Retreatment Options After SMILE: What You Should Know

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Retreatment Options After SMILE: What You Should Know

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Undergoing vision correction surgery is a significant decision, and while SMILE (Small Incision Lenticule Extraction) eye surgery is a highly effective procedure for many, some patients may require a retreatment to achieve their desired vision clarity. Understanding your options for retreatment is crucial to making an informed decision.

This guide aims to provide you with comprehensive information on the available retreatment options after SMILE, including the reasons why retreatment might be necessary and what you can expect during the process.

Understanding SMILE Eye Surgery

SMILE eye surgery is an advanced, flapless, and minimally invasive laser vision correction procedure mainly used to correct myopia up to -10D and astigmatism up to 6D. Known for its innovative approach, SMILE is gaining wide acceptance for those seeking precise laser correction.

Watch here to understand SMILE Eye Surgery

SMILE: The Revolutionary Flapless Specs-Removal Procedure | Dr. Raghav Malik | Planet Lasik

Overview of the Procedure:

  • Comprehensive Evaluation: Initial assessments include eye examination, corneal mapping, and measuring refractive error.
  • Anesthesia: Numbing eye drops are applied for patient comfort.
  • Laser Application: A femtosecond laser forms a small disc-shaped lenticule inside the cornea.
  • Incision: The laser creates a tiny incision (about 2–4 mm).
  • Lenticule Removal: The lenticule is precisely created and carefully extracted, reshaping the cornea to correct vision.
  • Faster Healing: No large corneal flap, so healing is typically quicker and dry eye risk is lower compared to other lasers.

Who Qualifies

  • Age 18 years or older
  • Stable prescription for at least one year
  • Adequate corneal thickness and healthy eyes
  • Myopia up to -10.00 diopters, astigmatism up to -6.00 diopters
  • No autoimmune disorders or active infections

Key Benefits

  • Small incision preserves corneal strength
  • Rapid visual recovery—many resume activities in 1–2 days
  • Less risk of dry eye and no flap-related complications as seen with LASIK

Why Might Someone Need a Touch-Up After SMILE?

There are several reasons why a patient might need a SMILE touch-up procedure. Understanding these can help set realistic expectations and guide follow-up care:

  1. Individual Healing Response: Every eye heals differently. Some corneas may not respond to the laser in exactly the predicted way, causing residual refractive errors.
  2. Subtle Changes in Corneal Shape: Even small, natural shifts in the cornea’s shape during healing can slightly alter the intended vision correction.
  3. Minor Tissue Rebound: A mild return of myopia (known as regression) can sometimes occur as the corneal tissue stabilizes post-surgery.
  4. Preexisting or Progressive Dry Eye: Patients with dry eye may find their vision fluctuates, and new or worsening dryness after surgery can affect clarity.
  5. Hormonal Changes: Natural changes, such as those during pregnancy or hormonal therapy, can temporarily impact vision stability.
  6. Progressive Myopia: For younger patients, ongoing changes in the eye can continue after surgery, requiring additional correction if myopia advances.
  7. Underlying Eye Conditions: In rare cases, new eye health issues—like early cataract formation or retinal changes—may reduce vision quality independently of SMILE.
  8. Inaccurate Preoperative Measurements: Occasionally, small inaccuracies in measuring refractive error or corneal thickness can lead to slight under- or over-correction.
  9. High Initial Prescription: Patients with higher degrees of myopia or astigmatism have a slightly greater chance of needing further enhancement for best results.

SMILE Enhancement Surgeries

CIRCLE Procedure

The CIRCLE procedure is a primary retreatment option for patients who have undergone SMILE and need further correction. It is especially suitable for individuals with adequate corneal thickness and healthy eye structures who have residual refractive errors after the initial SMILE procedure. By converting the original SMILE incision into a LASIK-like flap, the surgeon can precisely lift the flap and perform additional laser correction.

