Welcome to the complete guide to SMILE surgery at Clearvision Singapore, where we explain all that you need to know about SMILE, as well as walk you through the entire patient journey from start to finish! So sit back, relax, and smile as you join us on our SMILE Experience 🙂
SMILE (Small Incision Lenticule Extraction) was created with the aim of bringing over some of the benefits of LASIK, while being much less invasive. It makes use of the creation and removal of a tiny lens-shaped piece of corneal tissue within the eye, to reshape the cornea.
This tiny lens is referred to as the lenticule, and the minimally invasive 2 mm micro-incision (as compared to LASIK’s 22 mm flap cut) through which it is extracted from, contributes to a fast and comfortable healing process – patients are able to go back to work in just 2 days!
Unlike LASIK, no corneal flap is created which means that you do not get the risk of flap complications (dislodgement, wrinkles, inflammations) or dry eyes.
The History of SMILE
SMILE was introduced in 2011 by ZEISS, as ReLEx SMILE. It is performed using the ZEISS VisuMax femtosecond (ultrashort pulse) laser. Because of its safe treatment and quick recovery, SMILE was brought into Singapore in 2014. And in 2016, it was introduced into the US after passing the US Food and Drug Administration’s (FDA) notoriously strict regulations and safety standards.
For our SMILE procedures at Clearvision, we use the ZEISS VisuMax® femtosecond laser, which implements femtosecond laser technology known for its precision, speed and gentle treatment technique. Its minimally invasive approach does not require the creation of a corneal flap – instead it creates a lenticule inside the cornea and a small incision, in just one single step. With a pulse frequency of 500 kHz, the ZEISS VisuMax® enables short treatment times, making procedures easy and comfortable for our patients.
SMILE vs Other Methods
- Wide range of suitability criteria (high myopia, thin corneas etc.)
- Corneal flap creation
- 1% risk of flap complications (flap dislodgement, flap wrinkles, flap inflammations and flap interface issues)
- Risk of dry eyes
- Risk of night vision issues
- Impacts corneal stability
- No surgical instruments touching the cornea
- Wide range of suitability criteria (high myopia, thin corneas etc.)
- Length of surgery is short (5 mins per eye)
- Some discomfort early on during the healing process (mild itchiness or soreness on the surface of the eye)
- Slower initial recovery of surface cells, resulting in 5 days of downtime. Slower full visual recovery, with patients expected to achieve a stabilised visual clarity in 2 – 3 months
- More follow up reviews and medications required
The Downsides of SMILE
In Singapore, SMILE surgery typically ranges from S$5,000 to S$6,000.
Price at Clearvision:
S$5,188 for both eyes, inclusive of GST
Price comprises of:
- Surgery for both eyes
- Initial set of medications
- One pair of UV-protected sunglasses
- Post-operation reviews for three months
Important Notes –
- A suitability evaluation is first required and will cost S$37.50 (inclusive of GST).
- The amount of medications and post-op reviews required depends on the patient’s healing
- Consultations after the third month will be chargeable
- Subsequent medications will be chargeable
SMILE Suitability Criteria
Ideally, corneal thickness should be at least 550 microns thick, meaning that thinner corneas might not be eligible.
Corneal cross-linking (CXL) is not advisable as an adjunct treatment if your cornea is less than 550 microns thick. We typically recommend going for TransPRK if your cornea is too thin.
If you have myopia, your prescription should be between -2.5 to -8 diopters (250 – 800 degrees).
For astigmatism, it should not more than -2.5 diopters (250 degrees).
Hyperopia is not treatable by SMILE.
Please note, you will not be suitable for SMILE if you:
- Are pregnant or breastfeeding
- Are under the age of 18 (parental consent is required if you are under the age of 21)
- Have severe dry eye syndrome
Step 1: Eye Evaluation
When you are ready to take the next step and see if you are suitable for SMILE surgery, you will have to book an eye evaluation. Evaluations take around 1 – 2 hours at Clearvision and cost S$37.50.
If you’re a contact lens wearer, you must stop wearing them for about 3 days for soft contact lenses and 10 days for hard contact lens/ Ortho-K lenses prior to the eye evaluation.
During the eye evaluation, our optometrists will perform the following eye tests:
- Autorefraction (measures your prescription)
- Tonometry (measure your eye pressure)
- Lenstar (biometrical assessment of the eye)
- Orbscan (corneal surface evaluation)
- Sirius (corneal and anterior eye analysis)
- Subjective Refraction (to find your best corrected visual acuity)
Dilating eye drops will be administered to dilate your pupils. This enables us to examine the back of your eye and diagnose any existing eye conditions. Your eyes will have difficulty focusing on close objects for about 6 – 8 hours after the evaluation, and will also be sensitive to light. Ideally, you should leave the rest of your day free from having to do any computer work or reading, and we highly recommend bringing a pair of sunglasses to wear when you leave the clinic.
If you are found to be suitable for SMILE surgery, our optometrists will then take some time to tell you more about the surgery and what you can expect. If you have any questions, this is the perfect moment to have them answered!
You will then meet with the doctor, where he will review your test results and personally check on your eye health. The doctor will then decide the best surgery options for you, customised based on your eyes’ condition.
Now all that is left is for you to pick a surgery date and follow the pre-surgery instructions that our nurse will inform you about.
