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BLOG: Three reasons to SMILE in 2017

ByJohn A. Hovanesian, MD, FACS

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2016 was a great year for FDA approvals of new eye devices and drugs. Among the most noteworthy was the Zeiss VisuMax femtosecond laser for treatment of myopia with small incision lenticule extraction, or SMILE. In this procedure, a femtosecond laser is used to create an intrastromal lenticule that is surgically extracted through a small femtosecond incision. The result is correction of even high degrees of myopia with impressive precision.

Here are three reasons refractive surgeons should consider adopting SMILE sooner rather than later:

1. Excitement. Any new refractive procedure brings the excitement that only new technology can provide, among both the public and surgeons. Many patients who have reservations about LASIK are waiting for a perceived “newer and better” technology. SMILE gives us a chance to share a method with the world about renewed optimism in this procedure. In our own practice, promotion of new procedures has always led to growth in all areas of refractive surgery, both corneal and lenticular (ie, “all ships rise together”). There is pent-up demand among the public for a quality refractive procedure, so let’s share the story of SMILE.

2. Results. More than one peer-reviewed study has already shown better results, with fewer aberrations and more patients uncorrected acuity of 20/20 with SMILE compared with LASIK, And this is with first-generation SMILE! Ectasia may also be less frequent with SMILE because the anterior cornea is affected much less by SMILE than by a LASIK flap. As technology and approvals progress, we can expect even better results. Most of these modifications will be simple software changes, not requiring costly upgrades. While the current approval is just for myopia, we can expect astigmatism correction as well in the next year or so, according to Steve Schallhorn, MD, medical director for Zeiss.

3. Driving the industry. As I have blogged before about inlays and other technologies, we physicians should embrace technologies that serve patients better. Only through our adoption of promising technologies will industry invest in new drugs and devices that make us better physicians. As with premium IOLs, the medical community’s enthusiasm and the sales that result are the primary drivers of investment. We control both, and SMILE — and the future procedures it will beget — deserves further development.

My mentor, Robert Maloney, used to say, “There are old surgeons, and there are bold surgeons, but there are no old, bold surgeons.” Whether young or old, all refractive surgeons will do well to realize that SMILE offers promising benefits to our patients and deserves consideration for adoption in 2017.

Disclosure: Hovanesian reports he is a consultant for Zeiss, Alcon and Johnson & Johnson.