A Complete Guide to ReLEx SMILE

Laser vision correction has advanced significantly in recent years, providing patients with refractive eye errors more options for a clear vision without glasses. One of these procedures is the eye surgery ReLEx SMILE, a minimally invasive procedure utilising modern technology to treat and correct common refractive errors, with some exceptions. 

What is ReLEx SMILE Eye Surgery?

ReLEx SMILE (Small Incision Lenticule Extraction) eye surgery is a next-generation laser procedure based on the correction of refractive errors such as myopia (nearsightedness) and astigmatism. Developed as a refinement of earlier techniques, including PRK surgery and LASIK eye surgery, ReLEx SMILE utilises a single femtosecond laser to reshape the cornea through a tiny incision without making a flap in the cornea. 

A flapless approach spares a greater part of the corneal structure from resection, as well as eliminates certain complications that are well-known in traditional laser surgeries. While LASIK involves cutting a flap in the cornea, femtosecond LASIK utilises a laser for flap creation. SMILE surgery is performed through a keyhole incision of less than 4 millimetres. 

This innovation makes the procedure less invasive and is especially beneficial for patients with thinner corneas or those prone to dry eye. 

How does the ReLEx SMILE Procedure Work?

A few precise steps comprise the ReLEx SMILE procedure: 

• Anaesthesia: The eye will be numbed with anaesthetic drops so that the patient will feel no pain during surgery. 
• Lenticule Creation: A thin lens-shaped disc of tissue (lenticule) inside the cornea is created by the surgeon with a femtosecond laser. A small incision is also made on the surface through the laser. 
• Lenticule Removal: The lenticule is carefully extracted through the tiny incision. This changes the shape of the cornea and corrects the refractive error. 
• Healing: The small incision typically closes naturally, often without the need for sutures. 

The entire process is quick, typically taking less than 10 minutes per eye. Since no flap is created, the danger of subsequent flap complications is eliminated, leaving the corneal surface nearly intact. 

Who is an Ideal Candidate for ReLEx SMILE?

Many adults would be suitable candidates for ReLEx SMILE surgery if they sought freedom from glasses or contact lenses. The ideal candidate would most often conform to the following: 

• Age: At least 18 years of age, with vision stable for at least one year. 
• Refractive Error: Myopia of up to -10 diopters and astigmatism of up to 5 diopters. 
• Corneal Thickness: The amount of corneal thickness is generally above 480 microns. 
• Eye Health: No active eye diseases or infections; no severe dry eye. 
• General Health: Not pregnant or breastfeeding at the time of surgery. 
• No History of Lazy Eye: Patients with amblyopia may not achieve full visual acuity improvement, although the refractive error can still be corrected.

Individuals with thin corneas or contact lens intolerance are excellent candidates for ReLEx SMILE. Also, those with a higher risk of developing dry eyes after surgery are considered good candidates.

Benefits of ReLEx SMILE Eye Surgery

In comparison to other laser vision correction procedures, ReLEx SMILE eye surgery offers several advantages. 

• Minimally invasive: There is no flap and only a small incision. Hence, the operation is gentler and preserves more corneal tissue. 
• ReLEx SMILE surgery carries a reduced risk of dry eye. This is because fewer corneal nerves are affected, providing patients with a sense of relief about potential post-operative discomfort compared to other procedures like LASIK.
• Patients often feel relieved about potential post-operative discomfort with ReLEx SMILE surgery compared to other procedures like LASIK. This is due to a reduced risk of dry eye, as fewer corneal nerves are affected. 
• Greater Corneal Stability: Structural integrity of the cornea is better maintained, thus presented especially well in cases with a thinner cornea. 
• The precision of ReLEx SMILE surgery, facilitated by the femtosecond laser, ensures a high level of accuracy and consistency in the outcome. This gives patients a sense of reassurance about the procedure’s effectiveness. 
• Fewer Restrictions: People with higher degrees of myopia or astigmatism, which would disqualify them for other procedures, may often benefit from SMILE surgery. 

While the benefits are compelling, the disadvantages of ReLEx SMILE include its high cost, limited availability, and restricted suitability for certain types of refractive errors.

Possible Side Effects of ReLEx SMILE Surgery

Every surgery has some associated risks and side effects: ReLEx SMILE is no exception. Here are some of them: 

• Immediate Side Effects: During the first 24 to 48 hours following the surgery, patients may experience mild irritation, tearing and hypersensitivity to light. 
• Visual Disturbances: Patients may also experience glare, halos, or other blurring during the initial healing period. However, these typically disappear in most cases within a matter of days. 
• Dry Eye: Compared to LASIK, this is far less common. However, some people may experience mild symptoms of dry eye after undergoing ReLEx SMILE. 
• Rare Complications: Infection, inflammation, or undercorrection or overcorrection of the refractive error can occur, but are uncommon. 
• Enhancement Needs: In some cases, further correction may be necessary (enhancement) in rare instances where the desired vision has not been achieved following the procedure. 

Generally, the occurrence of serious side effects with Relex Smile is very low in patients who receive proper post-operative care. Most patients show a quick recovery.

Limitations of the ReLEx SMILE Procedure

Despite these advantages, ReLEx SMILE surgery has certain potential disadvantages that must also be considered. 

• Cost: ReLEx SMILE operations are typically more expensive than LASIK or PRK surgeries due to the sophisticated technology and expertise employed. 
• Availability: Not all eye clinics have the necessary facilities to perform ReLEx SMILE, as it requires specialised equipment and training. 
• Suitability: ReLEx SMILE surgery is currently approved only for treating myopia and astigmatism, and not for hyperopia or specific complex refractive errors. 
• Enhancement Options: In cases where additional correction is needed, options for enhancement are quite limited compared to flap-based procedures. These limitations should be considered when selecting the most suitable vision correction option. 
• Not for Everyone: Patients with unstable vision and certain corneal diseases may not be suitable candidates. 

Such facts should be discussed with the patients by their ophthalmologist. It will help determine the best vision correction option that suits the patient’s needs. 

Cost of ReLEx SMILE Surgery

The cost of ReLEx SMILE surgery varies widely according to several factors. 

• Average Cost: In India, the average cost is generally around ₹80,000 to ₹1,50,000 per eye. 
• Influencing Factors: This cost can be influenced by several factors, including the surgeon’s experience, the clinic’s reputation, pre- and post-operative care, and the complexity of the refractive error. 
• Comparison with Other Procedures: 
  • Cost-wise, LASIK eye surgery is less expensive. But it carries a higher risk of flap-related complications and postoperative dry eye. 
  • Femto LASIK utilises a femtosecond laser for flap creation. It is more precise than traditional LASIK. However, a flap is still created. 
  • PRK surgery is said to be the cheapest option. But recovery takes a long time and is often more uncomfortable. 

Most likely, ReLEx SMILE incurs a significant initial cost. However, its benefits, including enhanced security, rapid recovery, and suitability for specific patients, will justify the investment for many.