Smile-y eyes
A new procedure for refractive eye surgery, Smile, which has similarities to lasik, has reached Malaysian shores. learn more about it at the FitForlife fair to be held at the Mid Valley Exhibition Centre in Kl.
IF you are one of the early adopters of laser refractive eye surgery in the country, have you wondered how the technology has evolved since that time? The fact is, it has changed tremendously over the years.
When I first started 20 years ago, we did a corneal surface procedure using the excimer laser called Photorefractive Keratectomy (PRK). It had a rather slow healing recovery. The technology of the lasers and also the procedure has changed and evolved since then. The big change after PRK was the making of a flap before using the laser, and this was the Lasik procedure.
Lasik allowed faster recovery of vision (from many weeks with PRK to just days with Lasik) and less discomfort for the patient. The flap at that time was created using an automated blade cutter called a microkeratome.
Further advances in technology allowed improvements to be made to the flap creation method by introducing a Femtosecond laser to create the flap. This allowed us to make the flap in a more precise, accurate and safer way, as compared to using the microkeratome (Blade Lasik). Improvements in excimer laser technology have made it possible for better and more predictable surgery outcomes.
Now, the latest evolution of laser technology comes in the form of the Smile procedure, where the corneal flap is not made any more.
What is Smile?
Smile is short for Small Incision Lenticule Extraction. It is a procedure that uses only one type of laser – the Femtosecond laser for the complete procedure.
In contrast, Femto-Lasik uses two different lasers – the Femtosecond laser to create the flap, and the Excimer laser.
The Smile Femtosecond laser is able to penetrate the surface of the cornea (the front part of the eye) without making any cut and focus on the deeper part of the cornea to carve out a shape called the lenticule.
A small incision is also made at one side of the cornea to allow access to this lenticule, and the surgeon is able to remove the lenticule from the cornea. Once the lenticule is removed, the overall shape of the cornea is altered and the prescription/power of the eye will be changed.
What are the benefits of Smile over Lasik?
In Smile, there is no corneal flap, unlike Lasik. When there is no flap, there is no worry about flap complications, for example, the flap moving or dislodging (which can occur in Lasik). Also, by not cutting a flap, we keep the cornea much stronger compared to Lasik.
This is especially relevant to those with higher powers or thinner corneas where a lot of the tensile integrity of the cornea is affected by the flap or the greater amount of corneal tissue that has to be removed.
The third advantage is the preservation of the corneal nerves. In Lasik, in the process of cutting the flap, we also cut a lot of the nerves, and these nerves help reduce post op dryness.
So in summary, by not having a flap, you get a stronger post operative cornea, decreased occurrence of dry eyes, and no flap complications.
And because only a small incision is made in Smile, the patient experiences less post op irritation and pain as compared to Lasik, where a big flap incision is made.
Is Smile better than Lasik?
In certain safety aspects, it is – no flap means no flap complications, and it maintains more corneal strength post op, compared to Lasik.
It is also more comfortable, the patient experiences less dry eyes (because more corneal nerves are preserved) and less pain after the operation
Vision-wise, results are similar to Lasik. Lasik has been around for a long time, and is a mature technology and procedure, giving good and satisfying visual results.
At the moment, Smile it is not widely available in Malaysia. There are only a few eye specialist centres in the country that are currently offering this procedure.
That’s because it is the latest, state-ofthe-art technology which requires new laser machines. These machines are expensive.
Also, not many surgeons in Malaysia have the experience to adopt the procedure; it will take a while before it becomes more widely available.
In time, Smile should become the leading choice in terms of cornea preservation and also safer features, but for now, both Smile and Lasik have their own benefits.
Lasik is a good procedure, and it has been giving consistent results. In the near future, eye laser centres will probably offer Smile side-by-side with Lasik.
This is a similar situation to ASA (Advanced Surface Ablation). ASA is the first generation laser surgery, and has not faded away either. It is still being done as it has its own advantages and provides good results.
So, I believe that Smile will complement Lasik as an alternative for patients who prefer its advantages over Lasik.
Dr Stephen Chung is an opthalmologist and laser refractive surgeon. Dr Chung will be giving a talk and Q&A session on ‘Relax Smile And Lasik’ at the FitForLIfe fair this coming Sunday at 1pm. The FitForLife fair will be held in Halls 1 to 3 of the Mid Valley Exhibition Centre from April 10 to 12. It is open from 10am to 7pm. Admission is free. This year’s FitForLife theme, Get Fit. Live Great!, aims to inspire Malaysians to lead a healthy lifestyle and adopt a holistic approach that includes physical and mental fitness, financial health and general fitness. For details, call 03-7967 1388 or visit www. facebook.com/starhealthfair.
come alive again.”
The artificial heart uses soft “biomaterials” intended to lessen the risk of blood clots and rejection by the immune system.
It is powered by a belt of lithium batteries. The patient said the key was not to forget to charge the batteries.
“I have a spreadsheet in which I mark down the hours and changes, to make sure they last as they should. It’s not complicated,” he said. “To reach 100-years-old, if I can, why not?”
Professor Daniel Duveau, the surgeon who operated on the man, said that to his great surprise, his patient was even riding a bike outside.
“As part of his rehabilitation, we made him do a number of physical activities such as riding an exercise bike, and when we last met, he told us ‘of course, I have a bike, a traditional bike and I ride but... don’t worry, I avoid big hills,’ ” he said.
Duveau added that the patient, a black belt judoka, also wanted to resume the martial art, though his doctors had told him to ask their permission before doing so.
Nearly 100,000 people in Europe and the United States
I walk, I get up and I bend over 10 to 15 times a day, without any problem. I keep my balance. I’m not bothered. I don’t even think about it. In fact, pretty much from the day I was operated, I felt myself come alive again.
— ANONYMOUS SECOND RECiPiENT OF ARTiFiCiAL HEART
are in need of a heart transplant, according to Carmat, which plans to carry out the first phase of feasibility trials on four terminal patients.
The second phase will see around 20 patients receive an artificial heart, according to Carmat. — AFP Relaxnews