What are possible solutions regarding treatment/enhancement of poor ReLEx® SMILE® surgery results?

Doctor's Answers 2

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Dr E-Shawn Goh

Ophthalmologist

I’m so sorry to hear about your unfortunate experience with SMILE surgery. In all forms of refractive laser surgery, appropriate patient selection is so important!

SMILE is a great platform for patients who are suitable for the surgery. Unfortunately patients with significant amounts of astigmatism (anything more than -1.25D, i.e. like you!) are not generally considered optimal for SMILE. This is due to the platform which cannot control automatically correct for cyclotorsion of the eye during the suction-applanation portion of the procedure.

Nonetheless, all is not lost, and adjustments can be made to try to optimise your visual outcome.

Patients having had SMILE performed previously may choose an epi-LASIK enhancement option, or conversion to LASIK (with the side-cut laser profile algorithm) for enhancement of your surgical outcome.

All is not lost and I hope that you are able to regain satisfactory spectacle free vision!

Thank you for the extensive information. Let us address the issues one at a time. With regards to enhancement surgery following ReLEx® SMILE®, it is usually enhanced by way of PRK as the prescription to correct by then is usually low. PRK, in this case, is able to offer distinct advantages for lower prescription for example, the benefits of a flapless treatment are preserved. LASIK may also be a possible method, however, it involves the creation of a flap which does have its own disadvantages.

Before any enhancement is done, we have to first ensure that the residual refractive errors have been stable over a period of time to avoid enhancing an incorrect power. As such, the manifest refraction will need to be repeated a few times before the surgeon decides a suitable time to proceed with enhancement.

You also mentioned that you experience glares and haloes. Unfortunately, it is not possible to enhance this aspect of the vision away and some elements of glare and haloes may be present. However, this tends to be only experienced in the nighttime and with point sources of light.

To be sure, higher order aberration and residual refraction error are known to occur LASIK, Epi-LASIK and PRK as well.

Finally, it is crucial for you to express your current difficulties with your vision to your eye surgeon and discuss your expectations before moving on with any enhancement surgery.

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Is it possible to have perfect eyesight but blurry vision after Epi-LASIK surgery?

Hi, The term ‘perfect eyesight’ can be somewhat misleading as it could mean different things. When we check eyesight (visual acuity), we are asked to read a chart with smaller and smaller letters. One of the line of small letters near the bottom is called the 6/6 line, and if a person can read the letters on that line, some people would call that ‘perfect eyesight’. But being able to read or make out the letters does not necessarily mean that those letters are perfectly clear.

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What is the effect of LASIK on strabismus (cross-eyed)?

Thanks very much for your enquiry. Generally speaking, I would advise LASIK before any squint/strabismus surgery. This is because there is a risk that changing the spectacle power of the eye (via LASIK) may make the intermittent exotropia more obvious if a patient finds it harder to ‘fuse ‘ the images from each eye after LASIK. If so, the strabismus surgery can then address the full effect and magnitude of the squint. Ideally, if strabismus surgery is required, it would be performed at least a month after LASIK surgery when the vision and spectacle power has usually stabilized.

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