ReLEx® SMILE® Surgery

ReLEx® SMILE® Surgery

A DxD Session with Dr David Chan


Ended on Sun Jun 30 2019
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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
MBChB, MMed, FAMS, MRCS, FRCS

Ophthalmology, Atlas Eye Specialist Centre

290 Orchard Road
Paragon
#07-09 Singapore 238859


25 Jan 2018

One of the key aspects of any pre-ReLEx SMILE/LASIK evaluation is to exclude any abnormalities that may be present in the eye. A healthy eye is a pre-requisite to any form of refractive surgery including ReLEx SMILE and LASIK.

The presence of a retinal tear would require that the tear be treated first before proceeding to ReLEx SMILE. Retinal tears if left untreated may result in retinal detachment, a potentially blinding condition.

Hence, priority has to be given to managing the tear before it develops a retinal detachment. Fortunately, treatment for uncomplicated retinal tears can be well managed by your eye surgeon with a non-invasive laser treatment known as laser retinopexy; a completely different type of laser treatment to ReLEx SMILE.

Only upon stabilising the retinal tear will it be feasible to consider proceeding with ReLEx SMILE or any forms of laser refractive surgery.


Dr David Chan
MBChB, MMed, FAMS, MRCS, FRCS

Ophthalmology, Atlas Eye Specialist Centre

290 Orchard Road
Paragon
#07-09 Singapore 238859


25 Jan 2018

Collagen cross-linking (CXL) has been used to treat a condition known as keratoconus for many years now. Its purpose is to improve the structural strength of the front portion of the eye known as the cornea.

Keratoconus essentially results in the cornea losing its ability to keep its shape and patients may suffer from increased myopia and astigmatism. Keratoconus may occur naturally or rarely as a consequence of corneal laser vision correction (LVC) such as epi-LASIK, LASIK or ReLEx SMILE.

Due to its effectiveness as a treatment for keratoconus, there has been an increasing trend of laser refractive surgeons now offering CXL at the same time as LVC with the hope that it will reduce the risks of developing keratoconus.

As it is a fairly recent practice, the degree of protection when CXL is done in conjunction with LVC is currently still being studied. Suffice to say it is widely recognised that the cornea structure does strengthen following CXL. The procedure has low rates of complications and side effects, most of which are temporary. Due to the combination of the potential benefits of preventing a serious albeit rare condition and its relatively high safety record many surgeons have adopted CXL into their refractive surgery practice.

Though CXL does not necessarily permit the surgeons to widen their pool of suitable patients or improve the visual outcomes of LVC, its intended benefit is to offer LVC patients an added layer of corneal protection leading to better long term results following LVC.

Certainly with the added treatment comes increased costs. Though the cost of CXL done in conjunction with LVC is far lower than performing CXL as a standalone procedure.


Dr David Chan
MBChB, MMed, FAMS, MRCS, FRCS

Ophthalmology, Atlas Eye Specialist Centre

290 Orchard Road
Paragon
#07-09 Singapore 238859


26 Jan 2018

it is good that you take notice of such symptoms and are aware of how your eyes are feeling as well as closely following the eye doctor’s advice.

With regards to your situation, I would assume you swim in a swimming pool, yes? Swimming pool water contains significant amounts of chlorine and other chemicals which act as a disinfectant for hygiene purposes as public pools are shared areas. A common side effect of chlorine is that it dries out your skin, hair and eyes, and more so for the eyes if you do not use a pair of swimming googles.

This drying effect affects the function of your natural tears thus the sensation of dryness and blurring. However, these effects are not long-lasting as the body is able to overcome this dryness on its own, as you have experienced.

What I may suggest is to use a pair of goggles to keep your eyes away from the chlorine as much as possible. Also, lubricating eyedrops given by your eye doctor would help alleviate the dryness and blurring after swimming. You may also consider getting a bottle of saline to rinse your eyes after a swim just to flush out the pool water from your eyes.

Having said that, it is also good to be aware of the symptoms of an eye infection as swimming pool water does contain bacteria. These can be easily remembered by the following:

If you don’t:

  • “feel good” ie eyes are painful and pain is worsening.
  • “see good” ie vision is getting blurrier and blurrier.
  • “look good” ie eyes are getting redder and redder with yellow sticky discharge.

Should you experience any of the above symptoms, do immediately notify your eye doctor as it could possibly be an eye infection.

I hope the above information helps and do continue to follow up with your doctor as recommended. Take care.


Dr David Chan
MBChB, MMed, FAMS, MRCS, FRCS

Ophthalmology, Atlas Eye Specialist Centre

290 Orchard Road
Paragon
#07-09 Singapore 238859


26 Jan 2018

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

Ophthalmology, Atlas Eye Specialist Centre

290 Orchard Road
Paragon
#07-09 Singapore 238859


11 Apr 2019

Glad to hear that you are now able to see relatively well at far distances 2 days after ReLEx SMILE. From what you have described, it seems like you have some difficulty in reading at the moment.

