Profit from the advantages of SMILE^® eye laser surgery

Lukas Kruse, professional soccer player, has been the goal keeper of the SC Paderborn since 2010 and played all 34 premier league matches in the season 2014/2015 for the club. In the second league, Kruse stood in the goal 159 times. In the season 2017/2018, he has been signed by the second league club Holstein Kiel. He underwent eye laser surgery with the SMILE procedure by Dr. Breyer in 2014 and has been very satisfied with it since then:

"In May 2014, I underwent surgery by Dr. Breyer with the SMILE procedure. Due to having worn contact lenses for many years, I had more and more problems with my lenses which I had to rely on in my profession as a soccer player. To this day, I am more than happy with the result of my eye laser surgery and would always make the decision to undergo SMILE eye laser surgery again. Thank you so much to Dr. Breyer and his team!"

E. Kim underwent eye laser surgery by Dr. Breyer in early 2015 and has been very happy with the result since then. As an employee of Carl Zeiss Meditec, she knew all about the procedure and was familiar with many surgeons on the whole world. It is a great honor for us that she chose Dr. Breyer to be her surgeon. In an interview, she explains which advantages of ReLEx^® SMILE have convinced her the most.

If you compare the risk profile of SMILE^® with those of LASIK and femto-LASIK, SMILE^® does better: In contrast to LASIK, there have not been any severe complications reported for SMILE^® so far. This is due to two main reasons: Firstly, because ReLEx^® SMILE does not need a flap. A flap is a large circular opening of the topmost corneal layer which is required in LASIK and femto-LASIK. Thus, SMILE^® avoids all flap-related risks, e.g.: off-center flaps, torn-off flaps, epithelial cells growing into the cornea beneath the flap and causing clouding of the cornea. In addition, it causes significant weakening of the cornea and does not adhere again for the rest of the patient's life. This can cause severe injury to the cornea due to contact with foreign objects, e.g. if the eye is touched more strongly unintentionally.

• No flap-related risks such as flap tears, ingrowth of epithelial cells, etc.
• Weakening of the cornea, "keratectasia", is described significantly more rarely after SMILE
• So far, there were no reports about severe complications

Like Ms Kim (see the interview above), many patients come to us because they have dry eyes after wearing their contact lenses for years and are no longer able to wear the lenses. Femto-LASIK would only worsen these symptoms. Therefore, we are recommending SMILE^® to them, and since then, wearers of contact lenses are among our most satisfied patients.

• Instead of the 20 mm flap incision, a 2-3 mm incision (cap) is sufficient
• The protective corneal epithelium and the stabilizing Bowman's membrane remain almost completely intact
• The nerves in the topmost corneal layer necessary for regulating the tear film are preserved to the greatest extent possible
• Therefore, the risk of dry eyes after the operation is reduced significantly
• 30% less tissue removed than in a conventional (femto-) LASIK

In airplanes, relative humidity is only 10 to 20 percent on average - 50 to 60 percent are deemed ideal. Those working aboard are frequently suffering the consequences of such dry air: The mucosa dries out more, the eyes show the typical symptoms of keratitis sicca: They are painful or sting. Conventional eye laser surgery procedures such as LASIK or femto-LASIK would further increase these symptoms due to the flap incision. This is why we are recommending eye laser surgery with SMILE to pilots and crew members who want to be able to not wear their glasses or contact lenses.

One of the greatest advantages of the SMILE^® procedure is the fact that there is no pain either during or after the operation since the eye is connected to the laser during the procedure by a shaped contact lens only and is not flattened out. This is much gentler and significantly more pleasant for patients than the conventional suction ring. Therefore, there is also no excessive increase in pressure or bleeding in these procedures. After the laser treatment which only takes approx. 30 seconds per eye, this connection is dissolved immediately. A switch to a second laser is not necessary.

• Anatomically shaped contact lens (in three sizes), as pleasant as a normal contact lens
• One laser for the complete treatment (VISUMAX, Zeiss)
• Does not cause bleeding into the conjunctiva
• No excessively increased intraocular pressure during the operation
• Noiseless and odorless eye laser surgery procedure
• Gentle and painless - also after the operation
• Swift recovery after the operation

Do not compromise about your quality of vision: In SMILE^® , it is evidentially as good as in LASIK or femto-LASIK. You only need to be patient for a few days more until full visual acuity has developed. The best part about this is that we have achieved the target quality of vision in almost every patient.

• Wavefront-optimized procedure
• No artifacts in the incision result
• Reproducible result independent of external factors (e.g. ambient temperature, humidity, individual cornea characteristics)
• Highly precise calculation and preparation of the refractive lenticule

Since 2015, we have reduced the laser energy slightly in the settings of our VisuMax femtosecond laser for SMILE to be able to treat our patients more gently and effectively. A study on the energy settings (Energy Setting and Visual Outcomes) which was published in January 2018 confirmed that these settings also result in a better visual outcome.

For those of you who want to know it in detail: One of the most important differences between the procedures is the length of the incision in the cornea. The thick yellow dashed line is the flap incision of approx. 20 mm in LASIK or femto-LASIK, the blue dashed line of only 4 mm maximum represents the incision in SMILE^®. You can find further explanations for the figure below.

Description

Yellow dashed line:

LASIK flap incision of 20 mm, diameter approx. 9 mm

Yellow continuous line:

Corrective LASIK zone in which the excimer laser evaporates tissue, diameter approx. 9 mm

Blue dashed line:

SMILE^® incision of 3-4 mm for removal of the lenticule.

Blue continuous line:

SMILE^®: Size of the lenticule prepared with the femtosecond laser, diameter approx. 7.5 mm

This illustration assumes an optic zone of 6.5 mm in both procedures. Thus, the SMILE^® procedure causes less tissue damage under the same conditions and needs a smaller incision surface.

If the result is not perfect in an exceptional case, we are now able to even offer another laser procedure with the ReLEx^® SMILE procedure - at no additional costs, of course. With the aid of our physician, we have adjusted our laser precisely to the environmental parameters such as temperature, humidity, etc., and only had three patients so far which had to undergo an additional laser procedure after SMILE^® eye laser surgery.