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What is the smile technique?

The techniques referred to by ReLex – Flex – Smile variants are based on the semi-manual "bulk" extraction of a volume of corneal tissue (duckweed) for the correction of myopia. This duckweed is pre-cut to the femtosecond laser. "Flex" corresponds to an acronym for Femtosecond Laser Assisted duckweed extraction: This variant is today neglected for the "Smile" (acronym for "Small Incision duckweed extraction").

Also read: Smile or LASIK?

Introduced about ten years ago, these techniques have not supplanted the LASIK technique because of certain limitations, but can be proposed as an alternative to it. The number of smiles achieved this day remains much lower than that of LASIK.

The principles put into play smile are based on an approach that was implemented Before the onset of LASIK and was to achieve a «» Keratomileusis in situ To correct myopia, i.e. a technique where a duckweed of corneal stroma was removed within the cornea, after cutting a superficial flap.

With the keratomileusis in situ, the flap and the Duckweed were cut by a manual or automated microkeratome (technique proposed by Ruiz at the end of the years 80 see: history of LASIK).  Due to the relatively imprecise results (centering, and variations in the thickness of the lenticule cut under the flap), this technique has been supplanted by LASIK using an excimer laser to the photoablation of the lenticule under the flap.

The introduction of the femtosecond laser in corneal surgery helped resurrect the principle of the keratomileusis in situ, thanks to the extra precision provided by this technology.

Flex relex smile

Schematic representation of the RELEX technique. The Femtosecond laser allows to prédécouper the duckweed and the flap (Flex) or a tunnelisé path to a narrower superficial incision (smile).

The ReLEX (Refractive duckweed Extraction) techniques overlap The Variatnes Flex and smile, where the femtosecond laser (Zeiss sumas) performs the cutting of the duckweed to be removed in the thickness of the cornea. For the correction of myopia, this duckweed to the appearance of a lunula. The Flex and smile variants differ in the way this duckweed is removed: with or without flap.

The variant FLex (Femtosecond laser assisted Extraction duckweed) is to cut a flap at the top, always by the delivery of femtoseconds laser impacts (aggrandissant the cleavage plane corresponding to the most superficial part of the duckweed). The technique shares with LASIK the realization of a superficial flap: the laser Femtosconde (precision: 5 to 10 microns) is used to cut a duckweed that is removed in bulk, while the Excimer laser "vaporizes" the cornea layer by layer ( Accuracy: approx. 0.25 microns. In Relex, the femtosecond laser is used as well. This variant is very little used because it consists in making a LASIK, but by depriving itself of the precision of the excimer laser for the corneal sculpture.

The variant SMILE  (Small incision duckweed extraction) Consists of a limited superficial lateral cut, in order to remove the duckweed through an incision of some millimetres (there is no flap cut out strictly speaking). The lack of cutting of flap offers a psychological advantage, as for PKR, but unlike this one, the intrastromal extraction of the duckweed refractive, without removing the epithelium allows patients not to feel a sensation of Discomfort or irritation marked.

smile incision

The incision corresponds to the cut surface carried out to extract the lenticule after his laser pre-cutting followed his dissection of intra stromal.

edge of the lenticule refractive smile

The edge of the cutting of the refractive lens is visible in the biomicroscopique review.

Refractive lens Smile cutting parameters

Parameters used for the programming of the cutting of the refractive lens to correct myopia in 6 dioptres (optical zone 6.50 mm)



The Excimer laser is therefore not used for the correction of myopia with these techniques (which can lead to reducing the cost to LASIK); and This is paradoxically one of the weak points of the smile technique.

The performance of the Relex technique is  more "manual". than that of LASIK, especially in the Smile variant, which oBlige to dissect with the spatula surfaces anterior and posterior of the lenticule, before you extract it by a small lateral incision through a microphone clip, without that the lenticule disintegrates (the edge of the lenticule is at least 10 microns by default, regardless of the fixed programmed, to avoid that it crumbles during maneuvers of extraction). Thus, the realization of the Smile imposes ablation of a disc of tissue of about 15 microns of thickness... for reasons easier gripping but not for sight correction. If the edge of the lens was prafaitement end (like the one that vaporizes the excimer laser), it is desagregerait during the manoeuvres of extraction.

Benefits advanced for this FLEX technique are (for the Smile variant only) one any superficial corneal cutting with preservation of corneal innervation. The disadvantages in the need of a perfect centering (and keeps it during laser cutting), a technique of manual dissection effective (in order to leave no fragments of lens in the stromal interface and/or generate superficial microplis). The Visual effects associated with the coalescence of two surfaces (increased light diffusion?) femtosecond laser cut are not yet well documented. However,. the Visual recovery after SMILE is significantly longer than in LASIK; in the postoperative period, the presence of a 'fuzzy' Visual light is reported by the majority of patients. This vagueness fades in 1 to 6 months, and is probably linked to inflammation and necessary regulation related to the "stress" induced by the mechanical dissection of the faces of the lenses, and its extraction (see surgical videos of the techniques). The Visual results after this transitional phase of recovery are comparable to those of LASIK. Dissection of the lenticule, manual and sometimes laborious, imposes a sometimes excessive distention of the fabric the more anterior stromal, with risk of at least temporary impairment of the Visual quality (optical diffusion).

Theoretical studies suggest that the biomechanical impairment of the cornea would be less important in smile than in LASIK, and that paradoxically, it would be even better to achieve a smile than a PKR in case of "fine" or "atypical" cornea. These considerations, based on biomechanical models more than actual observations, are theoretical and must be carefully adapted to the clinic. Theoretical predictions are derived from models where the corneas are "healthy", but in practice, there is no evidence that the creation of a smile on a "fragile cornea" is less invasive than a PKR (the latter having demonstrated its effectiveness and safety For low and medium myopia). It is even possible that the biomechanical invasivity of the smile is more important than that of the PKR for fragile corneas because the removal of the duckweed is carried out in a deeper plane (it remains to be determined what carries it between the disadvantage of a wall Later Résiudel and the advantage provided by the respect of the very anterior stroma). case of Ectasia were reported after realization of a smile.

The major drawback of the Smile technique is theUnable to retreat in case of dollars or sur-correction, less with the same technique. Indeed, it is not possible to remove a second lens of the cornea; then realize a PKR, who run a risk of superficial inflammation potentially important in this context (the PKR issued on the deep corneal stroma exposed to the risk of haze). You can also try to cut out in full a flap above the interface created by the Smile, and retreat to the excimer laser: we get in a situation equivalent to that of a LASIK.

Initial clinical results show a close precision than LASIK for the correction of myopia, but one significantly slower Visual recovery (up to a few months). The absence of shallow circular cut (Smile) would be an interesting alternative in patients with dry eye pre existing, but this is not demonstrated a frank in the postoperative follow-up studies. case risk of severe eye injury, SMILE technique can also have an interest with respect to LASIK for high myopia surgery. The use of the techniques Smile seems less interesting for the small misuse because the fineness of the lenticule has remove makes its more difficult extraction, and the Visual recovery is longer than in LASIK (and in PKR).