Without the benefit of examining you, I can only offer a few possibilities why this might be.

To be honest, 2 days is still fairly early days in terms of visual recovery for any laser vision correction.

At this time, there will be some element of post-operative healing present. The healing process includes improvements in the post-operative swelling, which may mean that the refractive state of the eyes have yet to reach a stable state.

It would be best to reassess your visual experience about 1 week from the time of the surgery. For some patients, improvement to their vision may continue even weeks or months after the procedure. 

In the meantime, it would be a good idea to adhere to the post-operative advice given by your surgeon to aid in the healing, prevention of post-operative infection and dry eye.   Wishing you a speedy recovery.  

Dr David Chan


Dr David Chan
MBChB, MMed, FAMS, MRCS, FRCS

Ophthalmology, Atlas Eye Specialist Centre

290 Orchard Road
Paragon
#07-09 Singapore 238859


5 Mar 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


Dr David Chan
MBChB, MMed, FAMS, MRCS, FRCS

Ophthalmology, Atlas Eye Specialist Centre

290 Orchard Road
Paragon
#07-09 Singapore 238859


18 Apr 2018

Most patients can resume cycling, jogging, gym and yoga 1 week after ReLEx SMILE.

You are however advised to avoid water sports, hot yoga, jacuzzi and sauna for 1 month as the water is not clean enough.

Also avoid contact sports like boxing, martial arts and badminton for 1 month as we are concerned something or someone may hit your eye.

Do continue to use lubricating eyedrops generously, follow medication instructions and have your eyes reviewed by your eye surgeon in a timely manner. Wishing you a speedy recovery.

Dr David Chan


Dr David Chan
MBChB, MMed, FAMS, MRCS, FRCS

Ophthalmology, Atlas Eye Specialist Centre

290 Orchard Road
Paragon
#07-09 Singapore 238859


10 Jul 2018

Steroid eyedrops are often used for a short period of time following LASIK or ReLEx SMILE  to help with reducing post-operative inflammation. 

Your surgeon will usually check your intraocular pressure to determine that it is within the normal range both before and after your surgery.

Should you have a rise in intraocular pressure whilst on steroid eyedrops, the situation is often easily managed either by stopping the use of the steroid drops or adding another pressure lowering drop to allow the use of steroid to continue until such time it is no longer required. The intraocular pressure usually normalises after the steroid drops are stopped. 

Dr David Chan


Dr David Chan
MBChB, MMed, FAMS, MRCS, FRCS

Ophthalmology, Atlas Eye Specialist Centre

290 Orchard Road
Paragon
#07-09 Singapore 238859


17 Jul 2018

Take heart that most patients will achieve relatively good vision by 1 week after ReLEx SMILE. Keep in mind that as with LASIK and PRK, ReLEx SMILE patients may experience fluctuating vision in the initial post-operative period. They often transition through a period of dry eye for several week to months. This state of dryness tends to improve gradually. 

Meanwhile, be sure to be generous with your artificial tears usually provided after the surgery. Certainly if the vision is not to the level of what you expect, do ask your surgeon for his opinion as he should be monitoring your situation following surgery for signs of dryness and inflammation, both of which tend to settle with time and adequate post-operative medication.

Dr David Chan 


Dr David Chan
MBChB, MMed, FAMS, MRCS, FRCS

Ophthalmology, Atlas Eye Specialist Centre

290 Orchard Road
Paragon
#07-09 Singapore 238859


1 Aug 2018

Under normal circumstances, visual recovery for ReLEx® SMILE® is usually quite quick in the initial period. Patients usually can recover about 75% of their vision the very next day. The remaining 25%, which includes other aspects (such as contrast and haloes), will gradually recover in the following days and weeks.

We usually advise patients to be diligent with the prescribed eyedrops as they also help with the recovery and stabilisation of vision after the surgery.

It would be worthwhile to check in with your friend in a few weeks. It is likely his vision would have been much improved by then.

 


Dr David Chan
MBChB, MMed, FAMS, MRCS, FRCS

Ophthalmology, Atlas Eye Specialist Centre

290 Orchard Road
Paragon
#07-09 Singapore 238859


11 Apr 2019
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Disclaimer: Any answers provided are for general informational purposes only and is not a substitute for professional medical advice. If you think you may have a medical emergency, call your doctor immediately. Always seek the advice of your doctor before starting or changing treatment.

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Disclaimer: Any answers provided are for general informational purposes only and is not a substitute for professional medical advice. If you think you may have a medical emergency, call your doctor immediately. Always seek the advice of your doctor before starting or changing treatment.

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