Perfect eyesight without LASIK? It’s possible and it’s (joyously) called ReLEx SMILE.

One of our most valued senses has to be our gift of sight. There are so many things we rely on our sight for on a daily basis. If you’re like me, highly myopic with a decided disdain for glasses and contact lenses, you must’ve also considered getting LASIK done.

But all the LASIK horror stories I’ve heard involved sustaining extreme dry eyes, having permanently blurry vision, having to put eye drops for life, getting their LASIK flap dislodged (gasp)… I wasn’t about to take the risk.

Also read: 12 best eye clinics to do LASIK in Singapore

Determined to find a less invasive alternative, I came across ReLEx SMILE. Short for Refractive Lenticule Extraction and Small Incision Lenticule Extraction, ReLEx SMILE is also an eye refractive procedure like LASIK but a relatively newer technique. [1] Unlike the conventional LASIK, ReLEx SMILE does not cut a corneal flap which means it’s less invasive. [2] Recovery is also faster and less irksome than ever.

What is ReLEx SMILE and how does it work?

ReLex SMILE, like its name suggests, is a corneal lenticule extraction technique. Also known as a “key-hole” laser eye surgery, ReLEx SMILE is a minimally invasive procedure which corrects vision through reshaping the cornea curvature from within the cornea. [2]

Here’s how ReLEx SMILE is done: [3]

1. A lenticule is created with a laser

Numbing eye drops are first applied prior to the surgery. Then, the surgeon uses the Femtosecond laser to cut a lenticule – a tiny, pre-determined, lens-shaped piece of tissue that is cut according to your eye degree – within your corneal bed. 

2. The lenticule is extracted and removed via a small cut opening

The surgeon makes a small incision of 2 mm to 4 mm at the side of the cornea to extract this lens-shaped, disc-like tissue. This incision heals within a few days without stitches.

3. Cornea curvature is changed

The topmost layer of cornea tissue collapses into the space where your lenticule was, causing a change is curvature. This changes the way light bends into your eye and corrects your vision.

Is ReLEx SMILE suitable for everyone?

In general, not really. ReLEx SMILE can correct a certain range of myopia and astigmatism, which is estimated at about 200 to 800 degrees. This is due to the fact that the lenticule cannot be cut too thin or too thick. Thus, if you fall within this range of myopia and astigmatism, you should be suitable for ReLEx SMILE. [4]

Also, ReLEx SMILE is NOT suitable for those who have: [4]

• Hyperopia (long-sightedness)
• Eye diseases such as glaucoma, cataract, etc

Do note that you should be at least 18 years old to undergo any sort of laser vision correction as your eye degree would be relatively stable by then. You will also still have to undergo a detailed eye evaluation by the ophthalmologist to determine your eligibility for the procedure.

So what’s the difference between ReLEx SMILE vs LASIK?

Everyone knows what LASIK is, so it has become somewhat a procedure of comparison.

The main differences are: there is no cut external corneal flap in ReLEx SMILE like in LASIK and ReLEx SMILE procedure occurs internally within the corneal bed. [2] 

The benefits of ReLEx SMILE

Smaller incision = Less risk of dry eyes

Because most of the treatment occurs within the cornea bed, ReLEx SMILE is considered to be minimally invasive. The external cut on the cornea is only a tiny 2 to 4 mm wide incision as compared to LASIK, which requires a 20 mm cut circumference to create the corneal flap. This means that less external cornea nerves are damaged, reducing the risk of dry eyes. [5,6]

Flapless procedure = No risk of flap complications

ReLEx SMILE is a flapless procedure, which means there is no external corneal flap created. This means there is no risk of flap wrinkling or dislodgement that comes with LASIK.

Greater comfort during the procedure

For many patients, ReLEx SMILE is a painless procedure. The laser only takes less than a minute to treat the cornea.

Fast recovery

Within 3 days of the surgery, patients can expect 80% visual recovery. Vision will continue improving over the next 1 – 3 months and will usually stabilize 3 months after the surgery.

Ability to participate in contact sports

With no flap creation, it eliminates the risk of flap complications such as flap wrinkling or dislodgement. Hence, patients can take part in contact sports after ReLEx SMILE without any worry of dislocating a cut LASIK flap.

What are the possible side effects of ReLEx SMILE

Overall, ReLEx SMILE is a safe and low-risk procedure. However, as with any medical procedure, there are still risks involved. These risks include dry eyes, glares and haloes as well as the risk of post-op infection. [7] For most patients, these side effects rarely occur and are often temporary.

How much does ReLEx SMILE cost in Singapore?

In Singapore, ReLEx SMILE can cost approximately S$4,800 – S$8,000. [8] Other factors influencing cost include eye evaluation tests before the procedure to ascertain patient eligibility for ReLEx SMILE. Review check-ups after the procedure may add to the cost as well.

Pro tip: Ask the clinic if they have 6-months or 12-months installment plans if you pay via your credit card. Most clinics in Singapore offer it and you can immediately split up your total bill into smaller, more digestible chunks!

Does Medisave cover the cost the cost of ReLEx SMILE in Singapore?