Above all, LASIK and the PKR allow a higher refractive accuracy when there is a astigmatism Pronounced, and FLEX techniques (Relex and smile) do not provide compensation for the cyclorotation of the eyeball, which may have negative effects as part of the correction of astigmatism in case of marked Cyclorotation. So far it is not possible to make custom duckweed (guided by the wavefront), and the correction of the hyperopia, while the smile for myopia has been proposed for about ten years, seems difficult due to the geometry of the duckweed to be removed (topologically analogous to a torus, with a zero thickness in the center: the correction Of the hyperopia in smile requires to increase the volume removed with a constant thickness of 30 microns. Clinical studies are underway to evaluate the results of the smile for the correction of the hyperopia. The duckweed removed, theoretically of zero thickness in the center (in LASIK or PKR), must in smile be equipped with a thickness of 30 microns. This does not bode well for a good ability to effectively arch the cornea, as experience shows that the removal of a duckweed of constant thickness tends irreparably to flatten the cornea.


Even if their supporters put forward some theoretical advantages, the number of procedures in FLEX-smile remains relatively confidential to that of LASIK, whose precision of correction and the speed of obtaining the final visual result remain advantageous in the context of elective surgery. The rate of complications associated with the realization of flap in LASIK is very low, and the benefit of the absence of flap in smile does not seem to have really altered the lines in terms of postoperative satisfaction (recovery Longer in Smile) and visual (no difference in term between smile and LASIK). The eyes where there is a marked dry eye and where the risk of secondary displacement of a LASIK flap are very important are potentially good candidates for surgery by smile.   Most surgeons who routinely perform the smile technique continue to perform LASIK and suface techniques (PKR). Some even abandoned the smile, judging that any patient operated in smile could benefit from LASIK, without the result being lower, but with fewer complications and faster recovery.


74 Responses to "What is the smile technique?"

  1. Sam says:


    I was operated on Friday last by the SMILE method.
    The operation went very well: no pain during and after the operation.
    But I always see blur after 6 days. It's very cripking. Is that normal?
    Thanks for your reply,

  2. Dr. Damien Gatinel says:

    Recovery after achievement of the Smile technique is longer than in LASIK: this is explained by the need to dissect a lenticule (corneal tissue fragment) manually pre-cut by the femtosecond laser. This perforation is to trace the outline of the volume to remove to change the refractive power of the cornea in 'dotted'. This step requires the use of instruments that are introduced through the small lateral incision, to complete the separation of the lenticule. In LASIK, the lens is not removed manually, but 'photoablaté', that is to say removed by laser sculpture after the flap uprising. In fact, there is much less manipulation of the corneal tissue, and therefore less risk of prolonged postoperative edema, microplis, etc. After one to three months, the difference in result fades, and Visual performance obtained by the technique of Smile then joined that of LASIK.

  3. Stella says:

    I was operated from both eyes of a myopia-6.25 OG and-5.75 OD with a slight astigmatie by the RELEX smile technique last Wednesday.
    I said that I hesitated a lot before choosing this technique, I was rather part on a LASIK (more proven technique, possibility of recovery and more precision as to the quality of the vision from what is said... and less cost in addition...) but the surgeon who operated me was so insistent and assured that it was the best and safest technique I finally trusted.
    He had to make me at the beginning a small under correction of the OG in order to prevent presbyopia, but after I had done the test with lenses, I called him to tell him that I did not support this under correction and we agreed to correct both eyes to same level finally.
    The operation seems to have gone smoothly. The OD was very fast, the OG took more time.
    On the way out, in the evening, as it was planned, no pain but a big gene in your eyes. Nothing worrying.
    From the next day and until today, either days after the operation, I started to see very neat of the OD, as with my lenses, but very blurry and split the OG.
    I am very worried because my left eye, although less myopic than before the operation, seems to me under-corrected and I do not feel that it will evolve. I see really very blurry of this eye and this also gene in global vision with both eyes open.
    I am afraid that the surgeon did not take into account my request to not under correct the OG, since this had been said by telephone. I am also afraid that there is a astygmatie with an oblique axis on that eye that has not been corrected correctly.
    I went back to see last Friday the surgeon who operated me for a control visit.
    I told him of my worries, he just told me that he had corrected both eyes as needed. I asked him if my left eye was going to recover, he replied that probably yes. that maybe there would be a difference but that my brain had to get used to.
    That was not the plan at all. I want my brain to get used to seeing again well without a bezel or lens, but not having a headache because of an undesired eye correction. I think if my eyesight remains bad at this point on the left eye, my brain will never get used to it.
    My surgeon also told me that I had no astygmatie beforehand. yet I have previous analyses made by another ophthalmo that seem to indicate a mean astygmatie (-1.3) and ' oblique ' (165 °) to the left eye, and I read that the ' oblique ' side is not well treated with the RELEX smile.

    I am very worried and my surgeon, even if he tells me that I got very well, don't make me feel. I'm afraid that it's under fixed the left eye, both for myopia than for the astygmatie.
    Could you tell me if it is normal not to recover well from one eye after a RELEX smile?

    Thank you.

  4. Lefebvre says:


    I just make an appointment at the clinic of the vision (Paris).
    The surgeon advises me to intervene with the LASIK SMILE method.
    Is there enough recoil on this technique?
    Does the use of manual cutting not generate more irregularities (in terms of cutting I mean well)?
    Moreover, there is no risk of scratching the eye by inserting a spatula on 2/3 mm?

    Thanking you in advance for your valuable advice and back.

    Kind regards


  5. Dr. Damien Gatinel says:

    The Smile is both ancient and recent. Old, because the first intervention of keratomileusis myopic used a neighbour principle (remove block a lenticule of cornea to correct nearsightedness, the cut was under a flap with a microkeratome). The use of femtosecond laser allows precision greater than that of the mechanical microkeratomes used in the past, and a "small incision. However, the precision of femtosecond laser reached today by the excimer laser (10 microns at the level of the area of impact - bubble cavitation vs 0.5 microns for a pulse of excimer laser)... and the benefits brought by the Smile are more theoretical than real. Dissection of the lenticule in Smile through the small incision is not so easy, it requires dexterity and can in all case cause superficial folds micro and irregularity of the interface (just see a Smile on Youtube surgery to achieve mechanical 'stress' experienced by the superficial tissue of the cornea). In LASIK, cut a circular flap makes it to spread the forces and smooth the ablation zone, while in Smile a certain inconsistencies can persist, since there is a 'pocket' consecutively to the withdrawal of a solid lens. The recovery is longer in Smile, evidence that sudden 'stress' in surgery is greater than in LASIK. Finally and above all, the restatements (retouching) problem with Smile because it takes either a PKR on the surface of the cornea (risk of haze, inflammation of the interface), or redraw a flap to "LASIK". You can't redraw a refractive lens in the cornea again, for small corrections like those that we must often do in post surgery (ex:-0.50 D). Must then resort to the precision of the... excimer laser. Why not to use to start in LASIK?

  6. Dr. Damien Gatinel says:

    Recovery after Smile is on average slower than in LASIK, but home is the difference between the two eyes that suggest that there is a cause for any recovery. the induction of oblique astigmatism may be related to a harder lens removal (the left eye took more time), inducing an asymmetric corneal stress. A duplication of the image may be due to an induced astigmatism (regular or irregular). Only a clinical examination and a corneal topography compared between the before and the after can enlighten you. The Smile is a technique more "manual" than LASIK on many points. Since your message, the vision is can be clarified, I hope in all case.

