ReLEx SmILE Laser Vision Correction procedure

SMILE', short for 'Small Incision Lenticular Extraction' is no flap, no pain, quick recovery, and fully computer operated by the femtosecond laser. This new technique, is only possible with the Visumax femotsecond laser by Carl Zeiss, and is the least invasive therapy possible these days.

Relex EyePoster

The SMILE procedure has become the 3rd generation of laser vision correction after PRK and LASIK.

This unique micro invasive refractive method has now been successfully performed on more than 100,000 eyes worldwide.

SMILE stands for Small Incision Lenticule Extraction.

It is based on the removal of a tissue disc (called lenticule) instead of tissue ablation, distinguishing it from PRK and femto-LASIK.

An excimer laser is not required.

The refractive lenticule is created in the intact cornea, using the ZEISS VisuMax femtosecond laser system.

Unlike LASIK, the SMILE procedure is performed without creating a flap. We strongly believe that patients prefer to be treated without flap creation. The fact that a flap has to be cut in one’s eyes is a frightening prospect for some patients, which is not a concern when using SMILE.

Now we are using the VisuMax femtosecond laser to perform SMILE ,ReLEx, a pinhole procedure that we believe is the next logical step in refractive corrections.

If you look down the road to 5 years from now, however, it is very likely that the majority of practices and surgeons will prefer SMILE or other intrastromal refractive surgery treatments over LASIK.

It is a flapless procedure that has all the advantages of  surface ablation and all the advantages of LASIK. It would be like PRK without pain and LASIK without a flap.

SMILE is a flapless, bladeless, noiseless, odorless procedure.

Our patients are amazed at how quickly the procedure is over, as it takes only 28 seconds.


  1. The VisuMax offers the FemtoLASIK (bladeless) treatment PLUS a new technology called ReLex (Refractive Lenticule Extraction).
  2. SMILE is a single step laser treatment, an all laser LASIK
  3. It is 100% bladeless and flapless
  4. Entire LASIK treatment only on one laser
  5. Less invasive, no tissue ablation, no flap related risks
  6. Flapless keyhole procedure
  7. Post laser discomfort is practically nil
  8. More stable cornea as it preserves the strength of the cornea as it makes 1/5th the size of a bladeless flap
  9. Keyhole procedure with a self-sealing micro incision which is less than 1/5th the size of a bladeless flap

Especially beneficial for the following candidates:

  1. High powers achieve better quality of vision
  3. Those prone to dry eyes
  4. Those with corneal surface issues due to contact lens overuse
  7. Femtosecond lasers have been in use for some time now, and were started with the intention to replace the microkeratome used for ‘flap’ creation in LASIK. Every pulse in a ‘femtosecond laser’ takes less than one trillionth of a second. A femtosecond is 1-15 of a second or 0.0000000000000001 second.

These ultra short pulses of laser light are used to make very fine and precise incisions in the cornea. Here, the Femtosecond laser is applied first to create the corneal flap, which is then lifted before the application of the excimer laser which treats the refractive power. However, older Femtosecond lasers led to some adverse post operative conditions such as “Transient Light Sensitivity Syndrome” and delayed recovery of vision.

Today, Femtosecond Lasers, such as The VisuMax, go one step further; this new technology has made protecting the cornea’s integrity easier and creating flaps more consistent and precise.

The VisuMax femtosecond laser (Carl Zeiss Meditec AG, Jena, Germany) (Figure) is an attractive choice for two reasons. First, it gives the surgeon an extra margin of safety in creating the flap. Second, it offers a wide range of laser treatments in combination with excimer laser such as FLEx (femtosecond lenticular extraction), or an all – Femtolaser treatment- SMILE (Small Incision Lenticular Extraction) with the additional ability to be used in cataract surgery as well, now being called as FemtoLaser Cataract Surgery and also in keratoplasty. With these wide ranges of treatments available to a surgeon, it is a good investment in Ophthalmologicalpractice.

This new innovation in corneal surgery uses a femtosecond laser alone, compared with other procedures that use an excimer plus a femtosecond laser. With SMILE procedures, because the anterior corneal structure remains largely intact, there is a potential for the safer treatment of higher levels of myopia than is currently possible with excimer laser procedures. The corneal nerves are also mostly spared, so there is theoretically less risk of dry eye problems.

Advantages of this technology

‘Smile’, short for ‘Small Incision Lenticular Extraction’ is no flap, no pain, quick recovery, and fully computer operated by the femtosecond laser. This new technique, is only possible with the Visumax femotsecond laser by Carl Zeiss, and is the least invasive therapy possible these days.

The disadvantages of the older treatments have disappeared and the advantages have remained. The fact that we now finally do not have to make a flap lowers the chances of dry eyes drastically and improves the stability of the cornea extremely.

Despite its proven efficacy, LASIK still requires the use of two laser machines: one for the flap creation and another for the excimer ablation. This increases the cost as well as the surgical time for the procedure. SMILE uses only one laser machine, thus potentially reduces surgical time and cost. Moreover, SMILE does not involve any flap creation, which potentially reduces risk of side effects such as dry eyes. For these reasons, SMILE is potentially a new, improved form of refractive surgery, which may supersede LASIK and change clinical practice. There is also potentially a positive impact on healthcare as surgical time and costs are reduced with this new, ‘all-in-one’ laser procedure.

Unlike other excimer laser-based procedures, ReLEx smile uses a solid-state laser, and therefore, there is no need for consumable gases or tight environmental humidity control. The VisuMax is a silent, soft, and gentle laser. It does not produce a smell, there is no vision blackout during the procedure, and the cornea is not forced into a non-physiological planar shape. As a result, deformation and artifacts can be avoided in the results as well as unnecessarily high intraocular pressure.


Shroff Eye Hospital, Mumbai is one of the privileged centres in the world which offers the widest range of laser treatments from

  1. Wavefront LASIK
  2. Wavefront Bladeless EpiLASIK
  3. Wavefront Trans Epithelial Surface Ablation
  4. Topography linked LASIK
  5. Bladeless Femto LASIK, ReLex- FLex
  6. ReLex- SMILE and ICL (Implantable Lenses)
  7. ReLEx SMILE from the VisuMax Carl Zeiss Laser is a fresh approach to laser eye surgery in myopic patients. Considering that the evolution of refractive surgery is moving towards to the preservation of corneal biomechanics to increase safety and achieve aberration-free results, ReLEx SMILE appears to be a milestone in minimally invasive laser vision correction surgery.


  1. VisuMax is the new horizon of femtosecond technology in ophthalmology
  2. It is designed to become the corneal surgery workstation for a large spectrum of procedure options
  3. VisuMax can create extremely high precision 3D shaped incisions
  4. Unprecedented accuracy in corneal incisions
  5. A gentle procedure for the patient