What is a ReLEx SMILE?

ReLEx SMILE in India

The full name is cumbersome: Refractive Lenticule Extraction through Small Incision Lenticule Extraction. Which is why everyone uses the short form, SMILE. The marketing team earned their pay on that acronym.

What the technology actually does is more interesting than the name. ReLEx SMILE is a flapless, keyhole refractive surgery that corrects myopia and myopic astigmatism by removing a thin, disc-shaped piece of corneal tissue (a lenticule) through a small side incision. The entire procedure is performed using the VisuMax femtosecond laser in a single step, with no corneal flap and no excimer laser.

At Vasan Eye Care, ReLEx SMILE is offered as an evidence-based option for eligible patients who prefer a flapless, minimally invasive procedure. The technique preserves more of the cornea’s structural integrity than flap-based LASIK and leaves more of the corneal nerves undisturbed, which often translates into less post-operative dry eye. For certain patient groups (defence recruits, athletes, musicians, dry eye-prone professionals), these trade-offs are more than academic.

ReLEx SMILE has carved out a strong presence in the Indian refractive surgery landscape, particularly among patients in high-demand professions: defence forces, aviation, competitive sports, and screen-intensive careers in the IT sector. For all of these groups, the absence of a corneal flap is a genuine long-term advantage. A flap is a flap; it remains a potential point of weakness decades after the surgery, and in professions where a blow to the eye is plausible, avoiding one has real value.

Indian centres performing ReLEx SMILE follow the manufacturer’s clinical guidelines alongside All India Ophthalmological Society and international recommendations. Candidate selection involves detailed refractive and corneal assessment: topography, tomography, pachymetry, aberrometry, tear film evaluation, and macular imaging. Stable refractive error for at least one year, a healthy tear film, adequate corneal thickness, and no sign of ectatic corneal disease are essential prerequisites. The approved treatment range for ReLEx SMILE typically covers myopia up to -10 dioptres and astigmatism up to -5 dioptres.

Types of ReLEx Procedures

The ReLEx family includes earlier and later variants, each reflecting the evolution of lenticule extraction:

How ReLEx SMILE Works

The VisuMax femtosecond laser delivers extremely short, precisely focused pulses inside the corneal stroma. These pulses trace out the anterior and posterior surfaces of the lenticule, along with a small side incision of two to four millimetres. The entire laser phase takes under 30 seconds per eye. Nothing is cut on the surface; everything happens within the cornea.

The surgeon then introduces a fine dissector through the small incision, gently separates the lenticule from the surrounding tissue, and extracts it in a single piece. Removing the lenticule reshapes the cornea, which is what corrects the refractive error. Because the upper layers of the cornea remain intact, structural integrity is preserved far better than in flap-based approaches, where a circular hinge is permanently present in the cornea.

When Is ReLEx SMILE Indicated?

ReLEx SMILE may be considered for patients who want to reduce dependence on glasses or contact lenses. Typical indications:

• Stable myopia and myopic astigmatism within approved ranges
• Contact lens intolerance, including recurrent infections, dryness, or discomfort
• Jobs or lifestyles with a higher-than-average risk of ocular trauma
• A clear preference for a flapless procedure
• Mild to moderate dry eye tendencies, where the flapless design helps

Patients with keratoconus, very thin corneas, or significant ocular surface disease are typically not suitable. Hyperopia is also outside the standard ReLEx SMILE indication; other refractive techniques handle that correction.

ReLEx SMILE: Step-by-Step Procedure

1. Comprehensive refractive and corneal evaluation.
2. Treatment plan calculated and loaded onto the VisuMax platform.
3. On the day of surgery: topical anaesthetic drops instilled, eye prepared.
4. Curved docking interface applied to stabilise the eye.
5. Femtosecond laser creates the lenticule and the small side incision in around 20 to 30 seconds per eye.
6. The surgeon separates and extracts the lenticule through the incision.
7. Cornea irrigated, antibiotic drops applied.
8. The patient rests briefly, discharged the same day.
9. Follow-ups at day one, one week, one month, three months.

How Much Does ReLEx SMILE Cost in India?

Final quotations are discussed after pre-operative assessment.

Post-Surgery Care and Recovery

What to Expect After ReLEx SMILE?

Most patients notice a clear improvement in distance vision within 24 hours, with continued refinement over the first few weeks. Mild grittiness, light sensitivity, and watering typically settle within a few days. Dry eye symptoms are generally milder and shorter-lived than with flap-based LASIK, because fewer corneal nerves are disturbed. This is the single most tangible advantage of the flapless design in daily life.

Post-Operative Care Tips

• Apply prescribed antibiotic and lubricating drops on schedule.
• Do not rub the eyes for any reason.
• Keep water out of the eye for at least one week.
• Avoid swimming and saunas for four weeks.
• Eye make-up delayed for two weeks.
• Screen work can resume in a few days, with regular breaks and lubrication.
• Avoid contact sports and dusty environments for about a month.
• Attend follow-ups to monitor healing and IOP, and to address any residual refractive issues.

References

• American Academy of Ophthalmology. Lenticule Extraction Refractive Surgery Overview.
• Sekundo W et al. Small Incision Lenticule Extraction (SMILE): Clinical Outcomes.
• Zeiss Meditec. VisuMax and VisuMax 800 Technical Specifications.
• All India Ophthalmological Society. Refractive Surgery Guidelines.
• Indian Journal of Ophthalmology. SMILE in Indian Patients: Safety and Efficacy.