In the world of laser eye surgery, innovation is constant. New techniques and technologies are always emerging, promising better results, faster recovery, and fewer side effects. One such advancement is lenticule-based surgery, a family of procedures that includes ReLEx SMILE, SILK, and SmartSight. These minimally invasive techniques have been making waves since SMILE’s introduction in 2008. But the big question remains: Are lenticule-based surgeries ready to knock LASIK off its throne as the gold standard in laser vision correction?

What Makes Lenticule-Based Surgeries Different?

Unlike LASIK, which requires creating a large corneal flap, lenticule-based surgeries involve removing a small piece of corneal tissue, called a lenticule, through a tiny incision. This means that more of the cornea stays intact, potentially leading to fewer postoperative complications like dry eye or flap issues. Patients often experience quicker recovery times and fewer immediate side effects, which makes these procedures appealing for many.

But while the smaller incision is a clear advantage, it doesn’t mean lenticule-based surgeries are without their challenges.

The Hurdles: High Myopia and Astigmatism

Lenticule-based surgeries have proven effective for treating mild to moderate myopia and astigmatism, but they face difficulties when dealing with higher levels of refractive error. Studies show that patients with severe myopia may experience under-correction or even visual regression over time. Despite ongoing improvements, like updated nomograms (surgical guidelines), achieving consistently precise results in these cases remains tricky.

This is where LASIK holds its ground. LASIK is particularly effective for higher levels of myopia, even beyond -10.00 dioptres, giving it a significant edge for patients who need substantial vision correction.

Retreatment: Why LASIK Still Shines

One of the key advantages of LASIK is the simplicity of retreating patients if their vision changes over time. Surgeons can easily lift the existing corneal flap for adjustments, making follow-up procedures straightforward. In contrast, retreating with lenticule-based surgeries is more complex, often requiring an entirely different technique, which limits their appeal for patients who may need future adjustments. Additionally, lenticule-based surgeries cannot currently correct longsightedness or hyperopia, as approvals for these applications are still in the pipeline. While lenticule-based options perform well in minimising induced spherical aberration and compare favorably to recent treatment advances, they are unable to address higher-order aberrations.

What About SILK and SmartSight?

The newer kids on the block—SILK and SmartSight—are the latest iterations of lenticule-based surgeries. They’ve been designed to address some of SMILE’s shortcomings and have shown promising results, particularly for higher myopia and astigmatism. However, these procedures are still relatively new and have yet to prove their long-term effectiveness and predictability.

So, Is LASIK’s Reign Over?

In short, not yet. Lenticule-based surgeries like SMILE, SILK, and SmartSight offer exciting alternatives, especially for patients with mild to moderate myopia who want a less invasive option. These procedures boast quicker recoveries and fewer immediate side effects, which is a big win for many.

However, when it comes to high myopia, the need for retreatments, and long-term reliability, LASIK remains the go-to choice. Its proven track record, ability to treat more complex cases, and flexibility for future corrections keep it at the forefront of laser eye surgery.

Final Thoughts

Lenticule-based surgeries are certainly paving the way for future innovations in laser vision correction. While they’re not quite ready to dethrone LASIK as the gold standard just yet, their potential is undeniable. With continued advancements, these procedures could close the gap and become a viable alternative for a broader range of patients. But for now, LASIK still reigns supreme in the world of laser eye surgery.