  7. Karin says:


    I was made yesterday by the Relex smile system. From the start I felt discomfort on my right eye. It is as if I had a twisted and lens which is xxx_xxx_5163see. I red this place. Do you think this is normal? -What is flaming?
    I only go back two weeks for a review... When do I have to worry?
    I had a more than-10 myopia and a + 4.5 astigmatism.
    He told me that my cornea was too thin (475) for a standard operation or doing this one. That it was the only solution.
    I see better than yesterday but my vision is not clear from near and far.
    Could you tell me how long does of time does it put to get better and if this gene has my eye going to leave?
    Oh, yes... I also have a retouching must be re-made to the laser for my weakest eye!
    Thank you very much!

  8. Dr. Damien Gatinel says:

    The existence of a cornea to 475 microns is a priori a contraindication for LASIK, but also to the Relex SMILE! There is no evidence (other than speculative) that the RELEX Smile would preserve better rigidity and biomechanical structure of the cornea in case so thin cornea and high myopia. I hope that this response will give a conclusive result, but a priori must remain very cautious before programming a retouching excimer laser... Unfortunately, the presence of a thin cornea and a high myopia with astigmatism must renounce any refractive surgery, corneal (LASIK, PKR or Relex Smile). In some case, it is possible to envisage a phakic implant placement. The risk is to train a corneal ectasia.
    Finally, recovering a good vision in RELEX smile takes a lot more time than LASIK (several months). It will be necessary to distinguish in your unsatisfactory result what is under correction of what is an inflammation and microfolds of the interface in RELEX smile.

  9. Miss b says:

    I have strong myopia OD - 17/OG - 13 plus I cornne too thin, is that I have a chance to be operated

  10. Dr. Damien Gatinel says:

    Unfortunately, your myopia is too strong to be able to be the subject of a correction LASIK or FLEX - Relex - Smile. On the other hand, a correction with phakic implant can be proposed.

  11. Ludovic says:

    Hello I have a myopia of-6.5 in the two eyes, my ophthalmologist did not agree for correction laser. Because I have a thin cornea OD: 490. OG: 510
    What do you think?
    Thank you in advance for your reply.

  12. Dr. Damien Gatinel says:

    If your corneas are fine but without irregularities (absence of Keratoconus subclinical beginner), that their Biomechanics reveals no excessive fragility, a PKR (surface laser) could you be proposed, although your myopia is located in the "limit" of this indication in terms of efficiency, and that there is therefore a risk of slot correction (ex:-0.50D residual myopia).

  13. Hadrian says:

    Hello doctor,

    I looked in several clinics (the clinics of the vision and Lamartine in Paris, Helios in Paris).

    I'm pretty short-sighted (-8.25 OG and-8.75 OD), but have a fairly thick cornea (approximately 580 microns). My eye is called in all case of 'normal '.

    On the other hand, being instructor of a combat sport where fingers in eyes are common (Krav-Maga), all advised against me the technique of LASIK (risk with the flap).

    It is in Paris that I was advised to use the SMILE method (although themselves do not practice it). It would have a healing more suited to my needs.
    However, I have read on several sites that case the PKR was needed. However, if I understood the PKR technique correctly, it would remove the benefits of SMILE ( flap ).

    Can you give me your opinion?

  14. Dr. Damien Gatinel says:

    The practice of fighting sports exposed actually to the theoretical risk of displacement of flap, but this secondary complication requires a particularly violent and "tangential" trauma, priori which occurred during training seems exceptional. The SMILE is a technique that effectively reduces this risk to zero since there is no flap (not the absence of editing and conversion in LASIK). As part of the correction of high myopia, retouching (for correction or secondary regression) are more frequent than after correction of low and medium myopia. After SMILE, the need for a touch-up for sous-correction or residual astigmatism, etc., requires either perform a LASIK flap to access the interface, or a PKR (surface laser). In secondary PKR case, we do not flap, simply remove the epithelium and we deliver secondary correction to the surface of the cornea. Achieve a PKR after correction of near myopia of 8 diopters in SMILE (or LASIK) exposed to a risk of "haze" (responsible for a reduction in transparency of the cornea corneal inflammation). Indeed, the secondary PKR will "perforate" the layer of Bowman, which separates the epithelium of the deeper stroma, and explains the absence of haze after LASIK (no contact between the epithelium and the stroma that received the excimer laser).

  15. small says:


    having attended a meeting on the subject of refractive surgery yesterday, today I think a question about the technique of the smile:
    Indeed, what makes cutting a central part of the cornea is possible without cutting at the same time the anterior part?
    Is this the index of the circles that comes into account with the wavelength used that makes this possible?

    I look forward to your response

  16. Cassandra says:


    Having been operated myopia and astigmatism in July with the Smile technique, my eyes do not recover well.
    The topography of both eyes shows abnormal reliefs. I am more astigmatic than before and my eyes are not well corrected as to my myopia (I had-6, I now-2). Lots of migraines and concentration difficulties.
    My doctor opted for a surface correction barely 3 months after the first operation.
    Do you think that is a good idea?
    Thanks for your reply.

  17. Mary says:


    I was operated by the Relex smile 6 weeks ago system. I see very well from the left eye, but the right eye is always cloudy. The right eye I have a gene. When I look on the side I feel discomfort and late in the day it hurts almost. Do you think this is normal? -What is flaming?
    Thanking you in advance for your valuable advice and back.

  18. Dr. Damien Gatinel says:

    Feelings of embarrassment or discomfort after Relex Smile can be induced by the scar through which is extracted the lenticule. The Visual recovery after Relex Smile is longer than after LASIK and be patient. The presence of microplis or inflammation of the interface can be the cause of low vision. The Visual recovery depends on the ease with which the lenticule is dissected and extracted. Sometimes, this maneuver is performed with more ease from one eye to the other.

  19. Dr. Damien Gatinel says:

    The Visual recovery after Smile is usually long and protracted than after LASIK. This relates mainly to the fact that the technique involves a lenticule bulk extraction pre-cut by femtosecond laser. Precision of femtosecond laser is useful for the pre-cut, but the extraction phase is a manual step that is easier or harder, depending on the eyes, the quality of laser cutting, etc. Astigmatism correction is less accurate than in LASIK, but the occurrence of a correction is not usual. Reprocessing is possible, but it is not possible to redo a Smile after a Smile. You can however achieve a LASIK flap and reprocess in the interface, or a PKR. The PKR is an effective technique for the small misuse and medium myopia; in the case of its realization after Smile, the risk of local inflammation (haze) is more important. One of the drawbacks of the technique Smile is not allowing to make alterations in the same plane as the first surgery, which then requires a conversion in LASIK, or the realization of a secondary PKR.

  20. Dr. Damien Gatinel says:

    The smile is carried out thanks to the femtosecond laser whose wavelength is centered in the infra-red. The cornea is transparent to infra-red, and the laser light can spread. The femtosecond laser delivers convergent laser light trains, who are brought to focus in a very precise depth (by a converging lens system). At home, the laser light is concentrated and power (due to the very short time) causes a particular physical effect (effect of plasmatisation of matter). If the impacts are focused to a certain depth corneal surface (ex: 120 microns), the power delivered to the point of impact causes a 'break' of the corneal tissue, upstream of the home light is not intense enough to cause a particular effect. The LASIK technique involves cutting of a flap and the creation of an interface according to the same principles and using the same laser.

