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Quality of life improves after refractive surgery with ReLEx SMILE procedure
A surgeon explains why he chose this newer refractive procedure over LASIK for his own eyes.
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This issue’s Refractive Surgery Story is the first of the series to discuss the SMILE procedure, an acronym for small-incision lenticule extraction performed with the Zeiss VisuMax laser. This procedure is not yet approved by the FDA in the U.S., and in fact, submission of data for myopic correction has just begun.
Dr. Dirisamer chose this procedure, performed in Europe, although he was a LASIK candidate, because he felt that the post-procedure structural integrity of the cornea would be better maintained than with LASIK. Other advantages may include higher predictability in higher myopes, less induction of spherical aberration and a more comfortable docking procedure. Visual recovery is sometimes a little slower than with LASIK.
We are looking forward to approval of this procedure because of the purported advantages, and a truly small-incision procedure may give our refractive volumes a boost.
Richard A. Norden, MD OSN Refractive Surgery Stories Editor
Growing up, I was always dependent on either spectacles or contact lenses. This is my own personal reminder that myopia and astigmatism influence daily life quite negatively, especially at a younger age. Simply imagining this state of dependence is enough. There is no need to talk about the millions of situations in which spectacle wearers would like to throw their glasses against the wall regardless of how much they spent for their designer frames or the routine agony of waking up in the morning with red, burning eyes after forgetting to remove contacts the night before. And do not forget the challenge of playing sports with –7 D spectacles and the constant fear of losing a contact during a tough, sweaty tennis match.
In the last years of medical school, my myopia stabilized and I began to think seriously about laser refractive surgery. Later, during my training and cornea fellowship, I performed a number of different anterior segment surgeries, including lamellar keratoplasties such as Descemet’s membrane endothelial keratoplasty and deep anterior lamellar keratoplasty and also laser refractive surgery such as LASIK and PRK, so I was quite familiar with cornea surgery. The final push that I needed to get rid of my contacts was an experience 2 years ago.
A colleague, a surgeon at a trauma and reconstructive surgery department in Austria, consulted our department. Although he was a routine and typically responsible contact lens wearer, during the prior night’s shift, he had forgotten to remove his contacts. Over the next few days, one of his eyes became increasingly red and painful. Despite intensive topical antibiotic treatment for weeks, there was no improvement. After several excruciating weeks, the correct diagnosis of Acanthamoeba was finally made. But even then, saving the eye required a penetrating keratoplasty that left this physician, my colleague, with persistent pain in the eye and finger counting vision. He was devastated and feared not being able to work as a surgeon any longer with only one seeing eye. In that moment, I thought: This could have happened to me!
Recently, we have begun performing a new minimally invasive laser refractive surgery procedure called ReLEx SMILE. I myself had this procedure after the above nightmare encounter with my colleague, and it has now been many months since the operation. Because the spherical equivalent in my left eye was –8.5 D, I did not feel comfortable with femtosecond LASIK, even though technically I still would have fallen within the safety range for the procedure. After my own operation, my residual stromal thickness was about 270 µm in each eye. And because ReLEx SMILE is a fully flapless procedure, a higher biomechanical stability is anticipated.
I appreciate the minimally invasive approach, which may also reduce the risk of infections. Plus, I like the procedure as a surgeon. It is easy, quick and straightforward. In the clinic, the overwhelming results of the operation have been great with almost no re-treatments (below 1%) being necessary so far.
So, I decided to ReLEx and SMILE.
Two weeks of not wearing contact lenses (only spectacles) before surgery was the last barrier to overcome. The treatment itself was easy and painless, as expected. Blurred vision and irritation disappeared after 3 hours postoperatively. The next day, I traveled to London to the European Society of Cataract and Refractive Surgeons meeting and gave talks about keratoplasty procedures.
I am very glad to have received laser refractive surgery in my own eyes, and I will close with a bit of encouragement for those persistent contact lens wearers out there. My old colleague with the Acanthamoeba who inspired me to ditch my own contacts: Eventually, we changed his medication and did a re-keratoplasty. Now we are both happy because he has no pain anymore, achieves a visual acuity of 20/25 and can do his job again.
There are many reasons for deciding on refractive surgery, and frequently, the result is a tremendous improvement in quality of life.
- For more information:
- Martin Dirisamer, MD, PhD, FEBO, is the head of department for refractive surgery at the University Eye Clinic, LMU Munich, Germany; email: dirisamer@me.com.
Disclosure: Dirisamer reports no relevant financial disclosures.