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Hello! I’ve been thinking of doing LASIK but I’m concerned that my dry eye syndrome may worsen after LASIK. I’ve been having dry eyes for some time, which have worsen due to over wearing of contact lens. Hence I’ve now switched to wearing spectacles only. I’ve read from one of your entries that the incidence of dry eyes is reportedly lower for ReLEx Smile.
Is ReLEx Smile the best option for those with dry eyes? Can I still consider LASIK as one of my options?
The incidence of dry eye indeed has been reported to be lower in ReLEx SMILE than LASIK. A large part of this difference has been attributed to the fact that ReLEx SMILE is a flapless procedure requiring just 2 to 4mm sidecut as compared to LASIK which needs a 22mm sidecut. Hence, ReLEx SMILE has often been described as a minimally invasive form of laser vision correction.
Now whether ReLEx SMILE is “the best option” for you is largely dependent on many factors that have to be taken into account when trying to determine which type of laser option best suits your eye.
Broadly speaking, there are now 3 different types of laser treatments available. LASIK has been the most common and popular form of laser treatment for the past 20 years, due in part to its excellent accuracy especially at higher levels of refractive errors, swift recovery and high level of comfort. However, in some cases LASIK, due to the creation of a flap, poses potential complications relating to dry eye, corneal ectasia (corneal weakening and warpage) and traumatic flap dislodgement.
Prior to the introduction of ReLEx SMILE, the only alternative to LASIK was Advanced Surface Ablation (e.g. PRK, TransPRK, Epi-LASIK & LASEK). Despite its many different names, Advanced Surface Ablation (ASA) has been around for over 30 years. It preceded LASIK and became less popular than LASIK primarily due to its longer healing & downtime (ASA – 1 week vs LASIK – 3 days), higher levels of discomfort or pain and inflammation and poorer accuracy at higher levels of refractive errors. However, ASA has some advantages over LASIK, which include lower risks of ectasia and dry eye as well as negating any flap dislodgement issues as no flap is ever created in the first place. ASA is an excellent choice for people who have low refractive errors or are involved in contact sports.
Though some may consider ReLEx SMILE to be a relatively newer technique, it has by now been in practice for over 10 years and is approved by both the US FDA and CE. More appropriately, one should view ReLEx SMILE as a refinement of previous generations of laser techniques whereby its goal is to draw benefits from both ASA and LASIK without some of their less desirable traits. ReLEx SMILE by nature of its techniques has similar recovery rate and comfort as LASIK with the advantage of not creating a flap as is the case in ASA (e.g. less dry eyes) without ASA’s pain and slow healing time. Does this make ReLEx SMILE the “perfect” choice? The answer is no. There is no perfect option. ReLEx SMILE in its current form has some limitations. For example, ReLEx SMILE cannot correct far-sightedness (hyperopia).
So the decision on whether any technique is suitable for your eyes has to be dependent on working closely with your eye surgeon. Factors to be considered include the level of refractive error, speed of recovery, comfort level, accuracy of results and risks from flap-related complications like dry eye, corneal ectasia and flap dislodgement. Key to navigating your way successfully through the various choices is to ensure your surgeon is willing and able to discuss, offer and perform all the available modalities of laser techniques and hence give you an unbiased recommendation of the technique that best suits your eyes.
Dr David Chan
Senior Consultant Eye Surgeon
Atlas Eye Specialist Centre