Through the keyhole… Lee smiles with latest laser eye surgery

Mr Greenaway, a groundsman from Essex, is the first patient to experience the new third-generation laser eye technology at specialist Optegra Eye Hospital London.

The new technology, SMILE, is a bladeless, flapless, minimally invasive alternative to laser surgery. Considered the ‘keyhole surgery’ of laser, the technology means that the popular 30 year old laser eye techniques can, for the first time, be performed without creating a ‘flap’ on the surface of the eye.

SMILE stands for Small Incision Lenticule Extraction. It allows laser eye surgery with the smallest of holes – just 2mm wide – which naturally heals, leaving the surface of the eye stronger, and less at risk of future damage. 

Ophthalmic surgeon, Mr James Ball, from Optegra Eye Hospital London, explains:  “While it is rare, if someone suffers trauma to the eye at any point after traditional laser eye surgery, there is a risk that the flap can dislodge.  This would need to be quite a significant trauma, but a Chinese study of vast numbers of soldiers who had been treated with LASIK, recently revealed that flaps can come loose if the eye is injured, even years later.

“So what that means for us, is that people who play normal contact sports should be very secure, but if you enjoy activities such as martial arts or if you were to be assaulted, the eye is more likely to suffer trauma with traditional methods than if laser is conducted with SMILE.”

This information is what led Lee Greenaway, from Basildon, to approach Optegra about his treatment.

Mr Greenaway, aged 36, said: “I had done a lot of online research looking into the kind of laser surgery available before making my decision.

“I am really keen on keeping fit – I run several times a week and enjoy swimming.  In the past I tried amateur boxing but poor eyesight proved a problem hitting a moving target.  One of my decisions to choose the SMILE procedure over LASIK was my concern about the risk of a flap becoming dislodged if I wished to try contact sports in the future.  To me SMILE sounded like the ideal solution – all the benefits of laser, but with keyhole surgery.”

A further clinical advantage of SMILE is the more rapid recovery of post-operative dry eye symptoms. This occurs because SMILE has less effect than LASIK on the nerves at the front of the cornea. 

In addition, the treatment itself is quicker than LASIK – just involving a couple of anaesthetic drops and then 5 minutes under the equipment.

The eye is also more comfortable afterwards than any other eye surgery.  The patient will just feel a little ‘scratchy’ for a couple of hours.  Vision restores fully over a couple of days.

Mr Greenaway was moderately short sighted in both eyes but also had a significant astigmatism, which meant he had been dependent on glasses since the age of just eight years old.  As with many people, his vision continued to deteriorate over the years, so while initially as a child he needed glasses for reading and writing at school, he finally found the need to wear glasses permanently.

A keep-fit enthusiast, Lee has found glasses and contacts a huge inconvenience.  And his work, which involves line marking and measuring rugby and football pitches also requires excellent vision.

Lee’s final momentum for opting for SMILE laser eye surgery was a long term discontent with image. He says: “While I know glasses are fashionable these days, I just could not get past the ‘geek’ thing! I feel that I look better without glasses and my confidence has really increased since I do not need to wear them any more.”

Following surgery, his vision is better than 20/20 and Lee is delighted. He says: “The simple things in life are such a joy without glasses. I can go running without them sliding down my nose and lenses getting marked with perspiration.

“Swimming is now a pleasure as I can avoid crashing into fellow swimmers and see underwater.  I no longer need to worry about rain on my glasses or getting steamed up in the bathroom. It’s great that I can see everything so clearly.  And knowing I have the option to enjoy contact sports without any concern for my vision is fantastic.”

LASER EYE SURGERY TIMELINE

Optegra’s Mr Ball says: “If you look at the history of laser eye surgery, it started nearly 30 years ago with excimer laser ablation to remove tissue from the surface of the cornea.  To do that we had to scrape the skin off the cornea which caused pain for a few days following surgery. The pain settled once the skin grew back but then it would take a long time for vision to settle down.

“Then LASIK came along 20 years ago, offering a rapid visual recovery, a very comfortable procedure which can be carried out quickly and with no scarring.  It involved making a thin flap in the front of the cornea with a hinge at the top – initially the flap was made with a vibrating blade.

“Then 10 years ago, femtosecond lasers were introduced which could create the LASIK flap.  The laser technology improved the safety and accuracy of the procedure.

“Now, in 2016, we have femtosecond laser technology which is so accurate that we can perform SMILE. The femtosecond laser can now draw out the entire lens of tissue that needs to be removed through a key hole incision.  There is no flap so the eye retains the strength seen after surface laser but with the speed of recovery and comfort similar to LASIK. So for the first time we now have all the advantages of surface laser and all the advantages of LASIK combined.”

Mr Ball says: “There was a lot of training involved because the procedure is technically demanding, but it’s been worth the investment because the results are fantastic. The Zeiss Visumax is the only femtosecond laser with the accuracy necessary to perform the SMILE procedure. This accuracy also provides benefits for performing LASIK flaps which makes this laser a privilege to work with.”

About ReLEx® SMILE

ReLEx® SMILE (Refractive Lenticule Extraction, Small Incision Lenticule Extraction) is a minimally invasive, bladeless form of keyhole laser eye surgery. SMILE is able to correct short sightedness and astigmatism without the creation of a corneal flap. It can allow the treatment of patients with very high prescriptions, dry eyes, contact lens intolerance, and/or thinner corneas.

During the procedure, anaesthetic eye drops are used to numb the eye, and the state-of-the-art Carl Zeiss VisuMax laser places a series of pulses in the centre of the cornea with extraordinary 3D accuracy. These pulses form bubbles that are less than 1/100th the width of a human hair, and which outline the tissue that needs to be removed to change the shape of the cornea. The laser then creates a tiny connecting tunnel through which the surgeon draws out this tissue.

With SMILE, no flap is created, so the eye is more comfortable post-operatively than other laser eye surgery techniques. The procedure takes a matter of minutes, and the vision is 80% better within a few hours. After a few days the vision is excellent, and it reaches 100% within a few weeks (according to trials conducted on over 1,000 patients between the UK, Germany, France and Denmark).