EyeWorld India September 2021 Issue

REFRACTIVE 34 EWAP SEPTEMBER 2021 Contact information Doane: jdoane@discovervision.com Hamilton: rex@rexhamiltonmd.com Reinstein: dzr@londonvisionclinic.com by Liz Hillman EyeWorld Editorial Co-Director SMILE: Acceptance, updates, and more This article originally appeared in the July 2021 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. T hough it has been available in the U.S. for a fraction of time compared to the well-established laser vision correction procedures PRK and LASIK, SMILE has quickly become the dominant procedure in the practices of many refractive surgeons. John Doane, MD, said about 90% of his refractive practice is SMI E; D. ,ex Hamilton, MD, said about nä¯; and Dan Reinstein, MD, said about 75%. Dr. Hamilton said the shift to SMILE in his refractive surgery patient population has been at his direction, for the most part. He performed the first SMI E cases on the West Coast in March 2017. With more recently approved (2018) indications for up to 3 D of astigmatic correction and better energy settings for faster visual recovery, he has been recommending SMILE to nearly all of his myopic patients for at least the last year and a half. Within the last 6 months, he’s had patients coming in asking for SMILE without his prior counseling. “The SMILE procedure market share went up by about 60% from 2019 to 2020, from 3% to 7–8%. That’s a pretty significant improvement in 1 year, particularly in the face of everything going on,” Dr. Hamilton said. While refractive surgery in general has enjoyed a spike in the months since practices reopened after the COVID-19 pandemic shutdown, why the uptick in SMILE over the last few years? In Dr. Hamilton’s view, it’s perceived as a safer procedure. There isn’t a flap and thus patients aren’t worried about flap-related complications. Although a flap dislocation is exceedingly rare, Dr. Hamilton says it is still a factor in the patient’s mind and a barrier to seeking refractive surgery. Even more influential is the dry eye factor, he said. “There’s no question, and the literature supports, that the severity and duration of dry eye is significantly less. I tell patients 6–12 months of dryness with LASIK, 1–3 months with SMILE and of a lesser degree. [Dry eye is] one of the aspects of LASIK that keeps patients on the sidelines,” he said. “At this point, more than 400 peer-reviewed articles have been published on SMILE, and overwhelmingly SMILE has shown advantages with regard to induction of dry eye or recovery of this symptom and biomechanical strength compared to LASIK,” Dr. Doane said. “SMILE has quicker healing and thus [more] patient Comparison of bubble pattern for high-energy optimized treatments: (A) Bubble pattern with high energy, manifesting a significant opaque bubble layer in the visual axis and fluffy irregularity at the side cut; (B) Bubble pattern with optimized energy without an opaque bubble layer or black spots and a sharp lenticular border, suggestive of an easier dissection.. Source: D. Rex Hamilton, MD