LASIK flap seals down so securely when the eye heals within a month that the risk of flap dislodgement is exceedingly rare or non-existent. Therefore, patients can engage in contact sports safely. |
Ability to engage in contact sports
As there is no flap, patients can engage in contact sports. |
Which procedure is more precise for correcting refractive errors – LASIK or SMILE surgery?
Both LASIK and SMILE can accurately and safely correct one’s refractive errors and reduce one’s reliance on spectacles and contact lenses. Both technologies’ results are similar and comparable.
Hence, both procedures are excellent procedures for vision correction.
But if one has to make a direct comparison between the 2, based on the different technologies used to reshape the cornea, then LASIK surgery has certain advantages over SMILE, because of its non-touch removal of cornea tissue using the excimer laser (compared to SMILE which requires a manual removal of a sizable lenticle). LASIK also has the ability to correct very small refractive errors very precisely, as well as its option of reducing the minute imperfections of the eye (i.e. higher order aberrations) through its customised Wavefront-guided treatment.
These advantages of LASIK over SMILE would generally allow for a more precise correction of one’s refractive error, with a faster visual recovery and better quality of vision.
What factors contribute to better visual results after refractive surgery?
The technology used in vision correction plays a major role. As mentioned above, some technologies and machines are generally more precise than others. However, technology is not the most important factor.
What is equally or more important is the expertise and experience of the refractive surgeon. A surgeon with greater specialised expertise and more experience would more likely be able to achieve a more successful outcome. Hence, surgeons who have undergone advanced fellowship training in cornea and refractive surgery are more specialised in performing refractive surgeries. This experience and expertise may help to increase the success of surgery, reduce the risk, and result in a better visual outcome with a higher chance of the patient achieving spectacle freedom.
Conclusion
We hope this article has been informative in helping you gain a better understanding of the differences between LASIK and SMILE surgery and at the same time clarify some misconceptions and myths.
Please contact Lang Eye Centre at +65 6684 1000 or [email protected] if you will to ascertain your suitability for LVC or if you have more questions.
