John F. Doane
WASHINGTON — A patient who is a LASIK candidate is also a SMILE candidate, according to a speaker here.
Conversely, a patient who is not a LASIK candidate should not be considered for a SMILE procedure, John F. Doane, MD, FACS, said at Refractive Day during the American Society of Cataract and Refractive Surgery meeting.
“[Small incision lenticule extraction] is a totally new procedure — different than LASIK, different than PRK,” Doane said, giving his pearls for surgeons new to the procedure.
Unlike the more vertical approach to LASIK, the approach to SMILE is more horizontal and the surgeon is working in a pocket, so the first task for the surgeon is to understand the anatomy and to identify anterior and posterior interfaces before dissection.
“Two things are very important. Understand where that side cut of the cornea epithelium is, and you also have to realize where the edge of the lenticule is. Once you find those two spots, specifically the edge of the lenticule and find the anterior and posterior, now it’s a very easy procedure,” he said.
Another pearl is to start with higher myopes.
“This is counterintuitive with PRK and LASIK, where you start with the lowers and work your way up. It’s opposite here, mainly because of tissue constraints,” Doane said.
Finally, Doane said surgeons should be cautious. Even though peer-reviewed literature reports SMILE has less effect on biomechanical structural integrity, “this does not mean one can treat early forme fruste keratoconus or pellucid with impunity. If a patient is a LASIK candidate, they are certainly a SMILE candidate,” he said. – by Patricia Nale, ELS
Doane JF. Five pearls for SMILE. Presented at: American Society of Cataract and Refractive Surgery annual meeting; April 13-17, 2018; Washington.
Disclosure: Doane reports he has a financial interest in Carl Zeiss Meditec, Presbyopia Therapies and RxSight.