Laser vision correction - is the Smile method really effective?

My initial data: slight myopia, -1 diopter, but only 20% acuity - I saw only two lines. Glasses or lenses were uncomfortable for me, so I decided to have an operation. The choice came down to just two types - Femto lasik or Smile.

Femto is a proven and reliable method, but I found out about Smile by articles from the Hilo clinic. However, when I started digging further, I realized that the Smile method has one serious drawback - the human factor.

2 years ago I did the operation femto lasik and am still happy with it - right after the operation my vision was 120% sharp, and now it is in the 100% region. My friends and acquaintances are interested and ask if they should do it;). I was a little tired of explaining the same thing to everyone, that's why I decided to write an article on the hub, in which I collected all the information I could find.

For those who are not in the know, I will briefly talk about the types of operations performed in our time:

1. PRK is the oldest and most traumatic. The laser completely removes the epithelium layer. It is used only when it is not possible to make Lasik / Smile. The risk of complications is about 15%.
2. Lasik - the blade makes a cut called “flap”, it rises, then the laser forms a lens. The risk of complications is about 6%.
3. Femto Lasik - the procedure differs from Lasik only in that the flap is cut off not with a blade, but with a laser. Less traumatic, less risk of complications - about 2%.
4. Smile - the lens is also formed by the laser, but instead of cutting out the flap, small cuts are made in the eye through which the surgeon removes residues with the tweezers, the so-called “lenticular”. The declared risk of complications is less than 1% (according to Shilova's articles).

How much is it? Weighted average prices at several clinics in Moscow, for both eyes at once.

PRK: 50 000 rub
Lasik: 50
000 rub Femto-lasik: 100 000 rub;
Smile: 200 000 rub

3 claims to a method;)

1. Smile does not have significant advantages in accuracy and speed of recovery. I did a femto, and immediately after the operation I drove by taxi myself to my house, and the next day I used a computer. How much faster?
2. The operation is very demanding on the direct hands of the surgeon. For example, if the doctor does not manage to remove the lenticular completely, a small piece will remain in your eye forever, because of which the vision in one eye may be worse than in the other. Are you sure you are ready to take such a risk?
3. High price. Femto costs 2 times cheaper, but at the same time the human factor is minimized, because the operation itself is almost entirely automatic.

What do patients say?

Any information you read needs to be double-checked yourself. Therefore, I will not continue to write my subjective opinion and will share with you one curious fact. I found a forum where people leave feedback on operations and conducted an analysis. I distributed each review into groups:

Positive - the operation was successful, vision was restored to almost unity, side effects (double vision, halo, dry eye) are either invisible or quickly passed.

Neutral - the operation was successful, but the vision either subsided a bit later, or some side effects still remain.

Negative - vision was restored poorly, there were side effects that did not exist before, and they greatly interfere.

I understand that Smile technology is relatively young - it would not be logical to analyze reviews from the moment it appeared. Therefore, I watched only those that were left from 2017.

Theme for comments on Smile
Theme on femto

Here's what I got:
Smile: 6 positive, 7 negative, two neutral. Total Negative: 46%
Femto: 12 Positive, One Neutral, No Negative. Total negative: 0%

Reviews, of course, are very few and this sample cannot be called representative. But even taking into account the fact that people often leave negative reviews on forums, how did it happen that femto don't have them, and smile has almost half?

An example of a negative response on Smile from a person who also read about the method on the Habr:

He did the operation in St. Petersburg in mid-November. At the moment, more than 3 months have passed. I am 35, I wore glasses from grade 10. The correction was -4.5 and -4.0 and has not changed for 19 years. I always saw 10th line in such glasses. I decided to make a correction.

At first I planned to go to femtolasik. In the same clinic, 5 of my friends performed an operation, only one has a comment - after 3 years, visual acuity fell to 0.7.

He planned to go there, but then a kind person spoke about the “new accurate super-gentle technology” SMILE. On Habré there is a whole series of articles of the notorious doctor on this site. I was inspired, found out that SMILE in St. Petersburg is done in only one clinic and decided to go there. At the examination, the doctor warned that I have a large pupil, and the halo effect will disturb about six months. He also said that recovery after the smile takes longer - "not in one or two days, but in a week or two." I accepted all of this and agreed.

We have already been told about the course of the operation. It didn’t hurt, only a couple of hours my eyes hurt and they watered a little. On the second day, a visual acuity test showed 0.2 / 0.7. My disappointment knew no bounds. However, after a week the severity was 0.9 / 0.7. In principle, it is normal for a distance, but I noticed that it is very uncomfortable for me to work behind the monitor or read at a distance of about 60 cm. The doctor said that I need to read more and strain my eyes - my vision will be restored. By the way, there was no halo effect. A month later, the severity was 0.7 / 0.6. The next inspection was scheduled in a year (!). I hung a table at home to check my eyesight. After 3 months, the situation is this. Visual acuity of approximately 0.7 in both eyes when viewed from letter. If you look at circles with cuts - somewhere around 0.4. It is still easier to distinguish W from B. The thing is that the image doubles to the right down in one eye, and up in the other. Ghosting is noticeable on contrasting objects, while non-contrasting ones simply merge into porridge (I look at the traffic light - I see two / three traffic lights, I look at the text - I see porridge). I used to see with glasses in the distance and close like an eagle, now only on the C grade. I don’t even know if I should wait a year before the next appointment, because if there are no improvements in 3 months, then where will they come from in another 9 months. I’m extremely dissatisfied with the operation, I regret that I did not find this forum before the operation - I would have thought a hundred times. Is it worth the wait a year before the next appointment, because if in 3 months there are no improvements, then where will they come from after another 9 months. I’m extremely dissatisfied with the operation, I regret that I did not find this forum before the operation - I would have thought a hundred times. Is it worth the wait a year before the next appointment, because if in 3 months there are no improvements, then where will they come from after another 9 months. I’m extremely dissatisfied with the operation, I regret that I did not find this forum before the operation - I would have thought a hundred times.

If there are improvements, I will definitely write an update on my story.

That is, Smile is definitely worse and should not be done?

No, I do not think the Smile method itself is bad. He does not have the risks of complications associated with flap, and also with proper execution, you can achieve fewer aberrations than after lasik. In 2017, it was approved by the FDA and is being held in the USA. I am very respectful to Dr. Shilova, and do not set a goal to insult her. If in her clinic complications do occur in less than 1% of patients, this is an amazing result. But I would not advise telling people that Smile does not have the disadvantages that lasik has. They can understand this so that the Smile operation in a cheap clinic by an inexperienced doctor will be much better according to the results than femto using good equipment.

Therefore, if you plan to do the correction using the Smile method, do not look for the clinic where it costs the least, but pay attention first of all to the experience of the surgeon who will conduct it.