Nick Wagoner, a 29-year-old from Kansas City, stood in the waiting area at Discover Vision Centers in Leawood on Friday, while a laser eye surgery was performed in a glass-encased surgical suite behind him.
He was preparing to ditch the glasses and contacts he had worn since fifth grade and also one-up his brothers: They had their vision corrected with Lasik surgery, while Wagoner was about to experience the next generation of laser eye surgery, born of German technology and tested here in the Kansas City area.
“I’m a little nervous,” Wagoner said. “But I’m excited because it’s a newer procedure.”
Wagoner’s surgeon, Dr. John Doane, said the Small Incision Lenticule Extaction, or SMILE, procedure has overtaken Lasik as the most common laser eye surgery in other countries and soon will do the same in the United States.
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“The incision we make now is about one-tenth the size of Lasik,” Doane said. “Lasik is a small incision, but this is even smaller.”
That means less disruption to the natural biomechanical structure of the cornea and less nerve damage, Doane said, which ultimately means a quicker recovery and less dry eye for the patient.
The procedure is geared to those who are shortsighted and can’t replace Lasik in all cases, but may be an option for some patients who could not previously get Lasik. In Lasik, surgeons use lasers to cut a hinged flap that they use to reshape the cornea, and that disqualifies some patients whose top corneal layer is thin.
In SMILE, surgeons reshape the cornea through a “keyhole” incision that is made by a laser that is computer-programmed.
Doane said he first saw the laser technology that makes the SMILE procedure possible in 2009 when he visited a medical device company called Zeiss in Jena, Germany.
The surgery is already popular in Australia and much of Europe, but was not approved in the United States until September because the U.S. Food and Drug Administration process takes longer than other countries’ regulatory schemes.
“Outside the U.S. a lot of procedures have been done already, about 795,000, and we expect by the end of 2017 for there to be 1 million SMILE procedures performed in total,” Doane said.
A comprehensive review of medical literature on the procedure was published in the Journal of Refractive Surgery in April 2016. It concluded that SMILE is as safe and effective as Lasik, with fewer dry eye symptoms and greater corneal sensitivity.
Discover Vision was one of five clinics in the country that was involved in the seven years of FDA clinical trials for SMILE and Doane said he is now one of three doctors in the United States training other ophthalmologists to perform the procedure.
They’ve trained 60 doctors so far and plan to hit 100 by the end of the year.
The surgery is now offered at other Kansas City businesses, including Durrie Vision.
Doane said there will still be occasions in which Lasik is the preferred procedure, but in other countries SMILE is now used in 60 percent to 70 percent of cases.
“Surgeons always migrate to the superior procedure and, no surprise, patients always migrate to the superior procedure,” Doane said.
Lasik costs $1,550 to $4,650 per eye at Discover Vision and Doane said the facility charges the same for SMILE.
“We have never wanted patients to make a decision based on price,” Doane said.
About two hours after he walked in, Wagoner was walking out of Discover Vision with a pair of dark, wraparound sunglasses the only evidence he’d had work done. He said he felt some pressure on his eyes during the surgery, but nothing else. He went back to work that afternoon and by 5 p.m. he said he was seeing street signs from a distance for the first time in years.
“I definitely can see things I shouldn’t be able to see,” he said with a laugh. “I’m sure that by tomorrow it will be crystal clear like they said.”