Abstract
In this article, we review the early experience with small incision lenticule extraction (SMILE) in the USA as well as recent international data. We address long-term experience, new techniques, optimization of settings, corneal biomechanics, and comparison with other refractive surgical procedures. Despite promising early experience, US refractive surgeons have adopted the SMILE procedure slowly, owing in part to limitations on energy settings that have impacted early visual recovery. Outside of the USA, advances in parameters and techniques have driven improved early and long-term outcomes, with the result of increasing adoption. Although there remains debate, there is evidence for parity with FS-LASIK in visual outcomes, as well as advantages to SMILE in post-operative dry eye, spherical aberration induction, and biomechanical stability. SMILE is a safe and effective procedure with promising advantages over other techniques and increasing usership worldwide. Continued improvements in energy optimization, nomogram development, and surgical technique allow for improved outcomes over early iterations of SMILE.
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