SMILE Laser Eye Surgery

Suitability assessment and planning with Dr. Nejmi Öztürk, ophthalmologist and eye surgeon, at HG Hospital in Kahramanmaraş, Türkiye — flap-free, small-incision treatment of myopia and astigmatism

What is SMILE laser eye surgery?

SMILE (Small Incision Lenticule Extraction) is a refractive laser (laser eye surgery) method in which a femtosecond laser creates a thin, lens-shaped disc of tissue (lenticule) within the inner layer of the cornea (the clear front layer of the eye), and this disc is then taken out through a small 2–4 mm incision. Removing the lenticule changes the curvature of the cornea, correcting myopia (nearsightedness, blurred distance vision) and myopic astigmatism (distorted vision).

The basic difference from LASIK is that there is no flap. In LASIK, a wide flap is lifted on the surface of the cornea; in SMILE, the outer layer of the cornea is largely preserved and the whole procedure is done through the small incision. As a result, flap-related problems do not occur and fewer of the nerve fibers in the cornea are affected.

“ReLEx SMILE” is the name of the lenticule extraction family of methods. “SMILE Pro” refers to the version performed on newer-generation femtosecond lasers with a shorter laser time (a few seconds per eye); the basic principle is the same. No excimer laser is used in SMILE; the entire procedure is done with the femtosecond laser.

Who is SMILE suitable for?

SMILE is suitable for people aged 18 or over whose prescription has been stable for at least 1 year, who have myopia or myopic astigmatism and whose corneas are thick enough. It stands out in the following situations:

• Moderate and high myopia; the treatable range depends on corneal thickness and is generally between 1 and 10 diopters.
• Astigmatism together with myopia; generally up to 5 diopters.
• A tendency to dry eye; because fewer corneal nerves are cut, early dry-eye symptoms are generally milder than after LASIK.
• People who play contact sports or work in occupations with a risk of blows to the eye, such as military and security work; since there is no flap, there is no risk of a flap being displaced by an impact.
• People who do not want a flap to be created.

Who is it not suitable for?

• People with hyperopia: SMILE has limited use in hyperopia (farsightedness, difficulty seeing up close) and is not widely used for it; in these patients LASIK or surface methods are considered.
• Very low myopia: Below about 1 diopter the lenticule becomes very thin and difficult to remove; surface laser may be preferred in these patients.
• People diagnosed with or suspected of having keratoconus (thinning and bulging of the cornea), and people with thin corneas.
• Pregnant and breastfeeding women, and people whose prescription has changed in the last year.
• People in whom a cataract has begun, people with uncontrolled diabetes or an immune system disease, and people with an active eye infection.
• Eyes that need a customized laser profile, such as irregular astigmatism; wavefront- and topography-guided profile options are limited in SMILE.

Examination and tests

The examination before SMILE assesses the thickness and map of the cornea to determine whether the method is safe; it usually takes 1–2 hours.

• Prescription measurement without and with drops (cycloplegic refraction).
• Corneal topography and tomography: maps of the front and back surfaces, screening for keratoconus.
• Pachymetry: corneal thickness; it is calculated whether enough tissue will remain after the lenticule is removed.
• Pupillometry: pupil diameter in the dark; for planning the laser zone.
• Tear tests, eye pressure measurement and a dilated retinal examination (with the pupil widened).

How is SMILE performed?

SMILE is done with anesthetic eye drops, takes about 10–15 minutes per eye, and you go home the same day. The steps are as follows:

1. The eye is numbed with anesthetic drops; there is no injection or general anesthesia. A small device is placed to keep the eyelids open.
2. The eye is held steady against the laser’s contact glass with gentle suction. During this you feel pressure, and your vision dims briefly.
3. The femtosecond laser creates the lower and upper surfaces of the lenticule and the 2–4 mm incision. The laser time is usually 10–30 seconds per eye; it is shorter on newer-generation devices.
4. The surgeon separates the lenticule from the surrounding tissue with a fine instrument and removes it through the incision. No stitches are used; the incision closes by itself.
5. The eye is rinsed and antibiotic drops are applied. In most patients both eyes are treated in the same session.
6. The discomfort felt varies from person to person; most patients describe pressure during the suction, and mild stinging and watering afterwards.

What is recovery like after SMILE?

After SMILE, vision usually reaches a level sufficient for daily life within a few days; full clarity is reached within a few weeks. Compared with LASIK, slightly hazier vision in the first 1–2 days is normal.