  21. Lila says:


    I was operated of the Smile relex about 3 months ago. I wanted to know if it was normal to always feel like tingling occasionally burns in the eyes? Is it of a scarring of the eye?
    Thank you.

  22. Pascal says:

    Hello doctor,

    I would like to have your opinion on an operation I want to perform next month.

    It's the RELEX lasik on both eyes who have myopia of-3.5 each and astigmatism on the right eye.

    Is it that the operation, to the present day, and reliable? or do I have to wait the time it is approved because that, given the comment above I'm not too comfortable.

    Thanks in advance for your return and wish you a wonderful evening.

    Kind regards

  23. Isabelle says:


    I've become intolerant to contact lenses after wearing in during a decade in a reasonable manner and following the usual hygiene instructions.
    I have an average myopia on the left eye (-4) and a small myopia on the right eye (-2.25) as well as a slight astigmatism.
    My cornea is rather thick and in good condition, on the other hand I have dry eyes.
    A first Surgeon told me about LASIK and a second recommended me the smile technique due to my dry eye and an allergic terrain (pollen in the spring).
    What do you think?
    Thanks for your response

  24. Dr. Damien Gatinel says:

    The Relex Smile technique is reliable, it is based on the principle of "tissue subtraction" to correct the myopia by changing the shape of the cornea. The volume remove is "block", and the technique is a bit more "manual" than LASIK, because the surgeon must dissect the lenticule of corneal to withdraw after the pre cut laser femtosecond. It is therefore important to call a surgeon trained in case of "Smile." Moreover, the Visual recovery is longer than in LASIK or PKR. It is important to weigh the pros and cons (for being the lack of flap, though the realization of a flap in LASIK is generally not a problem: millions of LASIK been performed worldwide since twenty years, and the Smile has not supplanted the LASIK to date: this last remains the technique of reference for the correction of myopia). The against is in editing case (rare), must then be a PKR because we can't make a SMile on a SMILE.

  25. Dr. Damien Gatinel says:

    It depends on the degree of dryness that you present. Dry eye making the port of uncomfortable contact lenses is logically a cause of application of refractive surgery. LASIK usually causes an increase in dry eye, especially in patients who have symptoms in connection therewith before the operation. But these symptoms tend to diminish with time, and the tears/gels / alternatives to switch between the postoperative course. In case of complicated chronic keratitis drought, it is prudent to delay the realization of a LASIK. The realization of a Smile technique is of potential interest in this context, because it exposes less than corneal denervation.
    Recent clinical studies tend to show the slightest degree of drought after SMile, but one study also showed that there was no significant difference:

    The PKR is also an alternative for patients who wish to not to increase their dry eye: but its aftermath are painful for 24 hours approximately. However, the Visual recovery after PKR seems faster than Smile, some patients operated of Smile reach perfectly clear vision after a few months (compared to a few weeks in PKR).
    Finally, the precision of the femtosecond laser (wavelength light in the near infra red) is less than that of the excimer (UV). In the future, a new generation of UV-operated femtosecond laser should allow a significant gain in the precision of the refractive duckweed cut in smile.

  26. Dr. Damien Gatinel says:

    These sensations may actually result from surgery. The scar (about 4 mm) is in 'sensitive zone' (the cornea): it is necessary for the withdrawal of the lenticule intra corneal. Felt blight may be related to some degree of dry eye, but should pass with time.

  27. Sara says:

    I was operated on the 9/10/14 for a strong myopia-6.75 OD and OG by the SMILE technique by femtosecond laser. The operation went smoothly since one week after the operation I was at 10/10 for each eye. However, 3 weeks after the operation, I saw a decline in my vision. This decline becoming more and more important and annoying, the surgeon received me quickly and found that myopia had reappeared:-1.25 OG and-1 OD exactly 1 month after the operation. After reviewing, he told me that he had already had case where myopia reappeared temporarily and provisionally and certainly this should disappear. He prescribed glasses to reduce my migraines and a eyedrops to decrease a possible oedeme. In the case where my myopia would not have disappeared, he told me about a PKR operation in order to correct it.
    Today I want to know if you have ever had this type of case where a myopia reappears after a SMILE then disappear? What do you think? Moreover, I have the impression that my myopia continues to worsen and not that it tends to disappear.

    FYI, my myopia was stabilized for more than 5 years. I had 2 children, 1 in 2012, the pregnancy had not changed my myopia and a second in may 2014. So I deliberately waited 6 months after my last labor to perform this operation.

    Thanking you in advance for your answer.
    Kind regards

  28. Meryem says:


    Since 8 days I myself am operated on both my eyes (high myopia with irregular astigmatism, with - 8/OD --6/OG) technique SMILE, according to my first control after the procedure my surgeon tells me that everything is good, the scar, the pane, ect...
    So everything is impeccable, on the other hand I just want to know is what it is normal to have all the time a veil that makes the vision not clear, a dry eye and the most annoying is the eye fatigue because right now I see well without the need of glasses but at a distance limit....
    According to the surgeon, the view will improve little by little by cons it is really unpleasant to see but not enough and net and especially after every effort (computer, reading, TV) it ends with headache!!!,
    The check went so fast and I had not had the opportunity to explain everything, honestly I worry and I need your opinion.
    Thank you

  29. Dr. Damien Gatinel says:

    NET vision after the Smile technical recovery is slower than after LASIK, it takes from a few days to a few months (according to the case) for printing of sail dissipates. On the 8th day, it is still too early to judge the effectiveness of the correction that was made for your myopia. If the surgery is successful, the reduction of inflammation of the intracorneenne interface should subside gradually and your vision to improve little by little.

  30. Dr. Damien Gatinel says:

    The reappearance of myopia in a month after Smile may be bound, as to other refractive corneal (PKR, LASIK) techniques, to phenomena of healing (scarring regression). The corneal tissue regenerates partially, which tends to reduce the effect of the initial correction. High myopia are usually source of risk of slot correction increased. It is rare that one under correction self-limiting, except special case, and it is then indicated to consider a remodeling. In Smile, alterations are done in PKR in most of the case, because we cannot re cut of lens in the cornea. Please use the excimer laser, which reduces the (supposed) benefits of the Smile, as we find ourselves in the situation of a remodeling LASIK or PKR. The simplest is to realize a PKR, by removing the epithelium and by delivering laser excimer on the surface of the cornea. In LASIK, the alterations are made simply resoulevant the original flap. The Smile does not realization of flap. In some case, it might be possible to convert the Smile in LASIK technology for the times, using a special program of cutting of a circular edge to create a flap.

  31. Amal says:

    Good evening
    I have 35 years and I have a strong myopia: OG (-10.5) and OD (-12.5).
    I consulted a churirgien who, after a quick test, offered me LASIK with limited results either a correction limited to (-10D) for both eyes by justifying the impossibility of exceeding a ceraine thickness to be removed. I am not convinced by this operation since I deverais wear all the same glasses or rigid lenses (eye dryer)!
    I beg you to enlighten me on the possibility of having a perfect correction with the new technique smile. As for the feedback of this technique, I do not have to worry about the results and the side effects especially in Morocco where I believe that people do not have an important recourse to this kind of operation.
    Thank you so much.