This method minimizes extra corneal damage because it leverages the existing surgical site, usually leading to a smoother and faster recovery compared to creating an entirely new flap. However, a potential disadvantage is that the procedure is not ideal for patients with very thin or irregular corneas, as creating a flap could compromise corneal strength. Additionally, converting to a flap-based approach slightly increases the risk of flap-related complications, such as displacement or infection.

Surface Ablation (PRK or SmartSurfACE)

Surface ablation techniques, such as Photorefractive Keratectomy (PRK) or SmartSurf, are also viable options for retreatment after SMILE. These procedures involve removing the outer layer of the cornea to reshape the underlying tissue using an excimer laser.

Surface ablation is often recommended for patients with thinner corneas or when additional laser correction is needed in areas not accessible by the initial SMILE incision. Recovery may take longer compared to other methods, but the outcomes can be very effective.

LASIK Surgery

Another option for retreatment is undergoing LASIK after SMILE surgery. In this procedure, a new flap is created on the cornea, allowing for precise laser correction of any residual refractive errors.

LASIK is a well-established procedure with a strong track record of success. It is particularly beneficial for patients whose vision issues were not fully addressed by SMILE or who have experienced significant regression.

Factors to Consider Before Choosing a Retreatment Option

Several factors should be considered before selecting a retreatment option, including

  • Corneal Thickness: Sufficient corneal tissue is needed for safe retreatment.
  • Corneal Health: Presence of any corneal disease or irregularity may limit retreatment options.
  • Degree of Refractive Error Left: Higher or more complex residual errors may require different surgical approaches.
  • Eye Health: Existing eye conditions such as dry eye, cataract, or retinal problems can influence the suitability of retreatment.
  • Stability of Prescription: Fluctuating vision or progressive myopia may affect the timing and type of enhancement needed.
  • Age and Healing Capacity: Younger patients or those with unique healing responses may have different needs.
  • Patient Expectations: Realistic goals for vision after retreatment are crucial for satisfaction.
  • Previous Surgical Details: The initial SMILE procedure’s specifics and any unique corneal changes can guide retreatment planning.

Always consult your eye care specialist to select the most appropriate and safest retreatment method for your specific circumstances.

Safety and Effectiveness of Enhancements

Safety and effectiveness are paramount when considering any surgical enhancement. Modern retreatment procedures are designed to minimize risk and maximize patient outcomes, with many patients achieving significant improvements in vision clarity.

It’s important to follow all pre- and post-operative instructions provided by your surgeon to ensure the best possible results and to reduce the risk of complications.

What to Expect During and After Retreatment

The experience during retreatment will vary depending on the chosen method. Generally, these procedures are performed on an outpatient basis and involve similar steps to the initial SMILE procedure, albeit with specific modifications to address the unique needs of retreatment.

Post-operative care is crucial and may involve the use of medicated eye drops, follow-up visits, and temporary restrictions on certain activities. Recovery times can vary, but many patients notice improvements in their vision within a few days to weeks.

Conclusion

Understanding your retreatment options after SMILE is essential for making an informed decision about your vision care. Consult with your eye care professional to determine the best course of action and ensure that you achieve the best possible outcome for your vision.

FAQs

Can SMILE eye surgery be enhanced or repeated?

Yes, enhancements are possible if there’s residual refractive error.

What are the retreatment options available after SMILE surgery?

Options include CIRCLE procedure, LASIK, or PRK, depending on corneal thickness and eye health.

What is the CIRCLE procedure in SMILE enhancement?

CIRCLE converts the SMILE cap into a LASIK-style flap for further correction.

Can LASIK be performed after SMILE surgery?

Yes, LASIK can be done after SMILE using the CIRCLE technique.

Is it safe to get a touch-up after SMILE?

Yes, if evaluated and performed by an experienced surgeon.

How soon after SMILE can a retreatment be done?

Usually, after 3–6 months, vision stabilizes and healing completes.

Which is better for retreatment after SMILE: PRK or LASIK?

Both are effective; PRK is flapless and preferred in thin corneas, while LASIK may offer faster recovery.