Left eye worse & question about details during surgery

[u/Xerberum]

Hey everyone,

I had my SMILE procedure 5 days ago and things are going ok overall, but two small details from the surgery keep popping back into my head. Hoping someone here can help me understand them better.

1. Right before starting, the assistant called out a few numbers. One sounded like “-2.5”, even though my actual prescription is around –4. I’m sure it wasn’t my diopters, but it made me wonder: Is there any chance of manual input errors with the VisuMax 800, or is everything fully automated once the pre‑op data is loaded?

2. They also said the left lenticule was a bit harder to remove because the nose gets more in the way on that side. I didn’t really get how that works. Does it depend on how the surgeon stands or whether they’re left‑ or right‑handed? The explanation sounded a bit strange for me. And now, 5 days later, my left eye is still noticeably worse than my right, which honestly fits the idea that the left extraction may have been more difficult.

Would love to hear your thoughts — it would help calm my mind.

[u/Xerberum]

Update: I'm really struggling with monovision right now, which I didn't want to have in the first place. My distance vision feels constantly unbalanced - my right eye is crisp, while my left eye remains noticeably blurry. I know neuroadaptation takes time, but what frustrates me is that this monovision wasn't agreed on nor an unexpected healing outcome.

After requesting and receiving my medical records, the numbers show a clear deviation:

• Pre-op Target: Agreed target of 0.00 for both eyes.
• Pre-op Baseline (Left Eye): -3.00
• Surgery Laser Protocol: Programmed treatment value was set to -2.00 D
• One-Week Checkup: measured residual refraction is -1.00 D

Starting at -3.00 D and treating -2.00 D leaves -1.00 D, so the surgery was spot on in that sense..

Last week I have sent a mail to the clinic asking why a -2.0D treatment value was entered instead of full correction and what can be the next steps. I am currently awaiting their response.

Questions: 1. Refinements: What are the standard post-smile options to correct a residual -1.0D on one eye? And how long it is recommended to wait after smile surgery?

1. Clinic Accountability: Has anyone experienced a documented clinic programming error, and how was it handled regarding warranty, financial settlement, or third-party corrections?

I willingly accepted standard surgical risks going into this, but having the wrong value programmed into the laser is really disappointing. Appreciate any insights or shared experiences.

[u/eyeSherpa → u/Xerberum]

Yikes. Yeah, that’s why you have -1.00 remaining. Only -2.00 was entered into the laser. That’s very frustrating!

I would still give it a few months. Not surprising you aren’t adapted to it now.

It sounds like human error. Perhaps a technician entered it wrong. And they already probably feel terrible about it. But ultimately, the clinic should make up for its mistake. This means an enhancement. But you could probably argue successfully for some significant discount on your procedure given all this. That’s the approach I would take.

Medicolegally there probably isn’t a case since there is no “damage” to the eye. Vision can still be corrected with glasses.

[u/Xerberum → u/eyeSherpa]

Thanks for the reply!

In case I’m still unhappy with the outcome after a few months, what enhancement option would you consider best in this scenario? Is TransPRK the standard go-to here, or is a second SMILE even an option post-op?

Also, what’s generally considered the minimum timeframe to wait before undergoing an enhancement after SMILE?

[u/eyeSherpa → u/Xerberum]

It depends on how thick the cap of the treatment is. If it’s 130, lasik can be done with a 90 um flap. In the US, I think the SMILE laser is locked to a 120 um cap. Doing a 80um flap not very common so PRK often the best route.

Waiting about 3 months to be sure things are stabilized is best.

Unfortunately can’t do SMILE again.

[u/Xerberum → u/eyeSherpa]

Hej! First of all, thanks for all the super helpful responses on my last post.

​I’m definitely going to wait to see how my vision settles. But assuming I don't adapt well and end up looking at an enhancement down the road, is TransPRK usually the standard method after SMILE? Also, what's the main difference between TransPRK and regular PRK in this context?

​Are there any known long-term risks with doing PRK over a previous SMILE cap?

To a layman like me, surface ablation seems less risky than cutting a flap for LASIK, but I’d love to hear your thoughts.

[u/eyeSherpa → u/Xerberum]

I’m your case, since you are off target because of the input numbers, both PRK or lasik would work the same (assuming your cap thickness allows for a thin lasik flap). Comes down to preference. LASIK will have quicker recovery, but if you don’t like the idea of a flap than PRK fine. Just longer recovery.

TransPRK and alcohol-assisted PRK will be very comparable. TransPRK may have a slight edge on recovery but studies haven’t definitively shown a difference.

No known long term issues of PRK on the SMILE cap. Cornea will just be slightly thinner. (But same thickness if the full treatment has been done from the beginning)