ReLEx SMILE in Singapore (2025): Side effects, Costs, Suitability, Risks

ReLEx SMILE is the short form for ReLEx (Refractive Lenticule Extraction Small Incision Lenticule Extraction).

Types of Laser Vision Correction Options

You’re likely familiar with procedures like LASIK and Advanced Surface Ablation (ASA). Within the ASA category, several variations exist, including PRK, epi-LASIK, LASEK, and TransPRK.

Each of these techniques was developed to address specific vision problems. However, determining which procedure is right for you largely depends on your eye’s unique structure and characteristics.

When vision impairment affects your daily activities, work performance, or academic success, it can significantly impact your quality of life.

While glasses and contact lenses offer solutions, many find them inconvenient or limiting.

In this piece, I’ll explore why ReLEx SMILE might be an appropriate choice for your vision correction needs, walk through the treatment process, and offer comparisons with alternative procedures.

What is ReLEx SMILE?

ReLEx SMILE is a minimally invasive procedure that utilizes the Zeiss VisuMax femtosecond laser technology. It’s an appropriate option for patients with:

Myopia (nearsightedness): ranging from -1.00 (100 degrees) to -10.00 (1000 degrees)
Astigmatism: measuring up to -3.50 (350 degrees)

It’s important to note that ReLEx SMILE is not recommended for hyperopia (farsightedness).

With more than a decade of clinical application and USFDA approval, studies have demonstrated that ReLEx SMILE delivers comparable effectiveness to traditional methods like LASIK and ASA [1]. The SMILE incision is less than 4 mm long.

A key advantage of this technique is its flapless approach, which preserves the cornea’s outer layer integrity. The incision required is substantially smaller than those used in LASIK procedures, resulting in less nerve disruption and potentially reducing post-operative complications such as dry eye syndrome.

Because of thin corneas, high prescriptions, dry eyes, and other factors, some individuals are not suitable for LASIK surgery. Eye doctors have traditionally employed Photorefractive Keratectomy (PRK) and Advanced Surface Ablation (ASA) for these eyes, which is a significant operation but takes longer to heal.

However, this doesn’t necessarily mean ReLEx SMILE represents the optimal choice for everyone. A comprehensive assessment with a qualified ophthalmologist remains essential to identify the most appropriate treatment based on your specific eye condition and lifestyle requirements.

Is ReLEx SMILE suitable for me?

There’s a common misconception that laser eye procedures are universally appropriate. However, this isn’t accurate. Whether considering ReLEx SMILE, LASIK, or ASA, certain exclusion criteria apply.

You may not qualify for ReLEx SMILE if you:

Are younger than 18 years old, as your prescription is likely still changing
Have experienced prescription changes within the past 12 months
Have concurrent eye conditions such as glaucoma or cataracts
Present with corneas that are exceptionally thin, irregular, or steep
Suffer from significant dry eye syndrome
Have hyperopia (farsightedness)
Have astigmatism without myopia
Are currently pregnant or nursing
Have compromised general health

Regardless of which vision correction option you’re exploring, scheduling a professional evaluation with an ophthalmologist is essential. Even identical degrees of myopia can manifest differently between individuals, making a comprehensive assessment crucial. The most appropriate treatment approach will be determined based on your specific condition and eye anatomy.

If you’re considering ReLEx SMILE, beginning with a thorough consultation is the recommended first step. An eye care specialist is best positioned to guide you toward the procedure most suitable for your unique circumstances!

ReLEx SMILE vs LASIK vs PRK

Here’s a simple table of comparison to find out if ReLEx SMILE is suitable for you, and what the difference is compared to PRK and LASIK:

What are the benefits of ReLEx SMILE?

