ReLEx SMILE: The latest innovation in Laser Eye Surgery

If you look at pretty much every field of surgery — cosmetic, restorative, dental, vascular — you’ll notice a few common trends.

Thanks to an influx of technological advances and greater knowledge, more and more patients are enjoying fewer complications, less pain, quicker recovery times, and shorter hospital stays.

These developments are revolutionising healthcare. And they’re all thanks to a new approach that replaces traditionally invasive, and often risky, open surgery techniques.

This is what’s known as minimally-invasive surgery — what many experts believe will be an important part of the future of healthcare.

We couldn’t agree more. However, as experts in Laser Eye Surgery, we know that minimally-invasive surgery is not just a vision of some distant future, but something that’s well and truly already here.

Ever since the early 90s and the days of LASEK and PRK, Laser Eye Surgery has sat at the leading edge of surgical intervention. Instead of unreliable, manual processes, the procedure utilised state-of-the-art technology, cutting-edge scientific research, and minimally-invasive techniques.

Today, Laser Eye Surgery is celebrating the 10th birthday and 1 millionth eye having been transformed by ReLEX SMILE, the latest advancement in the field. With an even more effective and less-invasive approach than LASIK, the most popular laser eye treatment, SMILE is quickly becoming one of the most transformative and effective surgeries ever designed.

The pioneering technique of SMILE was first performed on a patient over 10 years ago, using the Carl Zeiss VisuMax laser. Several years later, in 2011, it first became available to the public under the name of ReLEx SMILE, here at London Vision Clinic.

Today, there are over 1,300 SMILE-registered surgeons, and the procedure has been performed at close to 700 clinics in over 65 countries. Going from treating one man’s vision to ridding hundreds of thousands of patients of refractive errors — high and low — all around the world.

It’s an extraordinary achievement. And one that will play a significant role in the shift toward minimally-invasive treatments and the revolution of the healthcare industry as a whole.

But this begs the question: what exactly makes SMILE so special? If you’re reading this, that’s likely what you’re here to find out. And so let’s dive right into the ins and outs of the surgery, starting off with — as many great innovations do — a strong and influential partnership.

What is Relex SMILE?

“I believe this long-term, strategic partnership will continue to help Carl Zeiss Meditec maintain its position as a technology leader.” —Stefan Kaiser, Director Refractive Lasers, Carl Zeiss Meditec.”

For over 6 years, London Vision Clinic has worked closely with Carl Zeiss Meditec — a world leader in the field of optics.

Our close association with Carl Zeiss stems from the pioneering work of our founder, Prof. Dan Reinstein. Prof. Reinstein is a key medical consultant for Carl Zeiss, playing a pivotal role in groundbreaking projects such as the Mel 90 Excimer laser and, of course, ReLEx SMILE surgery.

“ReLEx SMILE represents the next-generation in corrective vision treatments” —Professor Dan Reinstein

ReLEx SMILE is a lot of things, but first and foremost, as Prof Reinstein suggests, it’s a new surgical technique that represents a breakthrough in laser vision correction treatments.

Building on the huge success of LASIK, SMILE advances Laser Eye Surgery beyond the traditional techniques of creating a corneal flap to access the corneal bed, and into the realm of minimally-invasive, flap-less procedures.

This is possible thanks to the state-of-the-art Carl Zeiss VisuMax laser and the new technique ‘Small Incision Lenticule Extraction’ (SMILE).

When Laser Eye Surgery was first introduced in the 80s, surgeons used a microkeratome — a surgical instrument with an oscillating blade — to create the flap. At the turn of the century, when the femtosecond laser was approved for use in Laser Eye Surgery, surgeons moved away from the microkeratome and ‘bladed’ surgery and to an all-laser treatment.

Using a femtosecond laser, surgeons create an incision in the outer surface of the cornea (epithelium) with a number of ultrashort pulses. These pulses create tiny bubbles below the epithelium and allow the surface layer to detach from the stromal layer underneath.

Today, this is how surgeons create the flap in popular treatments like LASIK.

In SMILE, the VisuMax laser places a series of precise pulses in the centre of the cornea. With incredible accuracy from its 3D placement system, these pulses form tiny bubbles that outline the tissue that needs to removed to adjust the shape of the cornea.

The laser is then used to create a tiny connecting tunnel through which the tissue is extracted. Resulting in the same outcome as traditional treatments like LASIK but without the need to create and displace a section of the outer cornea.

What are the benefits of SMILE?

“Several great advances come from not having to create a flap or disturb the front of the cornea; the level of correction can be much higher without weakening the cornea, and people who are contact lens intolerant can now be candidates as there is little or no dry eye after ReLEx,” says Professor Reinstein

The biggest advantage of not creating a flap is that it transforms Laser Eye Surgery into a key-hole procedure, significantly reducing time in surgery and accelerating the healing process.

Laser Eye Surgery was already an incredibly quick and convenient procedure. Many LASIK patients receive the treatment in the morning and are back at work the next day. But SMILE takes this to a whole new level.

The SMILE procedure takes a matter of minutes to perform and patients recover at an even faster rate then LASIK. Due to the minimally-invasive technique and the impressive healing powers of the cornea, after SMILE, a patient’s vision reaches 80 percent instantly and 100 percent within a few days.

The speedy recovery time is one of the biggest reasons patients love SMILE. Whether they’re an athlete, beauty Youtuber, TV host, or simply value their time, SMILE allows them to get back to their normal routine even as soon as the very same day.

But perhaps the most revolutionary advantage of SMILE is its ability to treat a wider range of patients — including those with very high prescriptions. Before SMILE, patients with extreme short-sightedness, long-sightedness, and astigmatism would be ineligible for laser vision correction. And this is even still true at many clinics today.

The higher the prescription, the more tissue needs to be removed. And so the cornea needs to be thick enough to allow surgeons to remove a flap and reshape the tissue underneath. However, as SMILE does not require a flap to be made in the cornea, it can reshape the tissue while leaving the front of the cornea intact. This allows for the treatment of much higher prescriptions than previously thought possible.

“Not only is the patient experience greatly enhanced, as there is less surgical manipulation of the eye–making it less invasive than traditional Laser Eye Surgery, but it also makes vision correction available to people who would have previously been told they were unsuitable candidates. It’s a major development.” —Professor Dan Reinstein

In the same way, the minimal disruption of the cornea means that SMILE also opens Laser Eye Surgery up to patients who’re contact lens intolerant, have thin corneas, or have dry eyes — reducing and even eliminating the common side-effect of post-operative dry eye.

All these reasons mean the patient experience before, during, and after the treatment is greatly enhanced over its predecessor, LASIK. And that ReLEx SMILE is quickly becoming the new standard of Laser Eye Surgery.

With 1 million eyes treated in a little over half a decade, the future looks bright for SMILE. Find out more about the revolutionary laser treatment by asking a question below or contacting one of our friendly clinic coordinators.