[Review] ReLEx SMILE flapless eye surgery for myopia correction

[Review] ReLEx SMILE flapless eye surgery for myopia correction

As someone who has been wearing glasses since the age of seven, I’m well acquainted with the hassle, annoyances, and cost that come with having high myopia of -10.25 (right eye) and -8.75 (left eye).

The layman explanation for the above would be that I have an eye power of nearly 900 to slightly over 1,000. Even with high-index lenses, my spectacle lenses are thick and heavy, often causing redness and friction on my nose where the silicone nose pads sit.

I also unfortunately find contact lenses extremely uncomfortable and sometimes a little painful, so I’m 100% reliant on specs.

After 26 years of not being able to see my own reflection clearly without glasses, and paying RM900-RM1,000 per pair, I decided it was time to finally do something more permanent about it.

Disclaimer: This article is not sponsored by the eye hospital or any other brands. The eye surgery that I did was fully paid for by myself and no costs were subsidised by any third party. This experience and review is written from my own personal experience and should not be taken as medical advice.

LASIK versus ReLEx SMILE

The laser vision correction procedure that most people would know of is LASIK (Laser-Assisted In Situ Keratomileusis).

LASIK is a procedure that permanently changes the shape of the cornea by using an excimer laser. A mechanical microkeratome (a blade device) or a laser keratome (a laser device) is used to cut a flap in the cornea.

This flap is then folded back revealing the stroma, the middle section of the cornea, which is reshaped by the pulses from a computer-controlled excimer laser beam. Once the reshaping is finished, the surgeon replaces and secures the flap without the need for stitches.

There is another procedure that’s also for myopia and astigmatism correction, called ReLEx SMILE (Small Incision Lenticule Extraction). SMILE is also known as flapless surgery, because unlike LASIK, no flap is created during the procedure.

Both of these procedures can correct short-sightedness and astigmatism but there are clear differences between them.

I won’t go into all of the differences here, but I will list the three main reasons why I preferred the ReLEx SMILE option.

  1. ReLEx SMILE is less invasive than LASIK due to a much smaller side-cut on the cornea. LASIK requires a 20mm flap diameter, SMILE only requires an incision of between 2mm to 4mm.
  2. ReLEx SMILE usually has less side effects because less corneal nerves are disturbed. Plus, no flap is created, so there are no risks of flap-related complications such as wrinkles on the corneal flap or inflammations due to improper placement of the flap. In general, dry eyes and other common side effects are greatly reduced.
  3. Recovery time is much quicker after ReLEx SMILE, which was a high priority to me because I didn’t want to be away from my computer screen or the gym for longer than necessary.

But first, my eyes had to be eligible for the surgery. 

Full eye evaluation

I decided to do my eye assessment and surgery at Ikonik Eye Specialist Centre, Bukit Jalil. 

The eye assessment and evaluation was thorough. By thorough, I mean it was almost three hours long.

The eye assessment room is equipped with various eye machines to measure eyeball length, eye estimated power, optic nerves, eye blood vessels, cornea thickness, eyelid moistness, cornea curvature, and so on.

It was a long but necessary process. Every single measurement and detail was recorded and these figures would later be passed to an optometrist to decide whether my eyes could make the cut.

The results of the evaluation were positive, as apart from my very high myopia and moderate astigmatism, I had a pretty healthy pair of eyeballs.

The most crucial reading of all was the corneal thickness because that determined whether I qualified for ReLEx SMILE.

Ideally, corneal thickness should be at least 550 microns thick; fortunately, mine were way above average.

I was eventually given the green light for ReLEx SMILE, plus time to clarify the process, potential side effects, and risks with Datuk Prof Dr Che Muhaya Haji Mohamad. 

She is one of the Medical Directors at Ikonik Eye Specialist Centre, and would be doing the surgery herself.

She explained clearly the whole process and also post-surgery aftercare. My assessment readings were used to explain how many microns of cornea thickness will be lasered, and I was reassured that it’s supposed to be a quick and precise process.

Most importantly, she emphasised the importance of being calm and positive. Think about the end goal, she said, about how you want to be able to see clearly again. Her whole aura and confidence was so extremely assuring. I was 100% ready for this.

Price

The total price that I paid for the whole process was RM13,168 (RM660 for the full eye assessment, RM12,379 for the flapless surgery, RM129 for the post-surgery eye drops).

Flapless surgery (ReLEx SMILE) is more expensive than LASIK (may be about RM8,000 to RM10,000), but due to the fewer risks and potentially more positive outcome, I felt it was worth the higher price. 

The payment terms at Ikonik were RM3,000 deposit and the rest on the day of the surgery. I however did request for another round of clarifications before the actual procedure so they allowed me to not pay the deposit beforehand, and I paid in full on the surgery day itself.