Here’s the rephrased section that maintains the same meaning while avoiding plagiarism:

The ReLEx SMILE Procedure and Benefits

This technique involves creating a small piece of corneal tissue (called a lenticule) and a tiny 2-4 mm incision. Unlike LASIK, this minimally invasive approach eliminates the need for flap creation. Research highlights several advantages of ReLEx SMILE:

Minimal Incision Size
The procedure requires only a 2-4 mm opening, significantly smaller than LASIK’s 22 mm incision.
Reduced Complication Risk
Since no flap is created during surgery, patients avoid risks associated with flap displacement or dislodgement.
Enhanced Recovery Experience
As a flapless, minimally invasive procedure, ReLEx SMILE is associated with decreased likelihood of dry eye symptoms and visual discomfort during recovery. Additionally, it may promote better long-term corneal stability, potentially lowering risks of ectasia and regression of surgical outcomes.
Accelerated Healing
Most patients regain approximately 80% of their vision within 3 days post-surgery, allowing for a quick return to work activities. Vision typically continues improving over 1 to 3 months, generally stabilizing around the 3-month mark.
Superior Corneal Structural Integrity
The compact 4mm incision potentially delivers greater corneal stability and reduces the risk of corneal ectasia, a rare but serious LASIK complication.
Ideal for Athletic Individuals
Without a corneal flap, this procedure suits those with highly active lifestyles. ReLEx SMILE may be particularly beneficial for individuals participating in contact sports or activities with potential head impact risk. However, a mandatory recovery period still exists during which such activities should be avoided. Always consult your ophthalmologist before resuming sports participation.

How is ReLEx SMILE surgery performed?

As explained previously, this procedure employs femtosecond laser technology. The minimally invasive operation typically takes approximately 15 minutes for both eyes when conducted by a skilled surgeon. Prior to beginning, your eyes will be anesthetized with topical anesthetic drops.

The procedure follows these key steps:

Lenticule Formation and Access Creation
The surgeon uses the laser to precisely shape a predetermined lenticule according to your refractive requirements. This lenticule is essentially a small disc of corneal tissue positioned just beneath the cornea’s outermost layer. Following lenticule creation, the surgeon makes a small 2-4 mm incision.
Lenticule Extraction
The surgeon carefully removes the shaped lenticule through the tiny incision. This minimal access point allows the majority of your corneal tissue to remain undisturbed throughout the procedure.
Vision Restoration
The extraction of this lenticule effectively alters the corneal curvature. This strategic reshaping of the cornea is what corrects your refractive error and improves your vision.

Setting your expectations for a ReLEx SMILE surgery

ReLEx SMILE suitability test

Your ophthalmologist will check your eyes to determine whether or not you are a candidate for SMILE.

What he or she will do is as follows:

Put your vision to the test. It’s to ensure that your vision hasn’t shifted. It also indicates how farsighted you are and whether you can use SMILE to correct your vision.
Examine your eyes for any additional issues. Your ophthalmologist will ensure that you do not have any eye issues. It’s because other issues may interfere with your operation, or SMILE may exacerbate those other issues.
Measure and map the surface of your cornea. Your ophthalmologist will check the thickness of your cornea and make precise measurements of the cornea’s surface. Your eye surgeon uses these measurements to program the computer-based laser used during surgery.
Measure your pupil size.

How to prepare for ReLEx SMILE Surgery

Aside from following the checklist below, the most important thing you can do to prepare for your treatment is to relax as much as possible. Ask your ophthalmologist if you have any questions, doubts, or concerns about the treatment — no matter how trivial, you must be informed and satisfied with the entire ReLEX SMILE Surgery process from beginning to end.

Here’s a checklist for you to go through to prepare for the surgery:

Avoid wearing perfume or cologne and hair products like hair spray or mousse that contain alcohol.
Remove all eye makeup at least 24 hours before surgery. Don’t wear any makeup on your face on the day of your eye surgery.
Choose a comfortable piece of clothing and avoid wearing anything that will cause lint, such as wool.
Depending on your occupation, you may need to plan on missing work for up to two days after ReLEx SMILE. Please consult with an optometrist about your specific situation.
Make transportation arrangements; you will almost certainly be unable to drive yourself home, and public transportation may be exhausting.
Drinking any form of alcoholic drink should be avoided before and after your surgery because it dehydrates your eyes.
Do not bring small children, infants, or pets to the clinic.
You will have to sign an informed consent form and pay the balance of your treatment fee shortly before your procedure.

