New Form of Laser Eye Surgery Could Be More Effective Than LASIK, Doctors Say

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Glasses are geeky, contacts are cumbersome, and walking around with blurry vision is, well, just not an option. Nearsightedness is both a common and obtrusive condition that affects 40% of adults in the U.S. While this fortunately means it won’t affect your reading of this article, dealing with such a malady is more than an inconvenience or a chore; it’s an annoyance that greatly modifies what we can and can’t do in life. Want to be a chef? Those glasses and contacts could become a burden. Want to go for a swim? You’ll have to dive into the water without your glasses or contacts.

And the condition is becoming increasingly prominent. According to an article in Popular Science, researchers expect 50% of the world’s population to be myopic by 2050. This is thanks to both genetic and environmental factors. As people venture outside less and stare at computer screens more, we’re naturally becoming less dependent on our ability to see far distances. Eventually, myopia could become a universal problem. Yet, ironically, with advancements in corrective surgeries, we might see fewer and fewer people with contacts or eyeglasses.

LASIK VERSUS LASEK VERSUS PRK 

Since 1999, it’s thought there’s been merely one way to correct vision without the difficulty of putting in contacts or the vanity-killing act of wearing glasses: LASIK. There is also the similarly sounding LASEK and PRK corrective surgeries. While only a single vowel separates LASIK and LASEK, the procedures are very different. Both permanently reshape the cornea to correct vision, but in LASEK, the top layer of the cornea is moved and reattached after the correction has been completed. LASIK, on the other hand, requires the creation of an additional flap with a second laser. To put it simply, LASEK uses one instead of two lasers to correct vision, and it is considered a better choice for those who have thin corneas or medical conditions that make laser eye surgery challenging to complete. PRK was the first laser surgery that hit the market and is very similar to LASEK. The difference being that, with PRK, the surgeon removes the entire outer layer of the cornea to access the treatment area, requiring a new layer to grow during the healing process. 

Which procedure a patient selects is largely dependent upon what they’re looking for. LASEK has a much shorter healing time and patients are less susceptible to infections and other side effects such as inflammation and hazy vision. PRK, on the other hand, is preferred among patients with thinner corneas. 

LASIK has an even faster healing time, than its phonetic twin, LASEK. The Mayo Clinic also published a study stating that LASIK can be a better option for treating patients who struggle with more significant nearsightedness. However, the creation of a new flap via laser does require a thicker cornea.

According to the U.S. Food and Drug Administration, over 95% of people who have undergone the LASIK procedure report satisfaction with their vision. 

A New Vision Treatment: SMILE 

Seeing that LASIK and PRK have their pluses and minuses, a new procedure called SMILE (Small Incision Lenticule Extraction) attempts to combine the best of both worlds. 

According to Dr. Brian Ranelle and Dr. Jerry Hu of Texas Eye and Laser Center, SMILE differs from LASIK because no flap is created via laser, which lowers the risk of any complications. 

The procedure uses a new VisuMax femtosecond laser manufactured by Carl Zeiss Meditec, which creates a small, lens-shaped piece of tissue (lenticule) within the cornea. The laser then makes a small incision in the surface of the cornea, and the surgeon extracts the lenticule. This lenticule removal ultimately alters the shape of the cornea and corrects nearsightedness. 

Yes, this is a difficult procedure to explain without the assistance of visual aids or a YouTube video. However, according to Dr. Ranelle and Dr. Hu, who consulted with colleagues from around the world and vigorously studied FDA data, SMILE represents the next generation of laser eye surgery. 

While it’s still young compared to other refractive eye surgeries — Texas Eye and Laser Center is one of only two ophthalmology clinics in Fort Worth that offers the procedure — the early returns on this new form of laser eye surgery have been very positive. 

“Our patients continually tell us they couldn’t believe how easy and quick the procedure was,” Dr. Ranelle and Dr. Hu said via email. “The laser portion of SMILE takes only 24 seconds. Typically, patients feel no pain or discomfort during the procedure or recovery, and their vision is often 20/20 by the next day.”

According to a recent study of 328 people who underwent the SMILE procedure, all but one patient walked away with 20/40 vision or better after the surgery — and 88% had 20/20 or better. 

Studies are also showing that there may be less risks of dry eye symptoms after SMILE compared with LASIK. To put it simply, SMILE is a far less invasive surgery than LASIK that is proving to be equally successful in correcting vision.

Of course, this isn’t to say that SMILE is for everyone. Dr. Ranelle and Dr. Hu emphasize the importance to have a consultation with an ophthalmologist to find the solution that’s right for you.  

For more information about SMILE, visit the Texas Eye and Laser Center’s website at lasikdr.com


Subject Matter Experts

Dr. Jerry G. Hu, M.D.

Dr. Jerry Hu is a leading private practitioner who is a partner and owner of Texas Eye and Laser Center, an internationally recognized center of excellence, and a co-founder of Texas Eye Surgery Center. Dr. Hu specializes in refractive surgery, cataract surgery, as well as cornea and anterior segment diseases. He pioneers a wide range of cutting-edge ophthalmic surgeries including SMILE, blade-free LASIK, laser-assisted cataract surgery, intraoperative wavefront aberrometry, MIGS procedures, Intacs, cornea collagen crosslinking, and laser-enabled minimally invasive corneal transplantations.

Dr. Brian D. Ranelle, D.O.

Dr. Brian Ranelle has performed LASIK and Refractive Surgery for over 25 years. Dr. Ranelle also has special interests in advanced cataract surgery with the most advanced lens implants available in the U.S. including the PanOptix Len implant, the first Trifocal implant in the U.S. He also has special interest in treating glaucoma and practices comprehensive ophthalmology. 



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Luke Everdeen

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