Actual surgery 

Despite Prof Muhaya’s reassurances the other day, I was still scared sh*tless. I’m not going to sugar coat this, I was imagining the worst case scenarios. Like, what if I moved accidentally during the procedure and my eyeballs just get lasered right off.

Before entering the surgical room, I was given specific instructions beforehand on what to expect and what to do.

My eyelids were held open by a speculum, which was slightly uncomfortable initially. Some numbing eye drops were applied, these sting but only for a few minutes. Once the effects kicked in, all the discomfort (and other localised feelings) went away.

I was reminded to stay very still and look directly ahead at a green light. Even if the green light moved or became blurry, I had to keep looking straight ahead and not shift my gaze. The countdown started for the laser to do its job and I held my breath.

Prof Muhaya, bless her, kept repeating words of affirmation and positivity from start to finish. It really helped calm my nerves.

The whole process was so quick, it was maybe four to five minutes per eye, with the green light segment lasting about 20 seconds.

Once we were done, the effects were immediate. However, there was an initial cloudiness to my vision, as though there was a blurry veil covering my eyes. So manage your expectations, do not expect full clarity and clearness just yet.

Despite the blurriness, the difference is vast, I was able to see my husband’s face outside the surgical room window. I could read some words from afar. 

It was a whole new world.

Same day, post surgery

I was sent home with three different eye drops, one of which was antibiotics. I had to administer the eye drops at various intervals and keep to a schedule. 

Not expecting too much discomfort, I went back hopeful and excited. But pain kicked in within the same hour.

My eyelids felt like they were on fire, the stinging was excruciating. The sunlight did not help, every hint of light felt like microneedles against my eyeballs. I could hardly keep my eyes open.

Later over a call with the eye specialist centre, I was told that this is a normal reaction as the numbness was beginning to wear off. Some people are less sensitive and they don’t feel the discomfort as much. I wasn’t as lucky.

Unfortunately, the only thing you can do is use the eyedrops to keep the eyes as moist as possible, and wait it out.

A timer was set to ring every 10 minutes and my husband helped to diligently administer the drops. The discomfort lasted for over two hours till I eventually fell asleep.

When I woke up several hours later, it was already night time. With the sunlight gone and my eyes properly hydrated, I could open them, to my relief.

I decided not to push my luck, and went right back to bed after some light dinner in the dark.

Day 1, post surgery

The next day after surgery was most surreal. I woke up and the blurriness was greatly reduced. My vision was at 70% clarity and there was no more sharp or stinging pain.

The dryness occurs every now and then so I had to stick to my eyedrop schedule very strictly. I even went out and bought my first pair of non-powered polarised sunglasses. 

To avoid dryness due to blinking less, I was also supposed to not look at any screens. I pushed the boundaries of that by going into the office to work. I convinced myself that I found a loophole by forcing myself to blink at every touch and swipe on the phone screen. 

By night time, my vision was at 80-85% clarity and I was told that it would get even clearer over time.

Week 1, post surgery

It’s becoming harder to remember to use the eye drops because the dryness occurs much less frequently. I also noticed I was no longer entirely reliant on sunglasses when I’m out in the sun (although it is recommended), as the light no longer makes me wince or squint as much.

On and off throughout the week, I’d feel like there was an eyelash stuck in my eye, but actually there was nothing there. It didn’t hurt and it wasn’t very uncomfortable, just a slightly odd sensation that I tried to ignore. I read that this is normal and it’s part of the recovery process.

I had already scheduled a follow up appointment with Prof Dr Muhaya after the first week. It’s a similar process, I’m given an eye evaluation (but a much quicker one), with one of the main tests being the thickness of the cornea.

Given my above-average corneal thickness, with full correction of -10.00 (which is the maximum correction), my corneal thickness post surgery is still within a comfortable range. That might explain why I’m not feeling as much eye dryness too. 

Month 1, post surgery

It’s now been one and a half months since my ReLEx SMILE surgery, I can tell you with absolute certainty that I have zero regrets.

There are some days when I wake up and my eyes feel a little drier than usual, but a face wash and some eye drops will resolve it very quickly. During the day, I carry around my sunglasses just in case I need them, but truth be told, I only wear them when the sun is blazing or if I’m driving on a hot day.

At the time of this writing, yesterday I finally went for my first swim without any powered goggles and it was a liberating experience. 

People say you don’t know what you’ve got until it’s gone. I’ve been missing clear eyesight without heavy glasses for so long that I completely forgot what it’s like to be able to see with 20/20 vision. 

I still automatically reach for where my glasses used to be the moment I get up. I try to remove my invisible glasses before I wash my face. I catch myself occasionally pushing phantom glasses up on my nose while I workout or sweat.

But I don’t miss my spectacles at all and I can’t wait to try more activities and experiences without feeling limited by 23.1g on my nose.

  • Read our other reviews on various products and experiences here.

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