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BOOST YOUR REFRACTIVE AND CATARACT SURGERY PRACTICE 2 | SUPPLEMENT TO EYEWORLD | DECEMBER 2021 Why SMILE is now my #1 refractive procedure This article is based off of presentations from an EyeWorld, non-CME sympo- sium—"Benefits, outcomes, and enhance- ment options with the latest refractive surgery techniques"—sponsored by Carl Zeiss Meditec, which took place at the 2021 ASCRS Annual Meeting in Las Vegas, Neva- da, as well as an additional interview. The symposium included Sonny Goel, MD, Erica Liu, MD, Bruce Rivers, MD, Audrey Talley Rostov, MD, and William Wiley, MD. W ith more than 10 years of clini- cal proof and 4 million proce- dures worldwide among 2,500 practicing physicians in more than 80 countries, SMILE has been shown to be safe and effective. The 1,500th VisuMax laser (Carl Zeiss Meditec) was recently installed in the practice of Bruce Rivers, MD, Envue Eye and Laser Center in National Harbor, Maryland. SMILE has become the #1 refractive procedure in Asia, as well as in some U.S. practices. Sonny Goel, MD, with more than 20 years of experience, has performed more than 95,000 LASIK procedures. When he bought his first VisuMax laser and began conducting SMILE procedures in January 2020, there was a bit of a learning curve. "Adding a new procedure will always have a learning curve," he said. "Once I pushed through the early difficult dis- sections, and I learned how to tweak the laser energies, it has been a much better experience for surgeon and patient. … I encourage experienced LASIK surgeons to not give up when they have a difficult case. Push through, learn, and improve." Dr. Goel pushed through and said SMILE, after just 2 years, is now his most sensitivity after LASIK, and in the mean- time, corneal sensitivity after SMILE remained higher than LASIK. 1 William Wiley, MD, said it's "dramat- ic" how little dry eye is experienced after SMILE. He said his practice began notic- ing that SMILE patients weren't receiving prescription dry eye drops. "We have seen patients occasionally who have LASIK and end up needing Xiidra [lifitegrast, Novartis] or Restasis [cyclosporine, Allergan], hopefully not forever, maybe just to get them through a temporary healing curve, but we've not had anyone who we've had to do that for with SMILE, which is impressive," he said. Dr. Rostov said she puts all of her LASIK and PRK patients on dry eye drops postop for 3–4 months. She still prescribes dry eye drops for her SMILE patients, but only for the first month. Erica Liu, MD, said her patients who have had SMILE in one eye and LASIK in the other have noticed the difference between the two eyes in terms of dryness for several months. Greater tensile strength The anterior stroma, the strongest part of the cornea, remains largely intact with SMILE, equating to greater tensile strength associated with the procedure. SMILE is approved to treat up to –10 D of myopia and –3 D of astigmatism. Dr. Rostov said with less tissue removed at these higher levels of myopia and greater tensile strength, she's comfortable going to the max allowable treatment as long as there's enough residual stroma left. "When you talk about the anterior stro- mal part of the cornea, the fibrils there popular refractive procedure. His practice data between January and June 2021 showed that 80% of procedures were SMILE, 15% LASIK, and 5% PRK. "SMILE has been amazing for me, as a surgeon and practice owner, and for patients," he said. SMILE carries multiple benefits for the patient Audrey Talley Rostov, MD, was first exposed to SMILE overseas. She was so impressed and intrigued by what she saw that she arranged to visit the Carl Zeiss Meditec laser center in California and found herself "blown away by what this laser can do." She and "Helga" (what she named the VisuMax laser she now owns) have been together ever since. Dr. Rostov said she has patients com- ing in specifically asking for SMILE, in most cases because they want a less inva- sive procedure. As a surgeon, she appreci- ates that the procedure is associated with less dry eye, a faster recovery period, and greater tensile strength of the cornea. "I tell [patients], LASIK is great, PRK is great, SMILE is great—they all have equal outcomes. But if they are a candi- date for any of the procedures, the reason that SMILE has become my go-to is because it's less invasive, there's less dry eye, and the outcomes are the same, even for postop day 1," she said. Less dry eye There are multiple studies, Dr. Rostov said, showing less dry eye with SMILE vs. LASIK. One study showed that it took 6 months to return to baseline corneal Sonny Goel, MD Erica Liu, MD Bruce Rivers, MD Audrey Talley Rostov, MD William Wiley, MD

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