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SMILE can offer similar outcomes as LASIK with less dry eye

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Jodhbir S. Mehta

NEW ORLEANS — Athletes, patients with moderate to high myopia, military personnel and those with a risk for prolonged postoperative dry eyes are the best candidates for small incision lenticule extraction, according to a speaker here.

“The first generation of SMILE has been equivalent to what we’re seeing with 20 years of LASIK technology, but you need to optimize the nomogram and there are some issues with centration that need to be understood. You cannot take the same principles that we have with LASIK. SMILE shows less denervation and faster tear film recovery,” Jodhbir S. Mehta, MBBS, PhD, said at Refractive Surgery Subspecialty Day preceding the American Academy of Ophthalmology meeting.

Good candidates for LASIK with normal topography are also prime candidates for SMILE, Mehta said. SMILE is effective for patients with moderate to high degrees of myopia, anyone who participates in sports or has a certain occupation such as the military, or those who are at risk for prolonged dry eyes.

SMILE offers better preservation of the subbasal nerve plexus and offers patients a faster nerve recovery and better nerve morphology.

In several clinical studies comparing SMILE and LASIK with respect to nerve sensation, all have been in favor of SMILE, Mehta noted.

Ophthalmologists need to recognize patients who may not be good candidates for the procedure, he said, and should have a long discussion with patients who desire monovision.

“I do not perform SMILE on patients who are nervous — it does take longer than having LASIK done — or patients with topographical abnormalities because there is a risk of getting ectasia,” he said. – by Robert Linnehan

Reference:

Mehta JS. The best for SMILE. Presented at AAO Subspecialty Days; Nov. 10-11, 2017; New Orleans.

Disclosure: Mehta reports he receives lecture fees from Carl Zeiss Meditec, ReVision Optics, Santen and Ziemer; receives grant support from Carl Zeiss Meditec and Ziemer; and has a patent/royalty with Network Medical.