At last, not really. ReLEx SMILE and other laser vision correction procedures are considered as elective procedures under the Ministry of Health (MOH)’s guidelines, therefore, Medisave will not be usable. [9]

Things to note before your ReLEx SMILE procedure

There’s nothing much to prep for your ReLEx SMILE procedure, but one great tip is to sleep early the night before so that your eyes have had ample rest and are tip-top shape for the procedure. Avoid alcohol as it can cause your eyes to become dry.

You will also need to stop contact lens wear prior to the surgery; usually 3 days for soft lenses and 14 days for hard lenses.

On the day of your surgery, do not wear eye make-up and ensure that your eyes are clean. You don’t have to worry too much about this though; the doctor will also be cleaning your eyelids for you.

It’s also good to arrange for someone to accompany you home. Some patients can experience discomfort, tearing and light sensitivity, so your vision may not be very functional right after the procedure cos you may feel like you just want to close your eyes! [10]

Things to note after your ReLEx SMILE procedure

Right after your ReLEx SMILE procedure, your eyes may feel gritty and start tearing when the numbing effect wears off. This is normal and should go away within 2-3 days. Vision would also be slightly blurry, but 80% of vision should also return after 3 days. By Day 5 to 7, most patients will start to see very well.

Even though the surgery is relatively pain-free and it’s over before you know it, post-op care still applies! Be sure to follow your doctor’s post-op eye drop regime to ensure a smooth recovery process and avoid infections, and you’ll be back to your normal routine in just a few days. Depending on your eye degree, you could literally be back at work the very next day! [11]

Follow up review appointments will also be scheduled accordingly. In general, you will need to go back and see your eye doctor the next day, after 2 weeks and after 6 months, up till your eye degree stabilizes. This will ensure that everything is healing well and you’re well on your way to being discharged.

During the first few days post-op when your eyes are recovering, please:

• Avoid straining your eyes by engaging in prolonged hours of near vision work (computer work, reading, writing, etc)
• Avoid being exposed to direct sunlight and always wear UV-protected sun shades if you have to be outdoors
• Refrain from rubbing your eyes
• Avoid dusty and smoky areas
• Avoid contact sports and water sports

Okay I’m in! How do I get started?

To get started on ReLEx SMILE surgery in Singapore, book your eye evaluation with a trusted LASIK centre to first evaluate your eligibility for the procedure. During the consultation, you will need to declare your existing medical conditions and medical history so that your doctor can best advise you on the best treatment method. I am so excited for you to experience the same liberatingly brilliant sight that I do now!

Also read: LASIK in Singapore: Ready to say goodbye to myopia for good?

References

[1]Ağca, A., Demirok, A., Yıldırım, Y., Demircan, A., Yaşa, D., Yeşilkaya, C., …Taskapili, M. (2016). Refractive lenticule extraction (ReLEx) through a small incision (SMILE) for correction of myopia and myopic astigmatism: current perspectives. Clinical Ophthalmology, 10, 1905–1912. doi: 10.2147/opth.s80412

[2] Breyer, D. R. H., Beckers, L., Hagen, P., Kaymak, H., Klabe, K., Auffarth, G. U., & Kretz, F. T. A. (2019). Comparison of Long-term Results with Small Incision Refractive Lenticule Extraction (ReLEX SMILE) vs. Femto-LASIK. Klinische Monatsblätter Für Augenheilkunde, 236(10), 1201–1207.

[3] Thompson V. (2017). SMILE Laser Eye Surgery, from https://www.allaboutvision.com/visionsurgery/smile.htm

[4] Laser Vision Clinic Central Coast. Are you suitable for ReLEx SMILE®?, from https://www.lvccc.com.au/laser-eye-surgery/are-you-suitable/

[5] Klokova O. A., Sakhnov S. N., Geydenrich M. S., Damashauskas R. O. (2019). Quality of life after refractive surgery: ReLEx SMILE vs Femto-LASIK. Clin Ophthalmol. 2019; 13: 561–570. Published online 2019 Mar 26. doi: 10.2147/OPTH.S170277

[6] Euroeyes. ReLEx SMILE – Laser Vision Correction Beyond LASIK, from https://www.euroeyes.com/relex-smile/

[7] Agca A. et al (2016). Refractive lenticule extraction (ReLEx) through a small incision (SMILE) for correction of myopia and myopic astigmatism: current perspectives. Clin Ophthalmol. 2016; 10: 1905–1912. Published online 2016 Oct 3. doi: 10.2147/OPTH.S80412

[8] MoneySmart (2019). LASIK Singapore Price List – How Much Does LASIK Surgery Cost?, from https://blog.moneysmart.sg/healthcare/lasik-procedures-singapore/

[9] Eagle Eye Centre. LASIK FAQs, from https://eagleeyecentre.com.sg/service/lasik-faqs/

[10] London Vision Clinic (2019). What Should I do to Prepare For Laser Eye Surgery?, from https://www.londonvisionclinic.com/what-should-i-do-when-preparing-for-laser-eye-surgery/

[11] Atlas Eye Specialist Centre (2018). After a ReLEx SMILE surgery: Post-op care, from https://atlaseye.sg/health-basics/after-a-relex-smile-surgery-post-op-care/

Jolene

Jolene lives for avo toasts, yoga and is a little more OCD than she cares to admit. She never fails to start her day with morning coffee and is very partial to flat whites. She is obsessed with interiors and homeware, and is currently taking her RYT 200h yoga teacher training course as an aspiring ashtangi.