SMILE Surgeryalso known as Small Incision Lenticule Extraction

SMILE is a flap-free laser vision-correction procedure that uses a femtosecond laser to sculpt a contact-lens–shaped disc (lenticule) inside the cornea. The surgeon removes that lenticule through a 2–3 mm tunnel, gently reshaping the cornea so light focuses correctly on the retina. Approved by the FDA for myopia and astigmatism, SMILE offers comparable sharpness to LASIK with less disruption of the corneal nerves, which may mean fewer dry-eye symptoms.[1] The American Academy of Ophthalmology calls it a “next-generation” refractive option for patients who want rapid healing and minimal activity restrictions.[2]

During surgery the patient lies under a VisuMax® or similar femtosecond laser. A suction ring steadies the eye while the laser delivers two precise passes: one outlines the posterior surface of the lenticule and the second its anterior surface and a tiny side cut. Total laser time is about 25 seconds. Through the side cut, the surgeon teases the lenticule free and withdraws it with forceps—no blade or excimer laser is used. Treatment ranges: up to −10.00 D of myopia and −3.00 D of astigmatism. Emerging “SMILE pro” software shortens energy delivery and may expand hyperopia indications.[1][3]

Ideal candidates are adults 18–45 with stable prescriptions (change ≤0.50 D in the past year), corneal thickness ≥500 µm, and myopia between −1.00 D and −10.00 D with up to −3.00 D of astigmatism. Because SMILE preserves more anterior stromal tissue than LASIK, it can suit patients with borderline thin corneas or those who play contact sports where a LASIK flap might shift. Contra-indications include keratoconus, severe dry eye, uncontrolled diabetes, pregnancy, and unrealistic expectations.[1][4]

SMILE generally costs slightly more than LASIK because of the femtosecond-laser platform. U.S. clinics quote $2,500 – $4,000 per eye, which usually includes pre-op testing, the procedure, and one year of follow-up.[6] Some national chains advertise bundled financing or FSA/HSA payment plans comparable to their LASIK offerings.[7]

Benefits include 20/20 or better vision in over 90 % of eyes, minimal post-op pain, rapid return to exercise, and a markedly lower rate of transient dry eye versus LASIK at six months.[4] Limitations are a narrower treatment range (no hyperopia yet cleared in the U.S.), slightly slower visual recovery in the first 24 hours, and rare interface haze or “button-hole” cap tears, which surgeons manage with advanced instrumentation.[2]

Patients leave the clinic wearing clear shields and begin antibiotic-steroid drops for one week. Functional vision often reaches 20/25 the next morning, and most people drive in 24 hours. Because there is no flap, rubbing or accidental bumps are less risky, yet swimming and eye makeup are postponed for one week. Long-term data show refractive stability on par with LASIK and PRK, with retreatment needed in roughly 1 – 2 % of eyes.[2][7]

Current studies explore “lenticule-in-a-pocket” inlay for presbyopia and stromal lenticule banking for future corneal implants. A 2023 review highlights tissue-preservation advantages and reports 10-year follow-up with stable refraction and <0.5 % ectasia risk.[5] High-frequency laser settings and smaller spot spacing are also reducing interface haze while preserving excellent visual quality metrics.[4]

If you’re nearsighted and want laser vision correction with fewer dry-eye worries, schedule a full corneal mapping and dilated exam. A refractive surgeon will measure corneal thickness, pupil size, and lifestyle needs to decide whether SMILE or another procedure fits best. You can connect with the right specialist on Kerbside for a medical-education consult—no physician-patient relationship will be created.[1][7]