By Dr Angelo Appiotti

ReLEx SMILE: when the patient should not take “no” as an answer

By 4 November 2020 February 23rd, 2021 No Comments
A few weeks ago in the Milan clinic where I visit and operate I met a patient who had come to me to find out if she was eligible to undergo a surgical treatment to correct her myopic defect of -6 diopters of the right eye and – 4.50 of the left eye, and specifically wanted to understand if it could be treated with the new ReLEx SMILE technique.
During the interview, the patient confided to me that she had already undergone a fitness visit for this technique at another surgeon who advertised to practice the ReLEx SMILE, but that after some analysis he would have suggested that she undergo another type of operation because she was not eligible. The patient, not satisfied with a negative answer, had decided to contact me for a second opinion.
I therefore subjected the patient to all the practical exams (aberrometry, corneal topography, corneal diameter study, pentacam, pupillometry refractive examination in cyclopegia, pachymetry and fundus examination) to assess her suitability for the ReLEx SMILE according to the visual defect and of the individual eye structure some techniques are more suitable than others. The results of the tests were surprising as the patient was an ideal candidate for the ReLEx SMILE technique that I finally adopted and with which I completely corrected her visual defect obtaining a final natural vision of 14/10.
I don’t want to go into the merits of the negative response of the surgeon who had visited my patient before me, but considering that the ReLEx SMILE is a more recent technique (since 2014 in Europe) it is important for those who want to go for this solution that everyone has the elements for a conscious and informed choice.
Here are the 5 things to know about ReLEx SMILE and who practices this procedure:
1) The skills of the surgeon
Talking about the surgeon’s hand may seem trivial; however it must be said that every triviality is reflected in reality. In refractive surgery in general, the skills and experience in the surgical field are decisive on the result which can range from sufficient to excellent.
This principle is even more evident for the ReLEx SMILE: the surgeons who have adopted and who have been practicing it since its introduction in Italy will obtain better results on average than those who are just starting out with this method. The surgeon’s personal experience is equally a criterion of choice. A surgeon who has decades of experience in refractive surgery and who has dealt with FemtoLASIK for a long time will have a different dexterity than someone who has never had experience with this type of surgery. This is because certain skills learned with other surgical procedures can be useful to approach the ReLEx SMILE with greater confidence.
In my specific case, the transition to this technique was quite natural because the manual skills acquired in more than 30 years as a refractive surgeon practicing techniques such as RK (radial keratotomy with diamond scalpel) PRK LASIK and FemtoLASIK subsequently allows me to master this technique.
2) Cutting-edge technology
To be able to undergo the ReLEx SMILE procedure you need the appropriate instrumentation created by ZEISS, the VisuMax laser system thanks to which it was possible to develop this new refractive technique.
It is not possible to do this without the ZEISS laser, and anyone offering this type of surgery without having this technology available will not actually be able to do so. Before making a preliminary visit to the refractive surgeon of your choice, it is a good idea to find out if he or his referral center has ZEISS Visumax laser technology.
3) Team of excellence
To ensure the best possible result, the surgeon works closely with ZEISS and its staff. ZEISS works with the best refractive surgeons and only from this comparison was it possible to develop this innovative technique. Only surgeons who have had this collaboration can have the skills to safely perform this surgical technique. It is still not uncommon today to see ZEISS collaborators in the room who, through a direct relationship with the surgeon, bring this technique to levels of excellence.
Those who claim to practice this technique without having had this collaborative experience are unlikely to achieve excellent results so it is always good to inquire whether or not the surgeon has had a direct relationship with ZEISS staff.
4) Safety
The advantage of ReLEx SMILE arises from the increase in the structural integrity of the cornea, reducing any complications following post-surgical trauma. Furthermore, by harming a smaller number of nerve endings, there is a reduced risk of dry eyes following the surgery.
Despite being a relatively new technology, numerous studies claim this technique is absolutely safe and the benefits are obvious.
5) Who is the patient for the ReLEx SMILE
Following the approval of the ReLex SMILE, the FDA also stated which are the ideal parameters to undergo this surgery. The best results are obtained, in fact, in patients who have a myopic defect between -1.00 and -10.00 diopters and myopic astigmatism up to -5.00.
The choice of the various laser techniques must always be subordinated to a careful study of the characteristics of the eyes and of the personal or professional objectives of each patient in order to always offer a real personalized product. In my experience, I have found that patients with major myopia benefit more from ReLEx SMILE than other techniques.