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Is it possible to have overcorrected vision after ReLEx® SMILE®?

Eye & LASIK

It's been 3 months after my ReLEx® SMILE® surgery. When I get up I have 100% vision in both eyes, but after about 5 - 30 minutes the vision in my right eye starts decreasing to about 75 - 80%.

Streching my eyelid skin seems to help recover some vision. Could this problem be due to overcorrection or ciliary muscle function? I have an appointment next week, and it would be great if I could ask my surgeon the right questions.

DOCTOR’S ANSWER (4)
Hi Aspan

When you see your doctor next week, ask him/her exactly what you have asked over here. You already have the right questions to ask:).

But if we talk in general terms, yes, it is possible to have overcorrections after SMILE, just as it is possible to have overcorrections or undercorrections after LASIK/PRK/ICL surgery. Usually these over/undercorrections (if any) are small, and patients still have good vision without glasses. The percentage of patients who have enough over/undercorrection to need an enhancement/adjustment is usually 1% or less. Whether this is causing your symptom or not is difficult to say here.

The only way to tell what is causing your symptom is to do a full examination, including refraction (spectacle power check), slit lamp examination, corneal topography, and so on.

Hopefully your eye problems will be successfully addressed after you see your doctor next week.

1215 views 17 Apr 2018

I quite agree with Dr Por.  You should have a proper eye check first, including a refraction test to check your eye power to see if indeed it is overcorrection, or even undercorrection.  Hopefully it is not significant under- or over-correction, as enhancement is a bit trickier following SMILE and you may have to consider either LASIK or surface ablation as enhancement options if really necessary.

In my experience as a SMILE surgeon, in general it is more likely to be under than over corrected.  

However, the fact that you sight is fluctuating makes me wonder if you are in fact experiencing some post-SMILE dry eyes.  Even though SMILE induces less dry eyes after surgery than LASIK, usually patients will still need some dry eye treatment following surgery. Do rest your eyes more and continue with your lubricating drops.  

Hope it turns out alright! Cheerio!
Dr Han

1191 views 17 Apr 2018

Thanks for your questions!

Post-SMILE vision fluctuation as you described could be due to several reasons which you should consider. As you correctly mentioned, it is certainly possible that you were left with residual hyperopia during the initial procedure, and after prolonged accommodation to see clearly, accommodation fatigue may have set in and hence vision becomes slightly degraded.

The second reason to consider is that of droopy eyelids. You mentioned that when you stretch your eyelids (did you mean to elevate the eyelids in an upward position?) then the vision is fully restored? If so, then ptosis, or droopy eyelids as a result of previous contact lens use, or frequent eye rubbing, or simply an ageing change is a common reason for such symptoms. I usually inform my patients of this finding at the initial consultation, and advise that after the initial surgery, they would benefit from a short procedure to elevate the eyelids in order to refresh the appearance, and make vision more comfortable in the long run.

Of course, the last and very common cause of fluctuating vision is that of dry eyes.  

Do consider these suggestions, and hopefully you will be able to come to an accurate diagnosis and solution quickly!

ESG

1174 views 18 Apr 2018

Your description that your vision is ”100%” at certain times does suggest that you have managed to obtain a successful outcome from your ReLEx SMILE surgery.  

The fact that your vision seems to fluctuate would suggest other possible causes of transient blurring of vision which may include blepharitis, dry eyes or fatigue.

Rather than ponder over all the various possibilities, it would be best that you subject yourself to an eye exam by your surgeon to ascertain its root cause, and then the appropriate advice and treatment can be prescribed leading to a better overall post-operative experience. 

Dr David Chan

1143 views 18 Apr 2018
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