Eyeworld

DECEMBER 2022 | EYEWORLD | 51 R When choosing which procedure to use, it's a matter of matching the technology to the patient. "One thing I think surgeons should be mindful of is that patients are looking to them to make a recommendation as to the best procedure," he said. "It's impossible for patients to understand nuances among SMILE, LASIK, and other options." Because of this, Dr. Kugler said it's important for the surgeon to outline the differences and to recommend the most appro- priate option for each patient. 'There are some fallacies with SMILE' In Dr. Rostov's refractive practice, anyone who is a candidate for SMILE gets SMILE. She esti- mated that it's upward of 80% of patients who come in for a refractive surgical procedure. She said that over the years, outcomes with SMILE, LASIK, and PRK have been shown to be very similar. "There isn't a significant difference among laser vision correction procedures, and that's exactly what I tell patients," she said. "I tell them that when we look at laser vision "I think the more experienced surgeons become, the less time they're spending in the pocket. The less in and out there is, the less chance for epithelial ingrowth." Dr. Kugler offered some advice for surgeons just starting out with SMILE. "I think it's a little less forgiving than LASIK," he said. "The lenticule is removed with manual dissection, so there's definitely more technique involved." There are more surgeon technique and manual steps compared to LASIK, and LASIK has had a 30-year head start over SMILE, so it is more refined. "If you look at where SMILE is on the timeline, it's quite remarkable how far along it is," Dr. Kugler said. "But someone who is used to having a lot of things automated in the LASIK process is going to need to realize that SMILE is more surgeon dependent." Dr. Kugler said there is currently a gap in what is available overseas for the VisuMax femtosecond laser and what is available in the U.S. "We see a lot of great features that are coming but not here yet," he said. "I think that's going to be an important step forward in the technology for U.S. surgeons." There are also several femtosecond laser companies working on lenticular creation and extraction technologies and software. "We're going to see a real step forward in innovation and options on other platforms as well," he said. "I don't think there's any question that the lenticular extraction techniques are going to evolve and improve, and a lot of the advantages of that technique that have been theoretical will continue to be refined and become a reality." Dr. Kugler said that his practice made a conscious decision a couple of years ago to make sure that they were maximizing the SMILE technique because they think it's going to become more relevant as more options enter the marketplace. "Carl Zeiss Meditec deserves tremendous credit for bringing this to market," he said. "What's also great is that we have other companies innovating in the same space, and the innovation will propel everyone forward." continued on page 52 Day 1 postop photo of SMILE Source: Audrey Talley Rostov, MD

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