SMILE Surgery (Small Incision Lenticule Extraction)

SMILE surgery, or Small Incision Lenticule Extraction, is a minimally invasive laser vision correction procedure that reshapes the cornea without creating a flap. This innovative approach represents a significant advancement in refractive surgery technology, offering patients an effective alternative to traditional LASIK. At Fairfield County Laser Vision, our refractive surgeon uses this advanced femtosecond laser technique to treat nearsightedness and astigmatism with precision and comfort. According to a literature review in the Journal of Refractive Surgery covering 95 studies, 92.6 percent of LASIK patients reported being satisfied with their surgery, and SMILE achieves comparable outcomes (Susanna et al., 2025). Because SMILE involves only a small incision rather than a full corneal flap, patients often experience less dry eye and a quicker return to daily activities.

SMILE stands for Small Incision Lenticule Extraction. It was first performed in 2008 and received FDA approval in the United States in 2016 for the treatment of myopia (nearsightedness). The FDA later expanded approval to include myopic astigmatism, broadening the range of patients who can benefit from this procedure. Unlike LASIK, which requires both a femtosecond laser and an excimer laser, SMILE uses only a single femtosecond laser to complete the entire procedure. This streamlined approach reduces the complexity of the surgery while maintaining excellent visual outcomes.

LASIK involves creating a hinged corneal flap, lifting it, and reshaping the underlying tissue with an excimer laser. PRK removes the surface epithelium entirely before applying the excimer laser, requiring a longer recovery period while the epithelium regenerates. SMILE takes a different approach by forming a thin lenticule within the intact cornea and extracting it through an incision typically 2 to 4 millimeters in length. This flapless design preserves more of the cornea's structural integrity and reduces disruption to corneal nerves, which may offer advantages for certain patients.

SMILE is currently FDA-approved to correct myopia up to -10.00 diopters and astigmatism up to 3.00 diopters. The procedure is highly effective for patients with moderate to high levels of nearsightedness. It is not yet approved in the United States for farsightedness (hyperopia), though clinical studies are exploring this application internationally. Patients who need correction for hyperopia may benefit from an implantable collamer lens or other refractive options that can address farsighted prescriptions.

Vision typically improves rapidly during the first 24 to 48 hours, though SMILE recovery may be slightly more gradual than LASIK in the initial days. You may experience mild tearing, light sensitivity, or a gritty sensation, all of which usually resolve within a few days. Our refractive surgeon prescribes antibiotic and anti-inflammatory eye drops to support healing and reduce the risk of infection. Most patients can return to work and daily activities within one to two days, though visual clarity may continue to improve over the following weeks.

While many patients notice significant visual improvement within the first week, full stabilization of your prescription can take several weeks to a few months. During this period, minor fluctuations in clarity are normal and expected. Studies show that approximately 91 percent of SMILE patients achieve a final refraction within 0.5 diopters of the intended correction, and 99 percent achieve results within 1.0 diopter. These outcomes are comparable to those achieved with LASIK for similar prescriptions.

One of the notable benefits of SMILE is a lower incidence of post-operative dry eye compared to LASIK. Because SMILE preserves more of the corneal nerve fibers that play a role in tear production, patients tend to recover normal tear function more quickly. This advantage is most pronounced in the early recovery period. If you have pre-existing dry eye, our team will evaluate your tear film thoroughly before recommending a procedure and may suggest treatment to optimize your tear film health before surgery.

Research supports excellent long-term stability for SMILE, with most patients maintaining their corrected vision for many years. Studies following SMILE patients for five years and beyond show stable refractive outcomes and sustained visual acuity. SMILE may offer superior long-term visual outcomes compared to LASIK, particularly for patients with high myopia where preservation of corneal biomechanics is especially valuable. As with any refractive procedure, age-related changes such as presbyopia will still occur over time and may eventually require reading glasses regardless of the distance correction achieved.