ReLEx SMILE in Singapore: 20 Most Frequently Asked Questions

ReLEx SMILE in Singapore: 20 Most Frequently Asked Questions

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ReLEx SMILE is a relatively new laser vision correction procedure in Singapore. An alternative to Lasik in Singapore, ReLEx SMILE offers a no-flap approach to correct your near-sightedness and astigmatism for good. That’s also why ReLEx SMILE is often touted as better than Lasik as it is generally considered as less invasive than Lasik.

During a ReLEx SMILE procedure, the eye surgeon only makes an external cut of 3mm wide. No external corneal flap is created and folded back. On the other hand, a Lasik procedure involves the doctor cutting a 20mm wide circumference to create the corneal flap.

Other benefits of ReLEx SMILE include less risk of dry eyes, no risk of Lasik flap complications and a shorter recovery. ReLEx SMILE is a great alternative for you if you’re the sort who does a lot of sports and can’t afford to take too much downtime away from work. You will need only 2 to 3 days of MC and be able to return to work in no time with perfect eyesight. One caveat though: it costs twice as much as Lasik and other laser vision correction procedures, since it’s using the newest technology.

Here are 20 FAQs on ReLEx SMILE in Singapore — including common questions like is ReLEx SMILE safe; how much does ReLEx SMILE cost; how long does ReLEx SMILE last. If you’re considering laser vision correction this year, this one’s for you!

1. What is ReLEx SMILE?

ReLEx SMILE is an abbreviation for Refractive Lenticule Extraction — Small Incision Lenticule Extraction and is a relatively new laser vision correction procedure in Singapore. A minimally invasive procedure, ReLEx SMILE is able to correct myopia and astigmatism and thus provides an alternative to Lasik – widely considered the most popular laser vision correction, with millions of people having done Lasik worldwide. It is not suitable for people with long-sightedness though.

2. How is ReLEx SMILE in Singapore done?

During the ReLEx SMILE surgery, a lenticule (i.e. lens-shaped piece of cornea tissue) is cut inside your cornea using the Zeiss VisuMax Femtosecond laser. In other words, this laser technology is able to cut your cornea internally.

Once the laser has cut out the lenticule within your cornea, the eye surgeon then makes a small external cut of about 3mm wide and uses forceps to pull and extract this lenticule out. When the lenticule is removed, the topmost cornea tissue sinks down into the empty space vacated by the lenticule, adhering to the new cut curvature. In this way, the new curvature changes the way light bends into your eye, thus correcting your myopia and astigmatism, allowing you to regain perfect vision.

3. Is ReLEx SMILE safe?

The short answer is yes, ReLEx SMILE surgery is considered as a safe surgery. It has a track record of around 10 years and research showed high success rates and doctors generally consider ReLEx SMILE as an effective laser vision correction method in their surgical bag of tricks, along with Lasik and TransPRK. [1] The procedure is also US FDA-approved. [2]

Having said that, keep in mind that every surgery comes with risks. ReLEx SMILE is no different: there are possibilities of side effects and risks of complications. Ask your eye surgeon about the safety and considerations of ReLEx SMILE before deciding to do the surgery.

4. Is ReLEx SMILE better than LASIK?

ReLEx SMILE does have some advantages compared to LASIK, such as:

  • Smaller cut
  • Less invasive; no external corneal flap
  • No risk of Lasik flap dislodgement or flap complications

ReLEx SMILE also a relatively short recovery like Lasik, and offers a more comfortable surgical process and recovery since there is no open cut flap.

5. Is ReLEx SMILE better than Advanced Surface Ablation procedures?

ReLEx SMILE’s technology is newer than ASA procedures such as TransPRK and Epi-Lasik. While both ReLEx SMILE and ASA procedures are no-flap, ASA has a longer recovery time. The initial recovery takes about 5 to 7 days, with full vision recovery taking around 3 to 6 months. Overall, ReLEx SMILE is also less painful and more comfortable.

