SMILE Clear LASIK is an innovative and least invasive surgery to treat refractive vision disorders such as myopia, hyperopia, and astigmatism. In contrast to the conventional LASIK, SMILE employs a laser to sculpt a lenticule – disc-shaped tissue – from the corneal tissue and then excise it to alter the corneal shape for vision correction. There are numerous advantages of this technique, and some of them are a shorter time to heal, and less likelihood to encounter the side effect of dry eye.
However, if you have had corneal endothelial disease in the past, you’re probably asking yourself if SMILE Clear LASIK is the best option for you. The condition of the cornea is an important factor when deciding whether one can undergo LASIK and your eyes may not be suitable for this surgery.
Understanding Corneal Endothelial Disorders
The corneal endothelium is the posteriormost layer of cells in the cornea. These cells are important for the transparency of the cornea and for the control of fluid exchange within the eye. In individuals with corneal endothelial disorders the endothelial cells are compromised or die and this results in accumulation of fluid in the cornea leading to corneal oedema, blurring of vision and scarring.
Common corneal endothelial disorders include:
- Fuchs' Dystrophy: An inherited disorder of the endothelial cells of the cornea where the cells gradually degenerate, resulting in hazy vision and photophobia.
- Corneal Edema: This is a collection of fluid within the cornea and may lead to serious vision loss.
- Other Corneal Degenerations: Other conditions that affect the health and function of the corneal endothelium.
When the endothelial cells are not functioning properly, it can hinder the cornea's ability to maintain its shape and clarity, making it challenging to perform refractive surgery safely.
Eligibility Criteria for SMILE Clear LASIK
SMILE Clear LASIK has some conditions that must be met before the procedure is done to avoid causing harm to the patient. One of these is the condition of the cornea that is an essential component of the eye. The procedure involves cutting of a small piece of tissue from the cornea, and the cornea should have good thickness and tissue quality that can allow it to heal after the surgery.
The corneal endothelium in some patients with corneal endothelial disorders may be compromised and the procedure itself may cause the endothelial cells to deteriorate further and lead to complications such as corneal decompensation. Consequently, the patients with the history of corneal endothelial problems cannot be considered appropriate for SMILE Clear LASIK.
Potential Risks and Complications
For patients with corneal endothelial disorders, undergoing LASIK, including SMILE Clear LASIK, can increase the risk of the following complications:
- Corneal Decompensation: If the endothelial cells are not healthy, the cornea may swell or become cloudy after surgery has been conducted. It can cause a person to have poor vision or even complete vision loss in the most extreme of circumstances.
- Delayed Healing: Corneal endothelial dysfunction can delay the postoperative healing, pain, increased time to recovery, or even more surgeries.
- Increased Risk of Dry Eyes: Damage to the endothelium can interfere with the stability of the tear film of the cornea which may exacerbate postoperative dry eye.
Due to these risks, patients with corneal endothelial disorders are usually advised against the LASIK procedures. The comprehensive eye check up will therefore assist in establishing whether the individual is safe for the SMILE Clear LASIK or whether there are better options for handling the eye irregularities.
Alternative Vision Correction Options
If you have corneal endothelial disorders and are not eligible for SMILE Clear LASIK, there are several alternative vision correction options available:
- Surface Ablation Techniques (PRK, LASEK): These procedures alter the shape of the cornea with lasers but do not involve the creation of a flap that may pose some risks for corneal endothelium. These techniques are said to be ideal for use on patients with damaged corneas, but their drawback is that they take longer time to heal than LASIK.
- Implantable Collamer Lenses (ICLs): Patients with corneal problems or thin corneas might benefit from ICLs. These are placed inside the eye to correct vision without altering the shape of the cornea in any way.
- Corrective Lenses: In case an individual cannot undergo surgery, he or she can benefit from wearing contact lenses or eyeglasses to improve vision.
In some cases, the refractive surgery can be performed only after the primary corneal disorder has been treated, if the pathology is severe enough.
Importance of Comprehensive Eye Examination
It is strongly recommended that a thorough eye check up be conducted before considering any form of LASIK or any other similar procedure. During this exam, your ophthalmologist will assess the health of your cornea using specialized diagnostic tests, such as:
- Pachymetry: Uses an Orbscan to measure the corneal thickness in order to determine if there is sufficient tissue for surgery.
- Specular Microscopy: Determines the thickness and quality of the endothelium.
- Topography: Measures the shape of your cornea to determine if it is appropriate for surgery.
These tests also tell whether LASIK surgery offered by SMILE Clear is safe for the patient or if other treatment methods would be more suitable for the patient.
Consultation with Your Eye Care Specialist
In any case, one should turn to an experienced eye care provider who would examine the patient’s case. They will review your health history, examine your eyes and determine the best vision correction procedures that meet your eye health status. Your specialist will advise you specifically, including if SMILE Clear LASIK or another procedure is the best for you.
Incorporating a history of corneal endothelial disorders, the approach towards SMILE Clear LASIK should be cautious. However, the advantages of the procedure are apparent in people with healthy corneal endothelial cells; however, in patients with a low number of cells, there can be adverse effects.
Thus, it is recommended to consult an ophthalmologist and pass an examination to understand what treatment is suitable for your vision.
At The Eye Foundation, our professional eye doctors, the ophthalmologists, are always ready to help you with the best treatment plan for your eyes.
