Laser refractive surgery · Techniques

ReLEx SMILE

ReLEx SMILE is a more recent refractive surgery technique, requiring no flap: the laser cuts a thin lenticule inside the cornea, which is then removed through a micro-incision. It is indicated for selected profiles, determined by the pre-operative assessment.

Surgeon at the controls of a latest-generation laser

What is ReLEx SMILE?

SMILE (small incision lenticule extraction) is a laser refractive surgery technique that corrects the visual defect without creating a corneal flap. The laser maps out a thin disc of tissue, called a lenticule, inside the cornea itself. This lenticule is then extracted through a small incision of a few millimetres. By removing this volume of tissue, the curvature of the cornea is altered and the visual defect corrected. [TO BE VALIDATED BY THE PRACTITIONER: technical description]

SMILE is primarily used for myopia, with or without astigmatism. Its distinctive feature is that it requires neither the flap of Lasik nor the epithelium removal of PRK. [TO BE VALIDATED BY THE PRACTITIONER: actual indications]

SMILE relies on a single small incision. It is a more recent technique, reserved for selected profiles identified at the assessment.

1. Lenticule cutting 2. Micro-incision 3. Lenticule extraction
Schematic, non-anatomical illustration of the three stages of SMILE. The actual procedure is explained during the consultation.

Where does SMILE fit among laser techniques?

Laser refractive surgery techniques differ in the way they access the corneal tissue to be reshaped. SMILE requires no flap and does not expose the surface as PRK does. [TO BE VALIDATED BY THE PRACTITIONER: exact positioning]

SMILE

A lenticule is cut inside the cornea and extracted through a micro-incision, without a flap or epithelium removal. A more recent technique, indicated for selected profiles, primarily for myopia.

Lasik

A thin corneal flap is created, lifted, then repositioned after laser reshaping. Visual recovery is generally rapid; requires a cornea of sufficient thickness.

PRK

The laser acts on the surface after epithelium removal, without a flap. Often favoured for thinner corneas; recovery is more gradual.

No technique is objectively "the best": the right technique is the one that matches your eye, determined by the pre-operative assessment.

Who is it for?

The indication is established after a complete assessment. SMILE is indicated for selected profiles:

  • myopia, possibly associated with astigmatism;
  • a cornea with sufficient thickness and shape for the technique;
  • a stable visual defect, in an adult patient;
  • absence of any contraindication identified at the assessment (ongoing pregnancy, certain eye conditions).

How does the procedure work?

The procedure is performed on a day-case basis, under local anaesthesia with eye drops, and takes a few minutes per eye.

  1. 1

    Positioning and anaesthesia

    You are positioned lying down and anaesthesia is administered via eye drops, without an injection.

  2. 2

    Lenticule cutting

    The laser maps out a thin lenticule inside the cornea, according to the correction calculated for your eye.

  3. 3

    Micro-incision

    A small incision of a few millimetres is made to access the lenticule.

  4. 4

    Lenticule extraction

    The lenticule is removed through this micro-incision, which modifies the curvature of the cornea.

What recovery can I expect?

As with all refractive surgery, discomfort, a sensation of grittiness, watering, and fluctuating vision may be experienced in the early days. Eye drops are prescribed to support healing.

  • eye drops prescribed for healing and comfort;
  • visual rest and eye protection for the first few days;
  • avoid rubbing the eyes during the healing period;
  • return to activities in line with instructions given at the consultation;
  • scheduled follow-up checks.

Key points to know

SMILE is one technique among others: it is neither superior nor inferior in absolute terms. Its value depends on your eye, your visual defect, and your situation, evaluated at the assessment. Its advantages and limitations are explained during the consultation, as they are for Lasik and PRK.

How does the care pathway work with Dr Gattoussi?

The approach is progressive and without obligation: refractive assessment and corneal imaging, information and shared decision, procedure if the indication is confirmed, then close post-operative follow-up. This evaluation draws on Dr Gattoussi's expertise in ocular imaging, which allows a precise pre-operative analysis of the cornea.

Frequently asked questions

Does SMILE correct hyperopia?

SMILE is primarily used for myopia and astigmatism. The precise indications are determined at the assessment.

What is the difference from Lasik?

SMILE does not create a flap: it removes a lenticule through a micro-incision. Lasik, by contrast, relies on a corneal flap that is lifted and then repositioned. The choice depends on your eye.

Does SMILE leave a scar?

The technique relies on a micro-incision of a few millimetres. The details of healing are explained during the consultation.

Is recovery rapid?

Visual recovery depends on each individual eye. Timelines and instructions are specified after the procedure.

Is SMILE covered by health insurance?

Refractive surgery is generally not covered by the French national health insurance. Some complementary health plans offer a fixed allowance.

See also

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Consult Dr Gattoussi

Ophthalmology practice in Paris 11th. Online appointments via Doctolib, at any time. Sector 2 fees.