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PRK, LASIK and SMILE –
The Three Generations

ever striving for perfection

of Laser Vision Correction
The Brief History of Laser Vision Correction Milestones in Corneal Refractive Surgery

Corneal refractive laser surgery is a widely used option for correcting vision impairment,
one that has evolved within a relatively brief span of only 30 years. As in other areas John Marshall
verifies excimer
of life, advancements were largely driven by a desire for continuous improvement. Three laser suitability
generations of techniques, in particular, shaped the field: PRK, LASIK and SMILE. for vision
correction

Tsutomu Sato Marguerite Ioannis Pallikaris

PRK, the 1st generation of laser vision correction, is characterized by surface ablation makes the first First PTK is McDonald performs the first
Walter Sekundo 200,000 eyes
performs have been
practical attempt
surgery of the cornea using an excimer laser. Often considered an economic solution, it to perform
performed
by Theo Seiler
performs the first LASIK procedure
the first SMILE treated with
successful PRK and coins the SMILE
procedure
continues to be a commonly performed procedure. LASIK, which was introduced as the refractive surgery treatment term

2nd generation of laser vision correction, also involves reshaping the cornea with an excimer
laser. Using flap surgery, it enables quick visual recovery, which in part has made it a very
popular treatment today. SMILE, the 3rd generation of laser vision correction, is a small 1896 1930 1963 1985 1986 1987 1988 1990 1999 2000 2006 2011 2015
incision lenticule extraction technique. Entirely performed with the femtosecond laser, this
minimally invasive, flapless surgery is redefining refractive surgery as we know it. Leendert Jan Lans First Femto-LASIK
José Ignacio
publishes the first Development ALK is introduced LASEK as further treatment is SMILE is
Barraquer
experimental of the BKS by Luis Ruiz development performed by launched
develops
It seems that laser vision correction has never been more advanced, tissue preserving and study on
keratomileusis
technique of PRK Imola internationally*
refractive surgery Ratkay-Traub
gentle for the eye than today. The future is minimally invasive.

1st Generation: PRK / LASEK

2nd Generation: LASIK / Femto-LASIK
3rd Generation: SMILE

* US approval is pending
 The Three Generations of Laser Vision Correction SMILE
Small incision lenticule extraction offers many advantages

SMILE has made minimally invasive, flapless surgery possible for the first time. The clinical
PRK LASIK SMILE procedure is based on the lenticule extraction technique, in which a lens-shaped piece of
corneal stromal tissue is removed through a small incision. With an 80 % smaller
side-cut and a 30 % smaller cap cut than is needed for LASIK, SMILE offers the potential

1Generation
st
2 nd
Generation
3 rd
Generation
for less incidence of dry eye, infection and epithelial ingrowth. The cornea remains largely
intact to provide more biomechanical preservation and stability.

“SMILE is LASIK without a flap

and PRK without pain.”
D
 r. Rupal Shah
New Vision Laser Centers, Vadodara, India, ESCRS 2011 Vienna

“We love doing minimally invasive surgery because it´s faster, safer,
Surface ablation Flap Minimally invasive, more gentle on the patient and it delivers really good results.”
surgery surgery flapless surgery
D
 r. David Donate
• Subepithelial ablation • Stromal ablation • Intrastromal lenticule extraction Centre Laser Vision Roosevelt, Lyon, France, ESCRS 2014 London
• Excimer laser treatment • E xcimer laser treatment or • Femtosecond laser treatment
• Extended visual recovery time combined with femtosecond laser • Gentle treatment
• Patient discomfort • Quick visual recovery • N o flap complications “Convincing, long-term follow-up results with SMILE
• Some risk of flap complications (e.g. less incidence of dry eye)
mean that this is a technique that´s here to stay.“
Prof. Walter Sekundo
Phillips University Marburg, Germany, DOG 2014 Leipzig
SMILE combines the advantages of PRK and LASIK ReLEx SMILE from ZEISS
The first minimally invasive, flapless SMILE solution

PRK – 1st Generation With ReLEx® SMILE, ZEISS is the first company to provide a way for treating
patients with the minimally invasive, flapless SMILE procedure. The development
of SMILE suggests that the future of refractive surgery is minimally invasive.
Now is the time to move up to the 3rd generation of laser vision correction.

Layer preparation Epithelial layer removal Corneal sculpting Eye protection

Made for excellent performance
LASIK – 2 nd
Generation ReLEx SMILE is exclusively performed with one laser,
the high-precision ZEISS VisuMax®, a groundbreak-
ing femtosecond laser that ensures high-level re­
producibility and predictability, even with high
corrections. Its outstanding cutting precision,
exceptional speed and gentle treatment approach
make it an ideal platform for advanced corneal
Flap creation Patient transport Flap is folded back Corneal sculpting Flap is repositioned
surgery applications such as SMILE.

SMILE – 3rd Generation Perform all three generations

of laser vision correction
Combine the VisuMax with a MEL® excimer laser
from ZEISS, and you can perform all three
generations of laser vision correction. It is the only
combined platform of its kind that can do that!
The combined setup:
A refractive lenticule and The lenticule is removed Removing the lenticule VisuMax and MEL excimer laser
small incision are created through the incision with only changes the shape of the
inside the intact cornea – minimal disruption to the cornea, thereby achieving the
all in one step corneal biomechanics desired refractive correction