  32. Dr. Damien Gatinel says:

    SMile technique requires a perfect performance and it is preferable in all case to appeal to an experienced surgeon: dissection of the corneal lens to withdrawn is performed manually, and the speed of Visual recovery depends on the quality of the withdrawal. On the other hand, the possibilities of corrections are not superior to LASIK. In other words, if your cornea thickness limit the correction of myopia than 10 dioptres in LASIK, it will be similarly in Smile. LASIK and the SMile appeal to the same principle, the change in corneal curvature with the withdrawal of a certain tissue volume. Schematically, the myopia of 10 diopter correction involves the removal of a (fragment of corneal tissue in the form of optical lens) lens with the power of 10 diopters. That this withdrawal is "block" (Smile) or by photoablation laser (LASIK) doesn't change anything in terms of amount of tissue removed. Also be aware that modulations are possible: reducing the optical area scheduled to withdraw less corneal tissue for the same proposed correction: but the risk of nocturnal halos is larger when it reduces the diameter of the optical zone. If you want a response, it is best that you accept the possibility of a slight under correction. Finally, a surgeon who would guarantee you a total correction would be a bit presumptuous. Even if it can be obtained after the intervention, characteristic of the strong myopia (7 dioptres and more) is to make progress in existence (elongation of the eyeball). It is therefore preferable that you accept the possibility of a slight correction.

  33. remili says:

    Hello doctor,

    I intend to consider laser surgery to correct my farsightedness and my astigmatism.
    I was offered several techniques: ilasik and Relex smile. That it technique seems to you the most suited to my case ? Can the occular drought, which is more common with ilasik, persist for life?
    Thanks for your response

  34. Dr. Damien Gatinel says:

    The Smile is not able to correct farsightedness to date. This is related to the fact that volume to remove for the correction of hyperopia cannot be closed (there is a depth zero at the centre, and looks like a "doughnut": correction equal, the correction of hyperopia imposes a tissue volume to remove higher - Finally, balance is crucial for correction of hyperopia). For all these reasons, LASIK is (only) technique for the correction of your astigmatism with your farsightedness. the iLASIK is simply a LASIK done with the excimer laser to mark VISX (company acquired by Abbott Medical Optics - AMO) and a measure of the wave front preoperative to customize the lens correction.

  35. Myope0606 says:

    Good evening
    Operated by the smile technique of a myopia (-6OD/ -6, 50OG), my surgeon offered me the technique smile under correcting the left eye in anticipation of presbyopia. So I still have a myopia of-1.25 OG. Having 30 years, he finally received that it was "may be a mistake of under correct" given my age. 3 weeks after my operation, my vision is always unstable so very handicating to work in front of a screen, reading and driving almost impossible. I'm already thinking of a re-intervention in LASIK or PKR.
    What is the technique best suited to my case and in what timeframe?
    Residual stromal thickness 302 and 307 microns. Incision width 4mm.
    Thank you very much for your reply.
    A short-sighted myopic.

  36. Dr. Damien Gatinel says:

    Actually your under correction is maybe not wise at the age of 30 years. Presbyopia shouldn't affect you before fifteen years, so that the gene induced the slot distance vision left eye correction already exists. After a SMILE, it is unfortunately not possible to reprocess in SMILE. There are two options. The first is to cut a LASIK flap by extending the initial cutting (the 4 mm) and expand it in a circular manner to form a flap, lift, and carry out a complementary (conversion in LASIK) excimer laser photoablation. The module allowing this conversion in LASIK is may not be available in all centres, and there is not yet much recoil with this option. The second is proven, it is to perform a PKR (surface laser), conventionally (removal of the epithelium and issuance of a photoablation excimer to correct small residual myopia). In this case there is however a risk of local inflammation most important in case to PKR on a cornea not operated because of the prior achievement of the SMILE. LASIK has this advantage over the SMILE that he allows you to re treatment or alterations in a simple and effective way, maintaining the benefits of LASIK. Indeed, it is always possible to resoulever the flap made during the initial procedure, even years after it; presbyopic become short-sighted may have a touch up on the non-dominant eye, even when LASIK was conducted more than 10 years previously.

  37. Myope0606 says:

    Thank you very much for your promptness. And the hope of a possible re-intervention that will make me wait more serenely.

  38. Amal says:

    Good evening
    I am 35 years old and I have performed the tests for the operation by Lazer.
    Here are the measurements obtained.
    OD:-12.25; corneal thickness: 565 mm
    OG:-10 (-0.5 ~ 15); corneal thickness: 562mm
    The surgeon confirmed to me the possibility of correcting OG by smile and offered me the implant for OD with the possibility of a correction subsequently by Lazer for a highly probable under correction even with the implant.
    I refused the implant considering the possible complications and I would rather do nothing if c the only solution.
    On the other hand I wonder if I can live without glasses and lenses with OG corrected (if success is 100% biensur) and OD to-2D for example? this difference between the two eyes would not result in a drop in OG after the operation if I do not use a correction for OD? Is it true that such a difference would be benign to prevent presbyopia after 40 years?
    Thank you in advance for your answers which we are very helpful to make the right decision.

  39. Dr. Damien Gatinel says:

    Dune total correction of the partial of the right eye and left eye is an attractive option, able to strongly reduce your dependence on corrective lenses. The slot correction of the right eye allows you to read without glasses after age 40. I suggest you test this option in contact lens (total on the left, and calculated correction for residual myopia of about 2 diopters to the right). If the correction is comfortable (or not too uncomfortable), she can no longer wear glasses or lenses for everyday life, and a correction of extra of the right eye (glasses with neutral glass left, or lens) may be proposed to you for certain activities (conduct prolonged, sports type tennis, etc.). The high myopia tends to evolve over the existence, and it is possible that an editor is to consider in a few for the left eye in particular, if the return of a slight myopia proved particularly embarrassing. LASIK allows to make late alterations without problem, but it's more problematic in SMILE.

  40. Loly says:


    I want to make my 13 year old daughter and who has a myopia about-10 or - 9.5.
    Is that possible? My Entourage says no.

    Thank you for your understanding.
    Kind regards


  41. Smile not smile says:

    Hello doctor, there are apparently - it risk myopia to come back after a remodeling in PKR after an operation Smile. If the risk depends on the degree of myopia, is it the myopia of departure (so before the smile), or residual myopia after the smile? Concretely to 7 before the smile and - 1.50 after the smile. I evaluated just about the risk of a possible retouch in PKR because lasik seems too tedious. What think you? Big thank you.

  42. Dr. Damien Gatinel says:

    Your question is interesting and it is not easy to answer with certainty because the Smile is a relatively recent technique, and looking back on the times by PKR after Smile is still low. In general, more an eye is initially nearsighted, and more likely a correction increases. In PKR, we usually don't fixes beyond 6 diopters about (under correction otherwise). The PKR you benefit in terms of recovery will have to fix-1.50D, which is quite affordable, in all case for on an eye had never had surgery before. The PKR site is the superficial cornea (stroma) but the biological reactions may be triggered by the presence of an underlying interface (following the withdrawal of the lenticule Smile) and come to interfere with the correction of the delivered, as has been observed in the case where a PKR was made after a LASIK. Be sure to keep us informed.

