Eyeworld

44 | EYEWORLD | SUMMER 2025 R EFRACTIVE continued from page 43 "With less corneal nerve disruption, we have noticed less dry eye symptoms during the first 6 months than with LASIK. That's the main reason I moved to doing SMILE for the majority of my patients." Dr. Lin noted that SMILE has other ad- vantages because it has a larger optical zone, thus less halos compared to LASIK for higher prescriptions, and better refractive stability, especially in higher prescriptions. Our enhance- ment rate is below 1% in 25,000 eyes after SMILE, he said. The disadvantage of SMILE is that it removes a little more tissue because it starts deeper in the cornea, but there's some evidence that because there's no flap, the cornea is still stronger even though we are leaving less residu- al bed, he said. We should be careful about not removing too much tissue, Dr. Lin said, adding "that's where the ICL comes in." He thinks the EVO ICL is a great technology, it doesn't remove any tissue, and it can be reversed. Dr. Lin noted that in Asia, there was a lot of marketing of SMILE. In Taiwan in 2020 during the COVID-19 pandemic, LASIK was around 95% of the market and SMILE was 5%. Now the number of procedures performed for SMILE is 70%, and 30% is LASIK. The transition from LASIK to SMILE in Taiwan has been driven by a combination of factors, including marketing, clinical outcomes, and patient word-of-mouth referrals. Dr. Lin said LASIK is an amazing procedure, it's been around for so long, and patients ask for it. To perform SMILE, you must invest in a new laser. So if patients are not asking for SMILE and you are already an expert LASIK surgeon, you are not going to perform SMILE. Doctors want to do what's best for their patients, so if they're not as good at SMILE but good at LASIK, they're going to do LASIK, he said. Dr. Lin added that SMILE is easier to perform in patients with higher prescriptions because the lenticule will be thicker and more easily removed. In an Asian population, the average prescription of patients seeking refrac- tive surgery is more than –5.50 D, so it's easier to remove the lenticule. In the U.S., the aver- age prescription of patients seeking refractive surgery is around –3.50 D, so it can be difficult to remove the lenticule if the surgeon is not experienced in performing SMILE. The EVO ICL Source: STAAR Surgical VisuMax 800 laser used to perform SMILE Source: Zeiss

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