What are possible solutions regarding treatment/enhancement of poor ReLEx® SMILE® surgery results?Eye Health
I did the ReLEx® SMILE® proceduce for my eyes in January 2016. I had relatively low myopia (~100 degrees) but relatively high astigmatism (~175-200 degrees) before sugery. Unfortunately, even after 1.5 years since surgery, my resulting vision is not good, because of leftover astigmastism, some long-sightedness and probably High Order Abbrevations, which has caused night vision problems and side effects like halo and starburst. With more research, I probably should have just done LASIK instead of ReLEx® SMILE® for the best possible vision.
Looking forward, I am wondering what are the most suitable retreatment/enhancement for ReLEx® SMILE®. Enhancement for ReLEx® SMILE® seems to be more complicated from my research, due to the cut made but the absent of the flap. Does this make some treatments unsuitable for enhancement to ReLEx® SMILE®? Thank You!
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.
Dr David Chan
MBChB, MMed, FAMS, MRCS, FRCS
290 Orchard Road
#07-09 Singapore 238859
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!
Dr E-Shawn Goh
MBBS, MRCOphth, MMed, FRCOphth, FRCS, FAMS
MOUNT ALVERNIA HOSPITAL MEDICAL CENTRE D
820 THOMSON ROAD
#06 - 57/58/59/60/61/62 Singapore 574623
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