SMILE

SMILE candidates must be at least 22 years old with stable myopia between -1 and -10 diopters and astigmatism up to 3 diopters. Unlike LASIK, SMILE currently cannot treat farsightedness. SMILE is often preferred for patients with pre-existing mild dry eye, since the smaller incision preserves more corneal nerves.

Long-term studies show over 95% of SMILE patients maintain 20/25 or better vision after 10 years. The regression rate is generally smaller than with excimer laser procedures. Like LASIK, SMILE does not prevent presbyopia, so reading glasses will likely be needed after age 40-45.

LASIK creates a corneal flap and uses an excimer laser to reshape tissue underneath, while SMILE uses a femtosecond laser to create a lens-shaped piece of tissue inside the cornea, removed through a small 2-4mm incision — no flap is created. This flapless approach preserves more corneal biomechanical strength.

If residual refractive error remains, an enhancement procedure can be performed — typically surface-based PRK rather than a repeat SMILE, since SMILE does not create a flap that can be re-lifted. Enhancement rates are comparable to LASIK at roughly 1-2% within the first year.

Most surgeons clear patients to fly 2-3 days after SMILE — slightly sooner than LASIK because SMILE has no corneal flap that could be displaced. However, plan a 5-7 day trip to allow for the pre-operative assessment, procedure day, and a follow-up exam to confirm healing. Use preservative-free artificial tears frequently during the flight, as cabin air is very dry.