You and your ophthalmologist should discuss your SMILE expectations before surgery.

People who expect to achieve the perfect 20/20 vision through SMILE may be disappointed. SMILE enables people to do the majority of their daily chores without the use of corrective glasses. However, specific tasks, including reading or driving at night, may still require the use of spectacles.

What to expect during a ReLEx SMILE surgery

During surgery, the patient is given a drop of anesthesia and an antibiotic right before entering the operating room. The patient’s bed glides underneath the laser machine, gently guiding the patient up to the docking station.

The laser stays in place for about 30 seconds, which is all it takes to generate the planes within the cornea. It’s mild. It’s as though someone is softly kissing your eye. There is no discomfort, and the patient can keep his or her eyesight during the process.

There are numerous intriguing visual impacts, which eye surgeons usually explain to the patient as they go through the treatment. The laser releases the eye after 30 seconds and gently moves the patient back. Then, it will release the lenticule, the lens that we’ve formed within the corneal stroma, and slip it out via the small keyhole incision.

The entire ReLEx SMILE surgery usually takes around 5 minutes, with most of that time spent directing the slow-moving bed. So it’s just softly maneuvering the bed and talking to the patient the entire time, 30 seconds of laser, and then careful manipulation to pull the lens out, and the treatment is over.

What to expect after a ReLEx SMILE surgery

ReLEx SMILE surgery recovery can usually take days or weeks to settle, and the total healing duration for the cornea after ReLEx SMILE is estimated to be 3 to 6 months. That is when you may resume all of your pre-surgery activities without concern.

The recovery timetable will vary depending on each individual’s ability to heal.

Plan for relaxing activities, and avoid activities that will strain your eyes, like reading, watching television, or using the Internet. After the procedure, we recommend having a lengthy nap.

Although SMILE eye surgery needs a little downtime, you should plan on taking things gently for the following several days as your cornea recovers.

Avoid any water activities such as swimming in pools or bathing in hot tubs after the surgery.
Keep any kind of water out of your eyes even when showering, just until your eyes completely heal.
For at least 2 to 3 days, keep your workout modest and low-impact.
Don’t wear makeup, as brushes and applicators can include microbes that can cause serious eye infections.
Continue to use all prescribed medications and eye drops.
1. During the weeks after your SMILE eye surgery, you must continue all of your prescribed eye drops and medicines unless otherwise directed by your eye surgeon. Even if the adverse effects start to fade, you should still follow all aftercare recommendations. While recovering after SMILE eye surgery, do not use any other drops, pain killers, or non-approved drugs.
Wear safety glasses.
1. Wear the provided eye shield when sleeping for the first three nights following SMILE eye surgery. When you walk outside, you should wear polarized sunglasses to protect your eyes from damaging UV rays.
Avoid areas where there is smoke or dust in the air.
1. In the weeks following your SMILE operation, you should avoid environments with airborne particles such as sand, smoke, or dust. Minor irritants like these might cause eye damage or substantial discomfort while you recuperate.

A follow-up visit with your eye surgeon the day after your surgery should be necessary.

Possible risks and side effects of ReLEx SMILE

Like all laser vision correction procedures, ReLEx SMILE comes with potential risks and side effects, though it’s generally considered a safe and effective treatment option. Understanding these possible complications is crucial before deciding to undergo the procedure.

Common Side Effects

Dry Eye Syndrome Dry and scratchy eyes are among the most common side effects following laser vision correction. Fortunately, ReLEx SMILE’s minimally invasive approach may result in fewer dry eye symptoms compared to LASIK.

This is because SMILE doesn’t require creating a corneal flap, which preserves more corneal nerves responsible for tear production. Most patients find that any dry eye symptoms are temporary and can be effectively managed with artificial tears or other treatments prescribed by their surgeon.

