Advances in laser eye surgery
DR Stephen Chung, an ophthalmologist and laser refractive surgeon, talks about the future of LASIK in Malaysia.
You are one of the early adopters of laser refractive eye surgery in the country. How has the technology evolved since that time?
When I first started 20 years ago, we did a corneal surface procedure using an excimer laser called Photorefractive Keratectomy (PRK). It had a rather slow healing recovery rate.
The big change after PRK was the making of a flap before using the laser – the LASIK procedure, which allowed for faster vision recovery and less discomfort. 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 method such as the introduction of a Femtosecond laser, which enabled the flap to be made in a safer and more precise way.
Improvements in excimer laser technology have made it possible to have 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 anymore.
What is SMILE? SMILE is short for Small Incision Lenticule Extraction.
It uses only one type of laser – the Femtosecond laser – for the complete procedure, which is able to penetrate the surface of the cornea without making any cut, focus on the deeper part of the cornea and 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, enabling the surgeon to remove it from the cornea.
Once it has been removed, the overall shape of the cornea is altered and the prescription or power of the eye will be changed.
What are the benefits of SMILE? With SMILE, there is no corneal flap so there is no need to worry about complications such as the flap moving or dislodging.
By not cutting a flap, we can also keep the cornea much stronger. 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, which help reduce post-operation dryness.
In summary, by not having a flap, you get a stronger post-operative cornea, lesser dry eyes and no flap complications.
Since only a small incision is made in SMILE, the patient also experiences lesser post-operation irritation and pain.
Is SMILE widely available in Malaysia?
At the moment, no. There are only a few eye specialist centres in the country currently offering this procedure.
Why are so few centres offering SMILE here in Malaysia?
SMILE is the latest state-of-theart technology which requires new laser machines that 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.
What is the future of SMILE and will LASIK be a thing of the past?
In time, SMILE will be the leading choice in terms of cornea preservation and safer features but for now, both SMILE and LASIK have their own benefits.
LASIK is a good procedure that has produced consistent results.
In the near future, eye laser centres will probably offer SMILE alongside LASIK, similar to ASA (Advanced Surface Ablation).
ASA, the first generation of laser surgery, has not faded away either. It is still being done as it has its own advantages and provides good results.
Therefore, I believe SMILE will complement LASIK as an alternative for patients who prefer its advantages.
Dr Chung is a renowned ophthalmologist and laser refractive surgeon with 20 years of experience in performing laser refractive surgery in Malaysia.
This article is contributed by the Optimax Eye Specialist Centre.