By Dr Angelo Appiotti

ReLEx SMILE: a treatment option for astigmatism

By 11 November 2019 February 23rd, 2021 No Comments

In past articles we have often talked about ReLEx SMILE, a surgical refractive technique of recent creation that has completely revolutionized corneal refractive surgery.

As often happens when a new surgical technique is introduced the scientific medical world has split into two great categories; those who decide to step up their game and learn a new therapeutic approach, and those who remain anchored to past techniques due to ideological stands or lack of capability. This kind of behaviour is not exclusive to the medical world but can be seen in all areas of human life, whenever innovation is concerned there will always be those that refuse to adapt even when the benefits brought by innovation are undeniable.

A good surgeon should always be inclined to learn new techniques. Learning such techniques always passes through standardized guidelines and nomographs (devices used for graphic calculations) that show whether and when such techniques can be used.

It’s inevitable, especially when a technique is brand new, that a surgeon must investigate the potentials of such a technique and find out what results to expect when confronted with the variegated situations brought forward by clinical practise.

This is the situation I found myself in, due to being one of the first refractive surgeons that have used the ReLEx SMILE technique in north Italy.

I had to understand which were the real capabilities of this incredible technique and when it’s application was best. Whilst initially the benefits in treating myopia with ReLEx SMILE were evident the same could not be said for astigmatism.

To address this issue and having experienced the potentialities of the ReLex SMILE technique, I created personalized nomographs that allow me to treat even this pathology.

Obviously, some colleagues of mine not exactly experts in the refractive field have some issues operating astigmatic patients with the ReLEx SMILE technique whether due them being sceptic or unsure on their manual capabilities, or more importantly because they fear experimenting new techniques without standardized nomographs.

After a two-year study conducted on a great number of patients including professional athletes like Gabriel Vasconcellos and Nicola Vassallo (both affected by high astigmatism) using the ReLEx SMILE technique with great success, I developed my own personal nomographs for astigmatism treatment.

A practical example of the efficacy of astigmatic treatment with ReLEx SMILIE is the following case. Recently I treated a patient (who for privacy reasons I’ll call M.P.) that was affected not only by high level of myopia but also astigmatism in both eyes. The patient presented 4 dioptres of astigmatism in the right and the left eye which is a very high level of refractive disorder considering that 2 dioptres are already considered a high level of astigmatism and that 5-6 dioptres are considered the maximum from a fisiological perspective. After having M.P. go through the pre-op tests I decided out that ReLEx SMILE technique was the best way to treat his deficits and the final results confirmed my initial assessment. M.P. before the surgery presented 7 dioptres of myopia in his right eye and 8 in his left complicated as previously mentioned by 4 dioptres of astigmatism in both eyes, before his operation M.P. had 20/25 vision with the help of his eye-glasses.

30 days after having undertaken the procedure M.P. had a natural eye-sight (without the use of lenses or glasses) of 20/20 with a complete lack of astigmatism and myopia.

In conclusion everybody is entitled to their opinion, and everyone has the right to express such opinions at the best of their capacity. I on the other hand prefer to let the results speak for themselves, results that confirm that thanks to the ReLEx SMILE technique it is possible to treat successfully even high levels of astigmatism by applying personalized nomographs.