Vision Fluctuations While vision typically stabilizes within a few weeks after ReLEx SMILE, some patients may experience temporary issues such as night vision glare or double vision during the recovery period. These symptoms generally resolve as healing progresses.

Under or Over Correction Not everyone achieves complete vision improvement after the procedure. The level of recovery varies based on individual factors, and some residual refractive errors might remain. This means some patients may still require glasses or contact lenses, albeit with a much lighter prescription. If significant under or over correction occurs, follow-up enhancement surgery can be performed to address the remaining refractive error.

Medical Considerations

All surgical procedures carry risks, and laser vision correction is no exception. However, ReLEx SMILE’s minimally invasive nature—requiring only a small incision without creating a corneal flap—eliminates complications specifically related to flap creation and healing that can occur with LASIK.

Current Limitations

A notable limitation of ReLEx SMILE is that it’s currently approved only for treating myopia (nearsightedness) and astigmatism. Treatment for hyperopia (farsightedness) is expected to be available in the future but isn’t yet an option. This contrasts with LASIK, which can correct all three refractive errors.

Risk Minimization

To minimize risks, comprehensive pre-surgical screening is essential. Your surgeon will perform a detailed health assessment and vision examination to determine your suitability for the procedure. Factors such as corneal thickness, eye health, and existing conditions like dry eye syndrome will be carefully evaluated.

Being transparent about your complete eye history and any existing conditions is crucial for minimizing potential complications and maximizing the benefits of ReLEx SMILE.

Statistical Safety Profile

The safety profile of ReLEx SMILE is supported by impressive statistics, with over 10 million eyes successfully treated worldwide. The laser portion of the surgery typically takes less than 30 seconds, reducing the time your eye is exposed to the laser compared to some other procedures.

Post-Operative Astigmatism

Some patients express concern that laser vision correction might cause or worsen astigmatism. Research indicates that the chances of developing post-operative astigmatism with ReLEx SMILE are very low. In fact, the procedure is specifically designed to correct existing astigmatism rather than cause it.

Before proceeding with ReLEx SMILE, it’s essential to discuss your individual risk factors and potential side effects with your eye doctor during your consultation to make an informed decision about whether this procedure is right for you.

Here’s a summary of the potential temporary side effects of ReLEx SMILE that may occur throughout the healing process:

Irregular vision
Lights with haloes or glares
A lack of moisture in the eye
Sensitivity to light
Long-term increased sensitivity to light and glare
Temporary overcorrection
Burning, itching, and foreign body feel owing to dry eyes
Impairment of both eyes’ cooperation
Glares
Haloes
Dry eyes
Mild fluctuation of vision
Infections and complications – sporadic with today’s laser technology
Some temporary dryness can occur.
There is still a fair chance of under-correction overall.
- Although in general, SMILE patients usually require far fewer touch-ups than other laser vision correction patients.
Minor risk of infection (as with all laser vision correction procedures)
- There is a minimal danger that it may aggravate some unidentified structural weakness, in which case there will be a need to follow up with strengthening therapy. This danger looks to be substantially lower than with LASIK because SMILE surgery keeps the structural integrity of the hard layer upfront, which LASIK does not.
There is a risk that there will be some variation over time.
- Again, the European data suggest less drift since SMILE leaves the complex layer entirely upfront. The other surgeries, on the other hand, fundamentally degrade the tough layer.
Few epithelial cells (surface tissue) may be displaced. Hence, occasionally the eye surgeon might need to remove this cluster of epithelial cells known as a piece of clog. It usually does not reoccur within the first several months or so following the treatment.

If over or under-correction occurs in the range of +/-0.75 or more, you may have to undergo an enhancement 3 months after the procedure or when the refractive error has become stable. SMILE does not correct presbyopia, which requires reading glasses for people over 40 years of age.

How much does ReLEx SMILE surgery cost?

