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SMILE laser eye surgery in Paris

The SMILE method is the most recent technique in refractive surgery involving the use of a laser beam. It enables the correction of various refractive errors (ametropias), and its range of indications continues to expand thanks to technological advances.

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Home » Refractive surgery in Paris » Techniques » SMILE laser eye surgery in Paris

Learn more about other refractive eye surgeries

Trans PRK

PRK

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Presbylasik

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Refractive errors

When light rays pass through the eye, they are refracted—that is, their direction is altered. This process is performed by the eye’s two natural lenses: the cornea and the crystalline lens. When the eye functions perfectly, the light rays converge at a single point on the retina, regardless of the distance of the object being viewed.

For this to occur, there must be a perfect match between the length of the eye (anteroposterior axis) and the refractive power of the cornea-lens combination. In some individuals, this is not the case, especially in myopic patients. In myopia, the cornea is too steep and/or the eye is too long, causing the light rays to converge in front of the retina, which impairs distance vision. Less commonly, the crystalline lens may be responsible.

Conversely, hyperopic eyes are slightly too short and/or have a cornea that is insufficiently curved. As a result, the convergence point of the light rays is located behind the retinal plane, leading to poor near vision, and sometimes also poor distance vision.

Myopia and hyperopia are visual disorders known as “ametropias.” There is a third type: astigmatism, which is due to an ovoid rather than spherical corneal shape. This curvature defect causes the formation of a blurred image along the anteroposterior axis of the eye, resulting in poor vision both near and far.

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SMILE: definition

The goal of refractive surgery is to correct ametropias. Several methods exist, three of which use a laser beam. Although the operative techniques differ, both LASIK and PRK (Photorefractive Keratectomy) are based on the same principle: corneal photoablation with an excimer laser to modify its curvature and thus the eye’s refractive power, providing the necessary correction.

The SMILE technique (“Small Incision Lenticule Extraction”) is different. Using a femtosecond laser, which allows extremely precise cuts, the surgeon creates a tiny disc, or “lenticule,” within the cornea, which is then removed. The characteristics (thickness, shape) of this corneal fragment depend on the visual defect being corrected and its severity.

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Indications for SMILE

This method allows for the effective correction of myopia, astigmatism, hyperopia, and presbyopia. Even high myopia can be treated, up to 10 diopters (D). For astigmatism, the treatment range is from 0.5 to 5D. SMILE is also a good alternative to LASIK when the latter is contraindicated, particularly in patients with pre-existing dry eye.

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SMILE : what you need to know

Before the procedure

As with all refractive surgery procedures, the preoperative assessment is essential to ensure both the success of the intervention and patient safety. It allows the calculation of the characteristics of the corneal lenticule to be removed for the required correction. Additional tests (corneal topography, measurement of minimum corneal thickness, fundus examination, etc.) are performed to confirm that the SMILE protocol is suitable, ruling out contraindications such as keratoconus or insufficient corneal thickness. Patient preparation is simple and mainly involves not wearing contact lenses for 8 days prior to surgery.

Equipment for SMILE

The VisuMax 800 femtosecond laser is currently the best equipment available for performing SMILE procedures. With a higher pulse frequency than previous models (2MHz vs. 0.5MHz for the VisuMax 500), it significantly reduces the time needed to cut the lenticule—only 10 seconds compared to 30 previously. This shorter intervention time helps reduce patient stress and improves comfort.

Moreover, while SMILE was initially limited to myopia, the VisuMax 800 now enables effective treatment of astigmatism, thanks to advanced robotic assistance systems and cyclotorsion control, which enhances safety and precision.

Procedure steps

The SMILE procedure is performed on an outpatient basis: the patient can go home the same day, accompanied by a relative. The intervention lasts about 10 minutes per eye and begins after the instillation of anesthetic eye drops.

The first step is to apply a device to flatten the cornea, as the laser cannot work effectively on curved surfaces.
Based on the pre-entered shape and thickness characteristics of the lenticule, the VisuMax 800 laser makes the appropriate cut within the cornea.
Once the cut is complete, the surgeon releases any remaining adhesions and removes the lenticule under a microscope.

After the SMILE procedure

Postoperative effects following SMILE are generally mild, with minimal or no pain. It is normal for the operated eye to water for a few hours. Many patients also report a sensation of having a foreign body in the eye, similar to sand grains. Increased light sensitivity and perception of halos may also occur but are usually temporary.

Postoperative treatment must be followed precisely, mainly consisting of antibiotic and anti-inflammatory eye drops for at least 2 weeks to control the risk of infection. Unlike other refractive surgery techniques, no protective glasses or shields are required after a SMILE procedure.

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SMILE LASER EYE SURGERY : PRICES IN PARIS

The SMILE technique is performed by Dr. Camille Rambaud at a rate of €1,750 per eye.

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SMILE: results

It takes about 8 weeks to fully appreciate the benefits of the procedure, but by the next day, 80% of patients have already regained more than 80% of their vision. Based on postoperative studies, it is estimated that 98% of patients can live without corrective lenses after SMILE. The results are stable over time, provided the visual disorder was stable before surgery, which is a prerequisite confirmed during the preoperative assessment. However, SMILE does not prevent the natural progression of vision, such as the onset of presbyopia around age 45 or cataracts about 20 years later.

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SMILE treatment: Assurance Maladie coverage

Like other refractive surgery procedures, SMILE is not covered by the French national health insurance, as it is considered a comfort procedure (since the visual disorders it corrects can be managed with glasses or contact lenses). However, more and more supplemental health insurance plans offer packages that include refractive surgery. It is advisable to contact your insurer as soon as you receive a quote from your surgeon.

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$dr camille rambaud ophthalmologist paris refractive surgery and cataract$

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This page was written by Dr. Camille Rambaud, an ophthalmologist based in Paris and a specialist in refractive surgery.