EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/932603
93 EW SECONDARY FEATURE February 2018 … Where SMILE fits in is it addresses those concerns for the patient that you don't have the flap but at the same time you don't have the pain profile or the recovery delays that you would have with PRK." There aren't operational or job-specific reasons why SMILE would be an advantage over other refractive procedures in the military, Dr. Cason said. LASIK, for example, has been performed in special oper- ations forces and pilots and with the advent of femtosecond laser-created flaps, the risk for traumatic flap dislocation is much less. Dr. Cason said SMILE could offer some minor advantages in cases of dry eye and potential for haze. "Specific advantages for SMILE might be in those people who I'm concerned about going out on de- ployment and being exposed to dry conditions or a lot of sun. If there's a true advantage to not cutting a flap and having less damage to the corneal nerves and less dry eye symptoms afterward, that could be a benefit to the patient," Dr. Cason said. "From a haze standpoint, if someone had PRK and went out into a very sunny, desert environment, he or she might have a little higher risk of postoperative corneal haze, and with SMILE you would not have that much of a concern." Dr. Rings said each refractive procedure—SMILE, LASIK, and PRK—has its own unique benefits. "The surgeon still remains the best person to counsel the patient on the specific risks and benefits, taking into consideration his or her specific military job and working environment," Dr. Rings said. Dr. Rivers said if a waiver is needed given their current or de- sired job description for a refractive procedure, he would advise them to choose a procedure that has previ- ously been granted waivers, such as LASIK or PRK, until it's known there won't be a problem getting a waiver for SMILE. Dr. Rivers said it might take time for some in the DoD to become familiar with SMILE, and studies are being performed to evaluate its equivalence with other procedures. In terms of results, anecdotally, Dr. Rivers said his SMILE patients have seen similar outcomes to his continued on page 94 Dr. Rivers carefully separates the anterior and posterior planes of the lenticule.