• Day 1: Hazy and slightly blurred vision, stinging, watering and light sensitivity may occur. Antibiotic and steroid (cortisone) drops and artificial tears are started as prescribed. A day 1 check-up is done.
• Week 1: Vision sharpens day by day; return to desk work is usually after 2–3 days. Do not rub your eyes, keep water out of them and do not wear eye make-up. You can wash your face and shower carefully.
• Month 1: In most patients vision is largely clear. Stay away from swimming pools, the sea, hammams (Turkish baths) and saunas for 2–4 weeks, and from contact sports for about 1 month. Artificial tears may be continued for 1–3 months.
• Month 3: The prescription and the stability of vision are assessed; whether any additional correction is needed is checked.

Check-ups are usually on day 1, at week 1, at month 1 and at month 3. For patients coming from Elbistan and the surrounding districts, the day 1 check-up is done in Kahramanmaraş; the dates of the later check-ups are planned together at the examination according to travel time.

What are the risks and limitations of SMILE?

Because there is no flap, SMILE eliminates flap-related problems; but like any surgical procedure it has risks and limits.

• Vision clears slightly more slowly than after LASIK; hazy vision is possible in the first days.
• Dry eye: Although less common than after LASIK, stinging and dryness can occur in the first months; it is managed with artificial tears.
• Night halos and glare: May occur in the first weeks and fade over time in most patients.
• Under- or over-correction: A residual prescription can remain in a small group of patients. If additional correction is needed, it is usually done with surface laser (PRK) because there is no flap; this requires a longer recovery than lifting the flap in LASIK.
• Lenticule-related problems: Part of the lenticule remaining inside, a tear at the edge of the incision or loss of suction during the laser are rare; if necessary, the procedure is completed with another method.
• Infection and inflammation: Rare; using the drops regularly is important. Seek help immediately for sudden pain, redness or reduced vision.
• Limitations: Its use in hyperopia is limited, customized profile options are few, and it does not prevent presbyopia (the need for reading glasses after 40).

SMILE or LASIK, SMILE or No-Touch?

No single method is superior to the others for every patient; the choice depends on corneal thickness, the type of prescription, the tear film and lifestyle. The table below summarizes the main differences.

For high prescriptions beyond the limits of laser, or for very thin corneas, ICL (implantable lens) is considered. In eyes with suspected keratoconus, no standard laser, including SMILE, is performed; keratoconus treatment is planned separately.

Assessment and planning in Kahramanmaraş

Your suitability for SMILE is assessed with the examination and measurements at HG Hospital in Kahramanmaraş, Türkiye; the method that suits you is planned together with Dr. Nejmi Öztürk. Dr. Öztürk is an ophthalmologist working in cataract and refractive surgery; he sees patients at HG Hospital (Üngüt Mevkii, Prof. Dr. Necmettin Erbakan Blv. No:209, 46050 Onikişubat / Kahramanmaraş).

HG Hospital is a private hospital contracted with the Turkish social security institution (SGK); patients with valid SGK coverage may use it, although a private-hospital co-payment may apply. Refractive laser surgery to reduce the need for glasses is, however, generally not covered by SGK, and most private health insurance policies also exclude it. Patients without SGK coverage, such as international patients and visitors from abroad, pay privately or through their private or travel health insurance; the hospital checks coverage before treatment. Fee information is given by the hospital after the examination, and insurance coverage is clarified at the consultation.

For patients coming from Elbistan, Afşin, Göksun, Ekinözü and Nurhak, the examination and measurements are planned so that they can be completed on the same day; the drive between Elbistan and Kahramanmaraş takes about 2 hours. Dr. Öztürk does not see patients in Elbistan; for travel and check-up planning, see the patients from Elbistan and the surrounding area page.

Frequently asked questions

Sources

• Turkish Ophthalmological Society — todnet.org
• American Academy of Ophthalmology (AAO) — aao.org
• European Society of Cataract and Refractive Surgeons (ESCRS) — escrs.org
• National Eye Institute (NEI) — nei.nih.gov

Related pages

• Laser eye surgery — all methods
• LASIK and Q-LASIK eye surgery
• No-Touch laser (Trans-PRK)
• ICL (implantable lens)

This page is for information only; diagnosis and treatment decisions are made after an examination. The results of any surgical or interventional procedure may vary from person to person. You are advised to obtain detailed advice from your physician before any procedure.

Dr. Nejmi Öztürk

Ophthalmologist and eye surgeon. Graduate of Erciyes University Faculty of Medicine; completed his residency at Ankara Atatürk Training and Research Hospital. With 21 years of experience in cataract and refractive surgery, strabismus, glaucoma, retina and oculoplastic surgery, he sees patients at HG Hospital in Kahramanmaraş, Türkiye. Biography and training

This content was prepared and medically reviewed by Dr. Nejmi Öztürk. Last updated: 28 September 2026 · Site editor and contact