That said, every laser vision correction procedure come with its own benefits and disadvantages when you compare them. For example, ReLEx SMILE is better for someone who wants a fast recovery; but TransPRK may be better for someone who wants a procedure with no external cuts to the cornea and can tolerate a longer downtime. It’s important to know about all the pros and cons of each procedure and pick one which is best suited for you and your lifestyle.

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6. Am I suitable for ReLEx SMILE surgery?

You are most likely suitable for ReLEx SMILE if you:

  • Are at least 18 years old
  • Are not pregnant nor breastfeeding
  • Have nearsightedness (myopia) of less than -10.00 diopters [3]
  • Have a good amount of cornea thickness
  • Do not have any underlying health conditions, for example: diabetes, hypertension, etc.
  • Do not have any eye issues, such as extremely dry eyes, abnormal cornea, glaucoma, etc.

To determine if you are indeed a suitable candidate for ReLEx SMILE or any laser vision correction procedures, you’ll need to go for a pre-Lasik eye evaluation. The eye evaluation comprises eye tests which will determine the above-mentioned factors and also a personal consultation with your eye surgeon. Once you have the green light from your eye doctor, you’re good to go!

7. Is ReLEx SMILE surgery painful?

All laser vision correction surgeries, including ReLEx SMILE, are painless. That’s because anesthetic eye drops will be applied to numb your eyes right before the procedure.

However, you may feel some discomfort after the ReLEx SMILE surgery when the anesthesia has worn off. Your eyes may feel hypersensitive, uncomfortable and/or teary. It’s recommended to head home immediately and sleep so that your eyes can rest. ReLEx SMILE has one of the most comfortable recovery processes due to its no-flap and small incision technique — so if you’re the sort who has a low pain threshold — you can be rest assured that the recovery process is relatively comfortable and manageable for many.

8. How long does ReLEx SMILE take?

The actual ReLEx SMILE procedure itself takes about 30 minutes for both eyes. However, due to preparations and post-op care instructions and briefings, you may need to set aside 2 to 3 hours on your surgery day.

Be ready to take the full day off because you’ll need to go home to rest your eyes as much as possible after the surgery. Typically, you’ll be given 3 days of MC. It is not uncommon for ReLEx SMILE patients to go back to work the next day after the surgery as recovery is relatively fast.

9. Will ReLEx SMILE cause dry eyes?

There is a risk of dry eyes with any type of eye surgery, including laser vision correction. Some eye procedures have lower risk of dry eyes, while some have much higher risk of dry eyes.

Studies have found that the risk of dry eyes is lower in ReLEx SMILE patients as compared to Lasik patients. While permanent Lasik-induced dry eyes is a risk, it occurs rarely. Most of the time, dry eyes is only experienced temporarily after the procedure and goes away with after a few weeks of recovery.

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10. Can ReLEx SMILE treat astigmatism?

Yes, ReLEx SMILE can treat astigmatism. It is an eye-refractive surgery that can treat nearsightedness (myopia) and astigmatism (san guang). However, there is a limit to the degree of astigmatism ReLEx SMILE can treat so remember to check with your eye surgeon if your astigmatism can be fully corrected. 

11. Is the result of ReLEx SMILE surgery permanent?

Yes, ReLEx SMILE surgery will correct your vision permanently. The surgery is not meant to be reversible. After the Femtosecond laser permanently laser-cuts a lenticule within your cornea bed, your eye surgeon will then make a small incision at the side of your cornea and remove the lenticule. The removed lenticule will then be discarded.

As you grow older though, vision changes may take place as your eye naturally ages. Because of the ageing process, your eye gradually loses its elasticity and gives rise to a condition called presbyopia (old age reading problems). In other words, you should be able to enjoy perfect, spectacle-free eyesight for a good portion of your life, until presbyopia sets in. ReLEx SMILE cannot prevent presbyopia from happening nor will it exacerbate your eye’s ageing process.

12. How long will my ReLEx SMILE procedure last?

Your ReLEx SMILE procedure permanently corrects your eye refractive errors, thus the results of the surgery will last permanently. However, it is possible to get regression, i.e. myopia degree returning, if you subject your eyes to prolonged eye strain, causing nearsightedness to develop again. It is not possible though to regress back to your high myopia — for example, 500 degrees per eye of nearsightedness. Regression usually occurs slightly in 50 to 150 degrees of myopia. If this happens, you may want to go for an enhancement procedure such as TransPRK to get the regression corrected.