The average cost of ReLEx SMILE surgery range from $4600 – $5659 per eye. As with all medical procedures, you have your choice of public institutions and private clinics for your ReLEX SMILE procedure. Public institutions are generally, though not always, the cheaper options.

Check out the price comparison prepared for you (based on a few ReLEx SMILE clinics in Singapore).

Atlas Eye Specialist Centre – $5,359
LSC Eye Clinic – $5,659
Clearvision Eye Clinic & LASIK Centre – $5,200
W Eye Clinic – $5,337.16
Asia Pacific Eye Centre – $4,805.37
SNEC Laser Vision Centre – $4,600 – $5,000

Can I use Medisave or insurance to pay for ReLEx SMILE surgery?

ReLEx SMILE and other vision correction treatments are considered elective (non-essential) surgery, hence Medisave cannot be used to pay for them. It’s because your eyes are not suffering from any sickness.

However, there are exceptions. You can use Medisave if:

There is at least a 300 degrees difference between your left and right eyes.
If you are confirmed to be sensitive to eyeglasses and contact lenses.

Medisave may get you up to $1,200 with ReLEx SMILE. Contact your eye clinic for further information.

Is ReLEx SMILE better than LASIK?

ReLEx SMILE utilizes a technologically advanced femtosecond laser to create a hole in your cornea. The surgeon reshapes the cornea by using a lenticule to improve one’s eyesight. This treatment involves an 80% smaller side-cut and a 30% smaller cap cut compared to LASIK, and this means there is a higher chance of less side effects compared to LASIK.

SMILE also protects the biomechanical strength of the cornea after surgery to prevent dry eyes, which leads to a lower downtime than LASIK.

Is ReLEx SMILE permanent?

The effects of ReLEx SMILE surgery is usually permanent, but some people may see vision deteriorate to the original state, especially young people where myopia is not fully stable.

That’s why ReLEx SMILE surgeons don’t treat young people under the age of 20 or 21 who may have changing eye prescription.

As people reach middle age, what will happen eventually is that they may then need reading glasses. And as middle age progresses, the need for reading glasses may increase. But of course, if you’ve had SMILE, it doesn’t preclude you from having a further procedure in middle age to address the reading glasses issue.

How long does ReLEx SMILE take to heal?

As previously indicated, typical recovery time for ReLEx SMILE is approximately 3 days, though complete visual stabilization requires 1-3 months. During this recovery period, certain precautions are essential.

Here are important guidelines to follow during your healing process:

Initial 24 Hours
- Prioritize eye rest, ideally with a nap or extended relaxation periods
- Minimize reading activities that could strain your eyes
- Apply lubricating eye drops frequently
- Adhere strictly to prescribed medication schedules
First Week Recovery
- Shield eyes from UV exposure by wearing protective sunglasses outdoors
- Suspend all cosmetic applications and facial treatments
- Avoid touching or rubbing your eyes
- Stay away from environments with airborne irritants like dust or smoke
- Prevent water contact with eyes; exercise caution when washing your face and hair, and gently pat the eye area dry
- Refrain from vigorous physical activity and prevent sweat from entering your eyes
First Month Considerations
- Postpone participation in contact sports or activities with head impact risk
- Use protective eyewear when working with chemical substances
- Avoid aquatic activities, steam rooms, hot tubs, and hot yoga sessions
- Limit extended screen time on devices including phones, computers, and televisions
- Continue using prescribed eye medications and lubricants according to your ophthalmologist’s instructions

This represents general guidance that may require adjustment based on your specific situation. Your eye surgeon will provide personalized post-operative instructions tailored to your case. Following these professional recommendations closely ensures optimal healing and maximizes your surgical outcome!

ReLEx SMILE surgery, the 3rd generation laser vision correction procedure

Many studies have shown that ReLEx SMILE surgery produces excellent results, with minimal downtime. Because it corrects complications associated with corneal flaps, this technique is highly safe and effective. Furthermore, studies showed that it had excellent predictability and stability for myopia correction. Consider going for a ReLEx SMILE suitability test to kickstart your journey!