Step 2: Pre-Surgery
In the few days prior to surgery, we provide all our patients with a “practice target” – a green dot on a piece of paper which emulates the dim green guiding light you will see during surgery. We encourage all our patients to cover one eye at a time and practice staring straight at it for around 10 – 20 seconds at a time. This is to train their eye to move as little as possible during surgery and keep it fixated on the green light, which is where the laser is located. The less the eye moves, the less time it takes for the laser to correct your vision, resulting in a more seamless and quick procedure.
Here are some important things to take note of before your surgery:
- Similar to the eye evaluation, you will need to stop wearing contact lenses for at least 3 days before surgery day if they are soft lenses, and at least 10 days before surgery day if they are hard lenses / Ortho-K lenses.
- You will not be allowed to wear any makeup, aftershave, perfume or deodorant to surgery.
- We recommend bringing something warm to wear in the surgery room – it is cold in there!
- You must also shower prior to your arrival at the clinic – this allows you to go straight home and rest, without having to worry about showering, which is highly discouraged right after surgery.
- On surgery day, you will not be able to drive yourself to the clinic as your vision will be blurry after surgery, and your eyes may feel some discomfort. If possible, arrange for someone to accompany you to the clinic on your surgery day, or book a Grab ride. If you need help requesting a Grab ride, our staff will be happy to assist.
Step 3: Surgery
The moment your eyes have been waiting for their whole live has finally arrived! It is normal to feel nervous – just know that we have had 20,000 eyes and counting go through exactly what you are about to go through, with no problems! Now is not the time to fill your mind with irrational fears, but instead the whole new world or clear, unhindered vision that awaits.
When you arrive at the clinic, you will be asked to fill up a few final forms and go through some final instructions and briefings about what to expect. Before you know it, your life-changing procedure will begin:
Length of surgery: about 10 minutes per eye
- Put on your surgical gown and other protective equipment
- Enter the operating theatre, lie flat and get comfortable on the operating bed.
- A clamp is then used to gently keep your eyelids open
- Numbing eye drops are added so that your eye does not feel anything
- Your eye is lined up with the contact glass, which uses low suction pressure keep your eye in position
- You stare straight at the dim green guiding light
- The laser creates a lenticule (small lens shaped piece of corneal tissue)
- The laser then seamlessly makes a small micro-incision of 2 mm
- The lenticule is removed through this small incision, changing the shape of the cornea
- Your vision has been corrected!
Step 4: Post-Surgery
Your vision will be blurry immediately after the surgery. But your vision will clear up the next day, and continue to get less blurry in the next few days.
Right after surgery, you will be brought back out into the waiting area, where our optometrists will help administer the first round of eye drops. After which, you will be allowed to go home to rest.
It will take just 2 days for your eye to heal and for the blur to go away, after which you can resume your day to day activities and go back to work.
You will be given 3 days of medical leave.
Step 5: Recovery
Full visual recovery, where your vision has totally stabilised and your eyes are consistently seeing very clearly, takes 1 – 2 months (patients with high myopia may take up to 3 months)
Patients are required to follow a strict routine of eye drops application. SMILE requires 2 types of eye drops to be applied multiple times a day for at least the first week, after which number and frequency of eye drops will decrease (eye drops application can continue for up to 1 month or longer), depending on how the patient’s eyes heal.
Protective sunglasses must be worn whenever outdoors for 1 month, to prevent UV exposure which can be harmful to the healing process. (UV blocking sunglasses are provided to Clearvision patients).
After surgery, you will need to have your eyes checked up at these specific times post-surgery:
- 1 day
- 1 week
- 1 month
- 2 months
More follow-ups may be required, subject to the individual’s healing progress.
Post-surgery, you will be allowed to resume these activities after a specific period of time:
Long sessions of reading books, screens and watching TV: 48 hours
Driving: 48 hours
Applying eye makeup : 48 hours
Showering without having to make sure that no water enters the eyes: 48 hours
Swimming and other water-related activities: 2 weeks
Light sports: 5 days
Contact sports: 6 weeks
Soft contact lenses, including cosmetic lenses can still be worn but only after 3 months. Hard lenses cannot be worn as they tend to slip due to the altered cornea curvatures.
Can I go blind?
Will the results of my laser vision correction last forever?
Yes and no. Your treatment is permanent, but as with every part of your body, your eyes will continue to age and your vision will be affected as you get older. Laser vision correction cannot prevent cataracts and presbyopia, but most patients enjoy many years of focused vision without glasses and contacts.
Can I claim medical insurance or Medisave for SMILE surgery?
Will going for laser vision correction make future eye surgery such as cataract surgery difficult?
SMILE @ Clearvision
We have finally come to the end of our SMILE Experience! We hope that our it has helped you gain a better understanding of SMILE’s pros and cons, as well as what to expect if you choose to have SMILE surgery. Whichever procedure you choose, we can’t tell you enough how excited we are at the thought of you exploring the world with new eyes.
Book Your Eye Evaluation
The evaluation costs $37.50 and will take around 1 – 2 hours.
It will include a series of eye tests as well as a personal consultation with your lasik surgeon.
Suitability Evaluation Guide
Our suitability evaluations typically take place during these times, subject to availability –
|Mondays||2:30 PM – 3:30 PM|
2:30 PM – 5:15 PM
|Thursdays||2:30 PM – 3:30 PM|
9:00 AM – 11:00 AM
2:30 PM – 5:15 PM
Just let us know which days and times work for you and we’ll do our best to accommodate.