SMILE

Your eye works like a camera. Light passes through the cornea (the clear dome at the front), through the lens, and lands on the retina at the back. In nearsightedness, the cornea is too curved or the eye is too long, so light focuses in front of the retina instead of on it. SMILE reshapes the cornea so light lands on the retina again ².

The procedure has three main steps:

• 1. Numbing. Eye drops numb the surface of the eye. Some surgeons offer a mild oral sedative.
• 2. Lenticule creation. A femtosecond laser fires tiny pulses inside the cornea to shape a small, lens-shaped piece of tissue (the lenticule). This step takes about 25-30 seconds per eye.
• 3. Lenticule removal. The surgeon makes a small 2-4 mm cut on the surface of the cornea and gently pulls the lenticule out with tiny forceps. Removing this tissue flattens the cornea by the right amount to fix your prescription.

There is no big flap. The small incision seals on its own without stitches. The whole surgery takes about 10-15 minutes for both eyes ¹.

Good signs you may be a candidate:

• You are 22 or older (most U.S. surgeons prefer this age).
• Your glasses prescription has not changed much in 12 months.
• You are nearsighted from -1.00 to about -10.00, with up to -3.00 of astigmatism.
• Your corneas are thick enough and shaped normally.
• Your eyes are healthy - no significant dry eye, keratoconus, advanced glaucoma, or cataracts.
• You are in good general health.

Signs SMILE may not be right for you:

• You are farsighted or only need reading glasses. SMILE is not currently offered for farsightedness in the U.S.
• Your prescription is still changing or you are under 22.
• You are pregnant or breastfeeding (hormones can shift the prescription).
• You have severe dry eye, keratoconus, thin corneas, or other corneal disease.
• You have uncontrolled diabetes or an autoimmune disease that affects healing.
• You take steroids or immunosuppressants long-term.

SMILE has been studied in millions of eyes worldwide. Most patients are happy with the results, but no surgery is risk-free ⁵:

• Dry eye. Common in the first weeks. Most people return to baseline by 6-12 months. Studies suggest SMILE may cause less dry eye than LASIK because fewer corneal nerves are cut ⁴.
• Halos, glare, or starbursts at night. Common at first, usually fade over weeks to months.
• Under- or over-correction. Some people still need glasses for some tasks or need a touch-up.
• Lenticule problems during surgery. The lenticule can tear or be hard to remove in a small number of cases. The surgeon usually still completes the procedure or converts to PRK.
• Infection. Very rare with antibiotic drops, but possible.
• Ectasia. A rare condition where the cornea bulges over time. The risk is higher with thin corneas or undiagnosed keratoconus. Modern screening greatly lowers this risk.
• Harder touch-ups. Unlike LASIK, there is no flap to lift later. If a touch-up is needed, it is usually done as PRK on the surface, which has a slower recovery.
• Loss of best-corrected vision. Very rare - losing the ability to see 20/20 even with glasses after surgery.

What it costs in the U.S.:

• SMILE: $2,500-$3,500 per eye.
• Standard LASIK: $2,000-$3,000 per eye.
• All-laser or wavefront-guided LASIK: $2,500-$3,500 per eye.
• PRK: $1,800-$2,800 per eye.

The price usually includes the pre-op exam, the surgery, follow-up visits for the first year, and any touch-up needed in that window. Confirm exactly what is included before you sign.

What insurance usually covers:

• SMILE is almost always considered elective. Most U.S. health insurance and Medicare do not cover it.
• Some employer vision plans offer a discount (often 10-20%) at certain centers.
• Most refractive surgery centers offer financing - interest-free 12-24 month plans are common.
• You can usually pay with HSA or FSA pre-tax dollars.