This is the first I've heard of this. In my area it seems comparable in price, within 1.5x the cost of LASIK. Considering how relatively cheap it is (a couple months' rent, or a fraction of the price of a car, to correct your vision for decades) I've never seen cost mentioned as reason to choose one over the other.
Maybe “severely more expensive” wasn’t the best wait to phrase it, but the difference is still quite steep and this can be a decision maker for many people. Especially as currently it appears that medium term/6-month outcome between PRK and SMILE are very comparable, or even slightly better in PRK [0].
This is exactly opposite to how I understood and experienced healing after Trans-PRK. My eyes are still very dry 6 months post surgery. Being at the upper limit of Trans-PRK yourself, did you actually go through with the surgery? If yes, how was your healing process? I would be very interested in chatting about it, since I am not particularly happy with mine, and wondering what can be done (and whom to blame).
From there on, the pain and foreign object feeling quickly subsided alongside the remaining "haze" and by day five, I neither had any subjective pain, nor any major issues reading text (both typed and digital). Had multiple check-ins of course, both at the clinic which performed the surgery and with my decades long ophthalmologist, no issues were found there either. Subjectively, I do not experience a heightened severity in dry eye symptoms for what that is worth.
Also had a clinical rotation in Ophthalmology just this month (small world, though was why I felt the urge to comment) and the attendings did assess my epithelium as having regrown evenly too.
What could have gone wrong for you and how to go about this, I really can't say and I am sure you have already considered /pursued it, but I can only suggest getting a second opinion from another established ophthalmologist, including looking at the eye drop regiment prior to the surgery and during, as well as post recovery.
In any case, I agree that a second opinion would be most helpful.
[0] https://crstodayeurope.com/wp-content/uploads/sites/5/2019/0... referenced from https://pubmed.ncbi.nlm.nih.gov/26871764/
[1] If you look at the source they are referencing, it compares TransPRK to aaPRK after three months and they were using Schwind machines, though did not clarify whether this was using Smartsurface. Very cursory search engine use tells me that this is toggleable, so an option on these machines. Even if this study did use Smartsurface though, that doesn't answer whether outcomes are different in TransPRK with Smartsurface vs TransPRK without Smartsurface. Additionally, I do not know whether this option was used in my case.
Some unsolicited advice: wait for widespread adoption, and review data on long term side effects from sources without a conflict of interest before you have a procedure like this. I went from 20/150 to 20/15 for a few years (which was pretty cool) but they're 20/40 now so I wear glasses/contacts when I leave the house anyway. Glasses and/or contacts aren't that bad.
In addition, vitamin D, fish oil, regular exercise, heated eye masks, and sun seems to help too.
Best of luck! It’s an annoying condition.
It is an unpleasant procedure and the recovery is quite painful. There is a reason why it is almost never done today.
https://moskowitz-eye.com/blog/most-popular-laser-eye-surger...
It seems that ASA is a wide term for methods of moving the epithelium and replacing it after the procedure. I had this with one of my treatments. It is far more pleasant. It makes sense that it is growing in popularity.
I had it done about fifteen years ago. My vision was perfect for a decade, but now I'm back in glasses.
PRK recovery was certainly uncomfortable, but I'd gladly do it again for another decade without glasses.
Yes, if the ophthalmologist messes up. Sadly!
My bet is on SMILE evolving but we'll see where it goes
She said a Collamer lens was inserted into her eye and the procedure was reversible. I assume this is also available in the US?
I'm here to tell everyone to listen to the doctor about pain medications and sleeping after PRK. I have a repeatedly-demonstrated very high tolerance for pain, and didn't bother to follow the directions.
As a result, I spent about an hour seriously considering whether it would hurt less if I physically scooped out my eyeballs by hand. That's not a metaphor -- I had to mentally restrain my hands.
And the punchline is that 12 years later I again need glasses for computer work, which is what I do all day.
First 30 hours after the surgery weren't the most pleasant but to me it wasn't painful—at least not as painful as a migraine.
I thought I generally had dry eyes but after the surgery I didn't notice any dryness at all.
My right eye is not fully healed yet so I don't see perfectly. But still very happy and overall a good QOL improvement.
As I understood it, the procedure in itself won't make you blind—ever. If you get complications—like an infection—then that's another story. I didn't have any.
So I didn't think about the risk-reward as everyone around me just had eye dryness or halos at night. Both of which are very easy to live with.
I think all Doctors would tell you that you should do the surgery because they have a financial incentive to tell you so. However, I don't live in the USA and a lot of things I read didn't apply to where I went. For example, they prescribe bandage lens for at least 7 days in the USA but I only wore mine for 40 hours. Then a bunch of eye drops and all was fine.
I used to have dry eyes afterwards for quite some time (years) as well, but that seems to have gone away at some point.
First 30 or so hours were pretty inconvenient: dry eyes, bandage lens that would cause itching and general photophobia. The Doctor removed my bandage lens after less than 48 hours and the same day I resumed my normal life. I was still sensitive to light but I could read screens without issues at all.
The eye shape changes are reversible, but not the retina damage.
Flaps aren't inherently dangerous either (flap detachments are very rare, even more so with modern systems that create essentially a cavity where the flap can rest in), but the difference in healing post OP is a lead cause of heightened dry eye after LASIK. Both PRK and SMILE, due to the way they work, are less likely to suffer from this, but every procedure has trade-offs naturally.
With PRK, the epithelium in the area is removed and has to regrow, a process that takes a few days (to get the initial part done, full regrowth takes far longer but isn't noticeable in general). This regrowth can be both rather painful and also rob you of the "instantly perfect sight"-effect many people desire from their laser eye surgery. As the epithelium does regrow naturally however, it is less likely (both in theory and in medical literature) to lead to dry eye and other side effects in the short and long term, making it the preferred choice by many ophthalmologists when choosing such surgery for themselves.
SMILE, on paper, might be able to offer the best of both worlds, but is severely more expensive than either and there is not a sufficient degree of long term research to make a definitive statement that the side effect amount and severity is comparable to PRK, simply because it is rather new. What research is out there is promising though.
Overall, each option is very well tolerated, leads to major QOL improvements and we need to keep in mind that even the more common side effects one may face with LASIK may not affect everyone and still are comparably small considering other medical fields and their elective procedures.
In this context, I'm very excited to see whether this method might have even fewer short and long term side effects than PRK, but like with SMILE, it may take decades to have a conclusive answer.
Edit: Another thing I missed and which was not covered in the article, is the potential that this new method could be applicable to people who, because of a variety of factors, are not eligible for any ablative eye surgery. I myself was at the upper limit for Trans-PRK in regard to the severity of my Myopia and the thickness (or lack there off) of my Epithelium. In that regard, I see far more potential than just reducing already low side-effect risks further.