  43. Dr. Damien Gatinel says:

    No this is not possible, because we don't operate the miners, and it is more preferable to wait that myopia is stabilized. Preferred equipment in flexible or rigid lenses.

  44. Emile says:

    Hello doctor,
    I underwent a SMILE operation with a femtosecond laser (Zeiss Visumax), the 06/02/15
    My vision was:
    OD: SPH-6.25 cyl + 1.25 AX 70
    OG: SPH-6.00 cyl + 1.25 AX 125

    First question: is it my astigmatism was not contraindicated for this technique?

    I have no pain, no eye dry. I could drive 2 days after the surgery, however I have several inconvenience:
    – The car headlight types lights, light me a lot, I perceive them as dazzling halos
    – My view from afar is not perfect far from it. On a scale of 1 to 10 I would put 6/10 (before operation without bezel I set 1/10). I get tired quickly, I feel like I'm forcing.
    – I work on screen. At the end of the day, I have trouble accommodating and I tend to see completely blurry. The "blur sail" effect is also intensifying.

    My eye doctor told me that there is nothing to worry about that everything was normal.
    I wish I had your opinion.

    Thank you for your answers.

  45. Dr. Damien Gatinel says:

    Astigmatism can be corrected in Smile, up to 5 diopters in theory, but it is there not the possibility to benefit from technologies of optimal alignment of the eye and LASIK (ex: recognition irisne). As pointed out on this page, the vision recovery is much longer after Smile than after LASIK (a few weeks vs. 1-2 days): the dissection and the lenticule extraction technique is manual, sometimes delicate, because of the need to not fragment (must remove it in full). These maneuvers expose the fabric corneal stromal to a 'mechanical stress' (strech) responsible for inflammation, of a disruption of the collagen fibers in contact with dissectors instruments... It is necessary to wait that the consequences of this stress subsides, which requires an average of 1 to 3 months according to the case. The dazzling halos reflect a scattering of light, linked to the interface and the lack of transparency at this level. If you have the impression of 'force', plus it could be related to an over-correction, which could also be temporary. You will be fixed in a few weeks as the expected improvement, and the evolution of your correction.

  46. David says:

    Hello doctor,

    I am 30 years old and I was operated on 7 November 2014 close to me using the SMILE technique.
    I was suffering from myopia and astigmastism (I was around – 4 at each eye, and the astigmatie no idea).
    The operation went very well, moreover the surgeon told me that if all these patients were like me it would be a joy for her...
    Suffering from dry eye and no longer able to wear lentils, this technique was advised.
    Three months later, I'm still very embarrassed by night-time halos when I'm driving.
    When I'm in a poorly lit environment, I feel like I have to force my eyes. I often have a veil, as if I had clouds in front of my eyes. Despite the instillation of artificial tears the result is the same.
    I don't feel like I'm suffering from more severe dry eye to date.
    Moreover, my vision of near and far is always very blurred see split. I have a lot of headaches, big difficulties working in front of a computer screen or just reading. It is very handicating and it worries me enormously!!

    What think you? Is this irreverssible? What is the agtigmatisme which has been poorly corrected?
    Is there a possibility of reworking the cornea with the laser? Can I aspire to regain a normal vision?
    I'll see her soon, but I wish I had your opinion.
    Very cordially.

  47. HAMBLI says:

    Good evening

    I have a-9.75 OD myopia and-9.75 OG!
    the thickness of my cornea is 539 microns OD and 544 OG!
    I was necessarily offered the operation via the SMILE technique but with all that I just read, I wonder if the LASIK technique is not the best suitable!
    In fact, a surgeon told me that it would be impossible to find a view of 10/10, and that I would be required to wear glasses afterwards!
    Another surgeon told me almost the opposite, according to him thanks to the smile I would have more possibility to get a near perfect view!
    So here I wanted to know what you advise me as an operation because I'm a little lost?
    And what do you think of LASIK Xtra for fine corneas?
    Principle: during the laser treatment with the LASIK technique, a CXL is performed at the same time operating. Its principle is to strengthen the cornea by impregnation of riboflavin exposed to ultra-violet radiation. This treatment in the treatment adds only 3 extra minutes of procedure per treated eye.

    Thanks again for your time!

  48. Dr. Damien Gatinel says:

    Let's start with the LASIK Xtra: this technique did not any proof of its effectiveness to prevent the ectasia, and she is generally discouraged because it puts them at risk of inflammation of the interface and endothelial lesion (which are in the deep surface of the cornea). In the best of the case, the cross linking will not be used much (to you). The Smile is potentially indicated in your case; the surgeon who offers certainly has the experience of similar case, and trust you in his view as to the chances of recovering a total correction. It is important for you to know that even in the case of a total correction, characteristic of the strong myopia that you present is to evolve, even after several years of stability. LASIK is also possible (whenever you can do a SMile, the thickness of the cornea is also compatible with a LASIK), realizing a fine flap and adapting the diameter of the optical zone to preserve a sufficient residual rear wall. The Smile is theoretically less source of dry eye, but the recovery is longer; regarding the biomechanical integrity of the cornea, the better preservation of the one by the SMile is very speculative, and all that the lenticule is more profound, even if the proponents of this theory argue that the most superficial stroma must be preserved because more resistant. In all case, be aware that the ectasia after LASIK is basically linked to the presence of a fruste Keratoconus and eye rubbing associated with. If you do not topographic irregularity, Biomechanics (review ORA) unadulterated (normal corneal hysteresis), the risk of ectasia is very low to no one, even in strong myopic correction case.

  49. Dr. Damien Gatinel says:

    In this context, the halos can have two main causes:
    (1) high-degree aberrations (not correcgible in spectacles), including so-called "spherical", which are sometimes induced by refractive surgery (LASIK, PKR or smile): If the functional optical area (the correction area) is smaller than the pupil , the rays that "pass" through the edges of the pupil are "always myopic" and can induce these halos. An aberrometric examination is quite appropriate and allows to measure these aberrations.
    2) a reduction in the transparency of the cornea: in the case of the smile, if the interface remains a little "inflammatory" or reengineered, this can result in an increase in light diffusion, which can give a sensation of Halo (bright Globe around the sources of bright lights). A review by OQAS (or HD Analyzer) can objectify this diffusion.
    What you feel in low light is a reduction in the sensitivity to contrasts, which can be the consequence of the two phenomena explained above.
    These phenomena tend to diminish over time. In LASIK, it is sometimes possible to correct the halos caused by high-degree aberrations by delivering a treatment intended to widen the functional optical area. In smile, reprocessing is more difficult because there is no flap , and that the cornea must be reworked on the surface (PKR) or cut a flap as in LASIK, but this is not always simple and the flap is small in diameter. In principle, 3 months after the intervention, an improvement should occur quickly and your surgeon will certainly confirm this and explain to you more precisely the cause of your Visual symptoms.

