Eyeworld

EW REFRACTIVE 66 June 2017 SMILE continued from page 64 who have active lifestyles. "The oth- er benefit of SMILE is that it is ap- proved up to 10 D of myopia, which is the upper limit of LASIK approval, but there are no nomogram adjust- ments. The results in the higher myopia group seem to be stable and accurate, probably at least as good as and maybe better than with LASIK," he said. "Other good candidates for SMILE are the many millions of contact lens wearers who may not have had LASIK because they don't like the idea of a flap. It may seem too aggressive to them, and this is perceived as a gentler alternative," he said. Conversations with patients While almost 1 million SMILE proce- dures have been performed inter- nationally, it is still not well known in the U.S. "There are limited sites, and there has not been a lot of buzz about it, so patients may be hearing about it for the first time in my of- fice. If we think a patient can benefit from having SMILE, we bring it up as an option," Dr. Dishler said. Dr. Doane said the conversa- tion with patients about SMILE is straightforward. "It is less invasive than LASIK. With LASIK, we have a flap, a larger incision, and a change in the biomechanics more so than we have with SMILE because it is a small incision surgery. With LASIK, there is a 9 clock-hour opening. With SMILE, depending on the pa- rameters, there is a 1 to 3 clock-hour opening. There have been well over 300 peer-reviewed studies on SMILE, and it is clear that it is biomechan- ically more structurally sound than LASIK. LASIK for the right patients is phenomenal, but we do know from studies that biomechanically we have more tensile strength with SMILE than we do with LASIK. As far as dry eye, that has been shown as well. There is less nerve interrup- tion, and there is a quicker return to baseline with SMILE than there is with LASIK, although I have found that there is very little dry eye with LASIK the way we are performing it in 2017," he said. The future Surgeons expect SMILE to become more popular with patients as the year goes on. "However, rolling this out into the real world has some challenges. Most people haven't heard of SMILE, while they have heard of LASIK for 20 years," Dr. Dishler said. "We are telling them about a new option that has some benefits but has a limited track record. I think SMILE is a paradigm- changing procedure, but I don't think it will take off like wildfire initially. I think it will have a slow growth and then an accelerated growth phase, especially once astig- matism approval comes. Then it can be offered to a much wider range of patients, but I think the U.S. experience will be similar to what it has been internationally. There will be slow, steady growth followed by rapid growth over the next couple of years. It wouldn't surprise me if 50% or more of all refractive surgery was SMILE 5 years from now." Dr. Vukich agreed. "SMILE is gaining momentum globally in areas of the world where the regulatory pathway isn't quite as encumbered. We are seeing significant double-dig- it year-over-year gains with SMILE, so I think it appears to be a bright spot in terms of acceptance," he said. EW Editors' note: The sources have finan- cial interests with Carl Zeiss Meditec. Contact information Dishler: jond@dishler.com Doane: jdoane@discovervision.com Vukich: javukich@gmail.com

• Blank Page
• Blank Page (1)