Advantages of LASIK vs. SMILE might depend on patient candidate

Advantages of LASIK vs. SMILE might depend on patient candidate

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September 28, 2021

1 min read

Source:

Thompson V. The comprehensive refractive surgeon in the year 2021. Presented at: Real World Ophthalmology; Sept. 18, 2021 (virtual meeting).

Disclosures:
Thompson reports consulting and researching for Alcon, Carl Zeiss Meditec and Johnson & Johnson.


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Patient candidates may be similar, but there are situations in which SMILE or LASIK might be better suited than the other procedure, according to a presentation at the Real World Ophthalmology meeting.

Vance Thompson, MD, said there are advantages and disadvantages of both procedures.

“I consider the candidates the same,” he said. “I don’t do SMILE on someone who I wouldn’t feel comfortable doing LASIK on.”

One reason for that is a critical need for proper centering in a SMILE procedure.

“When you dock, you have to dock with precise centration,” he said. “Once you dock, you can’t move the beam. Sometimes it takes a few approaches, and every now and then I can’t center it well. Since I do SMILE on patients who are also good LASIK candidates, if for some reason I can’t center perfectly, I can still do LASIK.”

Thompson said LASIK “wins” when patient fixation is unimpeded, when topographic or wavefront guidance is needed and in eyes with lower cylinder.

However, he said SMILE has some advantages. Because SMILE does not require full flap creation, like LASIK, there are fewer complications.

“I think time will tell us more and more, but right now, I consider SMILE something that has fewer dry eye symptoms, they don’t have to worry about the flap moving, and there’s the potential for improved biomechanics,” he said.

There are a few other areas in which SMILE might be a better choice, Thompson said. This includes patients in whom the correction is “high enough”; SMILE is approved for patients with myopia between –1 D to –10 D and cylinder between –0.75 D to –3 D. He said SMILE is also good in situations in which topography or wavefront are not need.

“If the correction’s optimal and centered perfectly, and they don’t need topo or wavefront guided, SMILE is actually my preferred approach,” Thompson said.

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Luke Everdeen

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