  50. Amal says:

    Hello. I've already written 3 months ago pr advice on high myopia and the smile.
    Indeed, I was operated by a strong myopia (OD:-12.25 7A 8/COF and OG:-10 (-0.5-16) 9 a 20/COF) by smile 3 months ago for an expected result of 10/10 PR OG and 1myopia residual of-2 PR OD.
    After checking, I have mnt og:-0.75 and od:-2.75 (-0.5 a 160 °) and according to the doctor I have a residual cornea suficient PR perform a retouching in PKR within a month PR both eyes.
    What do you recommend for me case : alterations only PR OD or also OG? Does the PKR have severe risks? the halos that I have mnt will disappear in case retouching? And the Interet of residual myopia to prevent presbyopia will not be case touching the two eyes?
    Thank you bcp PR l interest that you give to my Msg.
    Your advice m help bcp PR make the right decision because mnt with the smile all the same my daily is better without glasses apart at night or I am very genee in places poorly lit

  51. Dr. Damien Gatinel says:

    The risks of the PKR after Smile for high myopia concern the appearance of a scar "haze". The haze is a complication of the PKR for correction of high myopia (greater than 6 or 7 D). Even if the remodeling is more moderate, it seems that the importance of myopia corrected in Smile accentuates the risk of haze. It seems best to wait more than 3 months to perform this editing, because the phenomena of regression are can not be completed. The refractive result allows you to not wear glasses for activities seeking not too fine vision (e.g. driving) and it is may be wiser to be content. The occurrence of a haze after takeover by PKR in Smile would expose you a return of myopia, an accentuation of the halos at night, etc.

  52. Amal says:

    Thank you bcp for this clarification.
    I just want to know the probable causes of the result obtained in relation to the expected result (-0.75 difference). Is it the precision of the smile technique? or does it depend on the healing of everyone?
    On the other hand, the ocular sechress that I suffer can alter the quality of the vision and accentuate the halos that diminish from time to moment when my eyes are less tired and less dry.
    Thank you so much.

  53. Amal says:

    Thank you bcp for this clarification.
    I just want to know the probable causes of the result obtained in relation to the expected result (-0.75 difference + astigmatism OD). Is it the precision of the smile technique? or does it depend on the healing of everyone?
    On the other hand, the ocular sechress that I suffer can alter the quality of the vision and accentuate the halos that diminish from time to moment when my eyes are less tired and less dry.
    Thank you so much.

  54. Dr. Damien Gatinel says:

    According to studies published, the precision of the Smile technique is comparable to that of LASIK, once the initial phase is past. In refractive surgery, there is always an issued with respect to the correction, "margin of uncertainty" which is often due to the way in which the cornea 'reacts' to the laser, and heals. This margin (+/-O.50 D) is relatively narrow, given the effects brought into play during a correction. LASIK allows alterations in excellent conditions, since it is sufficient to resoulever the flap to reprocess. Drought you suffer after the Smile can quite occaseionner of halos and reduce the quality of vision.

  55. Myopia says:


    I just had surgery 4/06 by implant on the OG (-13) and the 5/06 by ReLex SMILE on the OD (-8).
    If the effective laser at the OD allows me to see at 10/10 of both eyes, it persists a slight myopia that I do not see progress. Admittedly, the recovery is longer and I am only 12 days post-intervention, but the fact that there is no progress is it normal? Or does that mean I should complement LASIK or PKR?
    I also come back to the question of light halos: for the OG (implant) I actually have a golden circle, or even several, that appear when a bright light source is in my Visual field. Is it due to the implant? I guess it will stay... I would like to know your return on this also? That said, the acuity being so good implant side, that I can not complain...
    Thanks in advance for your feedback.

  56. Dr. Damien Gatinel says:

    The recovery in Smile takes place within a period longer than after LASIK and it is still necessary to wait a few weeks to judge. If one under correction exists and it is troublesome, the recovery will not happen in Smile unfortunately but in PKR. About the circles on the side of the implant, they are certainly the consequences of optical phenomena of partial reflection by the edges of the optics of the implant. It is not certain that they persist in full, a mitigation of these phenomena in a few weeks is often reported by patients, we really know whether they are real mitigation or a "neutralization" of these phenomena by the brain.

  57. Karim says:


    To read the various comments, you seem, doctor GATINEL have a preference for the technique of LASIK rather than the SMILE. Is this correct?
    However, as an observer, I have the impression that the SMILE technique has fewer steps and therefore less risk to the patient. But I'm not a specialist on this.

    Thank you in advance for your clarification.

  58. Dr. Damien Gatinel says:

    The comments are the work of patients or "witnesses" of the art SMILE. The realization of the SMILe does not "fewer" steps than LASIK, considering that it is necessary to perform a dissection earlier, then after femtosecond laser, then an incision, then a manual dissection anterior, posterior, then an extraction of the lenticule cut through the incision said. The Smile is an interesting technique in principle, but which remains more manual than LASIK, more limited in its indications (as more limited for astigmatism and hyperopia, impossible to realize personalized corrections, no compensation of cyclorotation of the eyeball, because no recognition irisne active to this day), slower in terms of recovery, and especially which allows no alterations in Smile. A residual myopia or regression of the correction after SMile force to achieve a PKR. These reasons seem to me sufficient to guide the choice of a refractive correction to LASIK in the vast majority of the indications.

  59. Pauline says:


    I was operated in July 2014 of myopia by SMILE technique.
    Everything went well, I took about 1 month to totally recover my vision.
    But for a few months (4-5months) I have the impression of losing the left eye. I had my check-in this summer, the surgeon told me that actually I had a less good view of the left eye, that he was more "lazy".
    He didn't tell me how much I was. Last week at the medical visit I realized that I was only 5/10 to the left eye. I'm starting to really worry about this drop of sight which is becoming more and more annoying to me especially in the evenings with fatigue.
    I hesitate to go see another ophthalmologist to get his opinion.
    What solutions are possible for me? (New surgery, re-education, glasses, lenses..?)
    Thank you in advance for your reply.

  60. Dr. Damien Gatinel says:

    Find the cause of the decline of the vision of your left eye, to a measure for refraction, in order to highlight a residual astigmatism or myopia (ex: partial regression of the SMILE correction). If this is the case, a simple correction in glasses should allow you to find a Visual acuity of 10/10. Rehabilitation will be no conclusive effect (except to make you get used to the difference of correction between the eyes). A new surgery (reprise) is not possible in rework technology SMILE. PKR (surface laser) is certainly the technique to be considered as a priority, and your surgeon will be able to confirm this and explain the cause of your low vision after SMILE at the level of the left eye.

  61. Magali says:

    Hello doctor,

    I've scheduled two dates at ophthalmologists on Paris.

    My Visual acuity OD:-6.00 (-2.75-30 °) OG:-6.5 (-1.5 to 175 °)

    I suffer from a slight impairment on my OD (a first ophthalmologist told me about slight amblyopia but it tells me no) gives me a Visual acuity of 8/10 maximum to OD with glasses / lenses.
    My cornea is thick enough with both eyes (average 590 microns).

    The first ophthalmologist recommends the Relex / Smile for a faster operation and with newer hardware with a risk not to treat all the astigmatism on my OD (he said, a risk to keep a deficiency of 0.5 in astigmatism on this side).

    I told him about the second ophthalmologist that he knows because it operates at the same clinic. According to him, the second (known) ophthalmologist will only want to use the Lasik technique while the other is more recent.