13. Can ReLEx SMILE be done more than once, if my degree regresses a little?

No, you can’t do ReLEx SMILE more than once. This is because of the nature of the surgery, where the doctor uses the laser to internally cut and remove a lens-shaped piece of corneal tissue from your eye. To repeat this procedure is not recommended due to possible complications that may occur. Thus, if your eye degree regresses — i.e. you begin to develop low degrees of nearsightedness again due to prolonged eye strain — you cannot do an enhancement procedure with ReLEx SMILE but you can do an enhancement with a surface-based procedure like TransPRK.

14. Can I see clearly after my ReLEx SMILE surgery?

Of course! That’s the goal of your ReLEx SMILE procedure — to regain perfect eyesight without needing vision aids like glasses or contact lenses. In fact, ReLEx SMILE enables you to reach your best possible corrected vision. If you happen to have a lot of Wavefront errors (irregularities in vision due to unsmooth cornea), you will find that after doing ReLEx SMILE, you’ll be able to see better than you did before with your spectacles or contact lenses.

You will be able to see clearly immediately right after your ReLEx SMILE procedure, albeit your eyes may be slightly sensitive and needing lots of rest. But you will not need your glasses anymore, so you can leave it behind at the clinic or throw it away! Some Lasik clinics donate glasses to certain charity organizations. Or if you like, keep it as a souvenir to remember you were once myopic!

15. Is there an age requirement for ReLEx SMILE?

In Singapore, you must be at least 18 years old to do ReLEx SMILE. That’s when you have reached a stable eye prescription. However, you will need parental consent — i.e. you will need to bring your parent along to sign on the consent form — if you are under 21 years of age.

As for age limit, there is none. You could theoretically still undergo ReLEx SMILE even if you are 80 years old if you fulfill the suitability factors. However, there are other eye issues that will emerge as you get older. These eye problems that occur due to ageing are presbyopia (lao hua in Mandarin) and cataracts (clouding of your natural eye lens). Your eye health is no longer at its prime. For example, if you have cataracts, you will need to undergo cataract surgery to remove the cataract, instead of doing ReLEx SMILE.

This is why it will be best to do your ReLEx SMILE procedure (or any other eye refractive procedure) when you’re younger. This way, you can enjoy perfect eyesight for a longer span of time until old age eye problems set in.

16. How long is the recovery after ReLEx SMILE?

You will take about 2 to 3 days to heal after doing ReLEx SMILE. The recovery is considerably quick and you’ll be able to see clearly without vision aids after the procedure. Just make sure you get plenty of rest and sleep so that your eyes have time to heal and repair. Full recovery may take about 1 to 2 months.

17. How many days of MC will be given after ReLEx SMILE surgery?

You will be given up to 3 days of MC for ReLEx SMILE. Make sure you rest at home during this time and get plenty of sleep as much as you can! Do not do any heavy lifting, reduce stress and screen time as much as possible. Ensure your eyes are relaxed and well-rested during this period for a speedy and smooth recovery.

18. Any precautions I have to take before my ReLEx SMILE surgery?

Two precautions to take before your ReLEx SMILE procedure: No wearing of contact lenses, no drinking of alcohol and sleep early the night before your surgery. Alcohol and a lack of sleep can cause your eyes to become dry the next day when you wake.

If you usually wear contact lenses, you’ll need to lay off your soft contact lenses for at least 3 days and 10 days for hard lenses. This defers from clinic to clinic to make sure to check with yours!

Three things to take note of on the day of your ReLEx SMILE surgery: no wearing of make-up, deodorants or perfume, no contact lenses and strictly no driving. Make sure you arrive bare-faced as chemicals on your face or eyes from make-up or skincare products can irritate your eyes and interfere with the laser application. Have someone accompany you down for your procedure as your eyes may feel very sensitive right after your ReLEx SMILE surgery and you may feel like keeping them shut.

