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Smile operation disadvantage

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small incision lenticule extraction SMILE risks complications disadvantages official patient information

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SMILE eye surgery (small-incision lenticule extraction) is a laser procedure mainly for myopia and myopic astigmatism, not all types of refractive error. Kanski's Clinical Ophthalmology describes it as a small-incision laser technique for these indications (p. 299).
Possible disadvantages and risks:
  • Not guaranteed perfect vision: you may be under-corrected, over-corrected, or need glasses for some tasks later. A repeat laser procedure may be needed.
  • Night-vision symptoms: glare, haloes, starbursts, or reduced contrast, especially while driving at night.
  • Blurred/fluctuating vision during healing: vision typically improves over days to weeks, but may not settle exactly as expected.
  • Dry-eye symptoms: usually less common than with LASIK, but still possible. Pre-existing dry eye can worsen.
  • Surgical complications: suction loss during the procedure, incomplete or torn lenticule removal, inflammation, infection, corneal-interface debris, or scarring.
  • Rare loss of best-corrected vision: very rarely, vision can remain worse even with glasses or contact lenses.
  • Corneal ectasia: progressive corneal weakening/bulging is uncommon but possible, particularly if corneal screening misses early keratoconus or other risk factors.
  • Limited suitability: it may not be appropriate with thin or irregular corneas, unstable spectacle power, significant dry eye, some corneal diseases, pregnancy, or certain eye conditions. It is not generally used for farsightedness.
  • Less straightforward enhancement: if residual power remains, enhancement can be technically more complex than a standard LASIK flap enhancement.
  • Long-term changes still occur: age-related presbyopia means reading glasses are likely after about age 40-45 even after successful surgery. Myopia can also regress in some people.
The American Academy of Ophthalmology lists glare/haloes, inflammation, infection, retained debris, and under- or over-correction among SMILE risks.
A recent meta-analysis found SMILE generally effective and safe for myopia, but it does not remove the need for careful candidate selection (PMID 38329555). Before deciding, ask for corneal topography/tomography, corneal thickness assessment, dry-eye evaluation, and a discussion of SMILE versus LASIK, PRK, or ICL for your prescription.
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