    In my research, I see that the Smile is not recommended to treat a strong astigmatism, is this related to the fact that this doctor say there's a risk to keep a slight astigmatism to OD?
    Will these two lasers have a different impact on my post-operation vision?

    Thanks for your help.

  62. Tekin says:

    I am 33 years old, my acuity is to
    Right Eye-3 (-1.25) 110degre
    Left eye-3.75 (-0.75) 65degre
    Pachymetrie is 504/514 us and 490/490 ORB (UM, OD/OG)

    I passed two separate exams, one offered me the SMILE, and the other the femtolasik.
    I'm a little lost, and need your advice. Thank you

  63. Dr. Damien Gatinel says:

    case of thin corneas (less than 500 microns), the best technique to be considered first-line is the PKR (surface laser) for efficiency comparable to LASIK and the Smile. The speed of recovery is slower than in LASIK, but faster than SMILE. The PKR is truly a technique without incision, it occaseionne however pain lasting 24 to 36 hours (which can mitigate with painkillers). The Visual results are identical to those of the other techniques for less than 6 diopters myopia. The ectasies have been described after completion of a SMILE on initially thin and irregular corneas.

  64. Dr. Damien Gatinel says:

    The SMILE seems actually less effective than LASIK for the correction of astigmatism pronounced. Astigmatism is a more common than nearsightedness alterations, alterations in SMILE are a problem because it is not possible to redo a SMILE after a SMILE and then consider a PKR (or abstention, that offers your surgeon in advance). Contrary to what the marketing discourse suggests, the fact that the SMILE is more recent than LASIK won't say that this technique works better, is more accurate and gives a quicker recovery. Many Refractive Surgeons do not realize the SMILE, as they consider that this technique does not bring a great advantage, apart from the newer or less invasive nature-centered communication assets. In fact, LASIK provides corrections more accurate than the SMILE for astigmatism, and the SMILE can correct hyperopia. The principles at stake for the SMILE are older than those of LASIK (refractive removal "block" of a lens). The accuracy of LASIK is the use of the excimer laser (0.5 microns), whereas femtosecond laser provides a precision of 5 to 10 microns currently. This precision is sufficient for simple cutting (flap or interface) patterns, but does not really deliver fixes as accurate as those required for the strong astigmatismes and farsightedness. The interest of the SMILE is to reduce cutting a circular flap to a few mm, which may have an interest in patients who present a complicated keratitis in preoperative dry syndrome. If you do not have this type of Pathology, and you are looking for the correction accuracy above all with corneas with the Central thickness close to 600 microns, LASIK appears as a technique of choice.

  65. galdin says:


    I spent preoperatoires in March 2015 reviews but my ophthalmologist was inadvisable to Surgery LASIK as my cornea is too thin.
    However after researching I have seen that there are other laser models like the LASIK Xtra and the laser smile.
    Do you think these methods could be adapted to my case ?
    Measurements: OD:-6.5-1 115 ° pachymetrie: 527 μ PTA: 39.62%
    OG:-7.75-0.5 0 ° pachymetrie: 530 μ PTA: 40.56%

    Thank you for your answer

  66. Dr. Damien Gatinel says:

    The SMILE has the same boundaries as the LASIK with respect to the degree of correction and the original corneal thickness. In other words, if we consider that your cornea is too thin for a LASIK, it is also for the Smile technique. According the figures you mention, it is not excluded that a LASIK can be done if your corneas are regular and without evocative topographical anomaly of Keratoconus subclinical. Realizing a flap to close 110 Microns thickness, it is possible to leave a posterior residual wall close to 300 microns with a recent excimer laser.

  67. Catherine says:


    My surgeon leaves me the choice of surgery between lasik and the relex... What should I choose?
    Thank you

  68. Nina says:


    J made a speech to the SMILE 2/05/16, s all happened well except that since I see better from the left eye and the right eye. Actually I'm feeling discomfort in the right eye I see slightly fuzzy from far and near. I have the impression of having a twisted lens. I was on the left eye and the right eye myopia myopia and a light astigmacie... Should I m inquitter of the fact that the left eye sees better than the right?

    Thanks for your reply,

  69. Dr. Damien Gatinel says:

    It is still a bit too early to comment on the result of your intervention, a slight difference of view between the eyes after refractive surgery is not uncommon. The SMILE technique offers recovery usually somewhat slower than in LASIK. The feeling of twisted lens is revenge a little more unusual, and it will check without urgency that there is no impairment of the ocular surface (horny), or a dry eye more marked on this side, etc. Your surgeon can certainly provide information on the possible causes of this difference in perception between the two eyes.

  70. Dr. Damien Gatinel says:

    The choice of technique can actually be left to the patient in surgery of comfort. The Relex-SMILE presents a decrease lower than LASIK, and provides a sometimes more prolonged Visual recovery. In case of pre existing drought of the ocular surface, the SMILE could reduce the degree of emphasis of the postoperative with respect to LASIK. In terms of outcome, studies show no difference between these two techniques for the correction of the current myopia. Postoperative alterations are simpler in LASIK... These elements and possible discussion with your practitioner will help you surely make an informed choice.

  71. Romanesque says:

    Hello doctor,

    I was operated 3 days ago from a myopia of-4 to both eyes by the technique smile, highly recommended by my surgeon to whom I trusted. According to her, this technique allowed for a much faster recovery than the other 2 methods (PKR and LASIK).
    At 3 days post operation My vision is blurry and changing, close and far. And I really don't see much worse than my glasses before the surgery. I have read in your previous feedbacks to patients that the visual recovery post smile could be slow (info that I had not had before I was opered). These returns from before 2015, I would have wanted to know if the technique had evolved since or if a recovery of the net vision after a smile was always slower. In short, from what time post operative smile with blurred vision is there something to worry about?
    At the end of how long the blur is no longer synonymous with recovery but "failure" of the operation or insufficient correction? Thank you very much in advance for your return and your time. This type of exchange is truly precious for patients who like me doubt and unfortunately do not listen or trust their own surgeon.
    Thanks to you and very good day.

  72. Dr. Damien Gatinel says:

    The post-operative recovery in smile is indeed often slower than in LASIK, especially when the manual extraction manoeuvres of the laser duckweed pre are difficult and/or require repeated manipulation at the level of The interface. It is necessary to wait another few days or weeks so that the eventual inflammation will absorbed to pronounce.

  73. Kelly Rumana says:

    I was operated with the smile technique for my myopia last Friday (04-01-19). No pain to report despite a very blurred vision.
    I had a check-up with the surgeon the next day (I could see well from afar and blurred closely), my surgeon told me that it was normal and that the operation was successful, my view having been evaluated at 10/10 with every eye.
    My view was pretty good the following days (much less blurry sensation from near as far) and an improvement from days to days, until this morning when I see again blurring close... Is that normal? Do I have to make a quick appointment or wait for my next appointment in a month? I specify that I sometimes have a headache if I spend too much time reading or in front of screens.
    Thanks in advance for your expertise

  74. Dr. Damien Gatinel says:

    The recovery after smile technique depends in large part on how the manual extraction of the duckweed has been performed. The visual blur is sometimes pronounced, as in your case In the days following the completion of the technique. A close inconvenience may correspond to an overcorrection of myopia, but it takes at least one month to judge the outcome of the intervention.

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