Remember to consult your eye surgeon or optometrists at the clinic on any questions you may have and make sure they give you a detailed list of the dos and don’ts for your ReLEx SMILE surgery.

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19. What about precautions after my ReLEx SMILE surgery?

For the first 24 hours after surgery, prioritize resting your eyes. Sleep a lot. Don’t watch too much TV. Don’t try to read, use your computer or phone as much as you can as near vision activity strains your eyes and you’ll want them to be well rested for a good, fast recovery. Follow your doctor’s instructions and apply the relevant eye drops as instructed regularly to keep eye infections at bay and lubricate your eyes. Drink lots of water so that your eyes stay hydrated.

The next 2-8 days after surgery: avoid sunlight, smoke, dust, water and any other substances like the plague. There may be germs in your tap water etc so try not to splash water into your eyes. Clean your face and eyes with a wet towel instead. Wear UV-protected sunglasses when you’re outdoors. Do not engage in any water sports, go to a sauna or jacuzzi and don’t get sweat into your eyes. Obviously do not engage in any contact sports during this time. Take it easy on your exercise and fitness routines. Don’t wear make-up. Also, don’t rub your eyes!

Make sure you get the full list from your Lasik clinic in Singapore.

20. How much does ReLEx SMILE cost in Singapore?

ReLEx SMILE in Singapore is relatively more expensive than other laser vision correction procedures like Lasik or TransPRK. The cost of ReLEx SMILE in Singapore for both eyes is around $5,000 to $8,000. This is twice that of Lasik costs in Singapore. 

Here is a cost breakdown of your ReLEx SMILE procedure in Singapore:

Cost in SGD
Pre-Lasik Evaluation $5 to $300
ReLEx SMILE surgery (2 eyes), including GST $5,000 to $8,000
Medications (eye drops) $50 to $200
Post-op Reviews $50 to $200

Remember to check with your Lasik clinic on what the cost of ReLEx SMILE quoted entails, whether it includes things like medications and post-op reviews. Most clinics provide the first few post-op reviews for free.

Pro tip: Check with your Lasik clinic for interest-free credit card installment plans. Most clinics have partnerships with credit card companies to give you 6 or 12 months interest-free installment plans, which means you can break up your ReLEx SMILE cost into manageable, bite-sized pieces and slowly pay it over the course of 6 or 12 months.

21. Where can I go for ReLEx SMILE in Singapore?

You can go to either public hospitals or private clinics. The public hospitals that offer ReLEx SMILE are Singapore National Eye Centre (SNEC) and National University Hospital (NUH). Private clinics in Singapore can either be found in private hospitals such as Gleneagles Hospital, Camden Medical Centre etc or can be found mostly in the Orchard Road district.

You will also find a number of good private Lasik clinics that offer ReLEx SMILE in Singapore; such as Eagle Eye Centre, Atlas Eye Specialist Centre, Asia Pacific Eye Centre, and many more. It’s good to do your own research thoroughly to find out the doctor’s credentials, clinic’s processes and cost. Ask friends and family for recommendations if they have done ReLEx SMILE before.

References

[1] Blum M, Täubig K, Gruhn C, et al. (2016). Five-year results of small incision lenticule extraction (ReLEx SMILE). The British journal of ophthalmology, 2016(100), 1192-1195. http://dx.doi.org/10.1136/bjophthalmol-2015-306822.

[2] Reinstein DZ, Archer TJ, Gobbe M. Small incision lenticule extraction (SMILE) history, fundamentals of a new refractive surgery technique and clinical outcomes. Eye and Vision. 2014;1(1). doi:10.1186/s40662-014-0003-1

[3] Thompson, Vance. 2017. SMILE Laser Eye Surgery, from https://www.allaboutvision.com/visionsurgery/smile.htm#:~:text=SMILE%20laser%20eye%20surgery%20can,for%20at%20least%2012%20months.

Jolene

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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 her morning coffee and is very partial to flat whites. She also has gone a little too far down the rabbit hole with interior design and dabbles in styling her own home at @februarynest.

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