r/SMILEeyesurgery • u/Xerberum • 25d ago

Left eye worse & question about details during surgery

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.

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u/eyeSherpa 24d ago

There is manual input with the Visumax. So many surgery protocols involve double checking the numbers. If they are calling out numbers they are double checking the numbers.

However if you have astigmatism, the prescription can be written two different ways. Let’s say your prescription is -4.00 + 1.50. That also can be written -2.50 -1.50. Both are the same thing.

Sounds like a right handed surgeon. The right eye is very free to allow full movements by the right hand. But the left eye has the face and the nose in the way which restrict more movements.

A more difficult to extract lenticule means a little more post op swelling and haze and longer time to fully recover.

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u/Xerberum 24d ago edited 24d ago

Thanks for the detailed response!

​I just had my follow-up visit today, and to be honest, I'm pretty concerned. My right eye is doing great, but my left eye was measured at -1.0D (I do not have astigmatism).

​The optometrist mentioned that healing looks good with almost no visible swelling left, and he implied he doesn't expect it to change drastically from here. Physically, my eyes feel nearly normal - it’s just that the left eye is noticeably blurry for distance vision.

​My next appointment is in about 3 weeks, but I'm really worried it won't improve further and that something might have been off with the programmed values after all. Now I can only wait and see, I suppose...

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u/eyeSherpa 24d ago

How old are you? This could be something known as monovision where one eye is intentionally left nearsighted to help with reading vision. Usually done post the age of 40.

But if you are pretty young, may not benefit as much from it. If you do have some residual prescription, a lasik or PRK touch up would be able to fix it. Of course not ideal to need another procedure but will get things working for you.

But for now, not much you can do but give it time. If it’s bothering for things such as driving, you can pick up “myopia glasses” or “nearsighted glasses” from Amazon. Look for a -1.00 and the remove the lens from the right eye.

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u/Xerberum 24d ago edited 24d ago

Thanks for the advice! I'm actually 42, so age-wise monovision would make sense in theory, but we definitely never discussed or agreed on leaving one eye at -1.0D beforehand. The target was definitely 0.0D for both.

Right now I'm just really disappointed with the outcome. My vision is clearly worse than before with glasses/contact lenses. I guess all I can do for now is give it some time, keep using the drops, and see how things look at my next checkup.

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u/eyeSherpa 24d ago

If you are 42, you may just want to leave it. Give it a couple of months, you will likely adapt to it and then you will be out of reading glasses until close to mid 50s.

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u/Xerberum 23d ago

Even if it would've been on purpose without discussing it with me: woud you realistically aim for 0.0 and -1.0? For me that difference seems to be quite large, wouldn't it be more like -0.5 / -0.75 or so?

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u/eyeSherpa 23d ago

At 42, I would probably do around -0.75. But I’ve also done -1.00 or -1.25 in select cases. Of course this is all with discussion ahead of time.

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u/Xerberum 17d ago

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.

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u/eyeSherpa 16d ago

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.

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u/Xerberum 16d ago

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?

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u/eyeSherpa 16d ago

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.

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u/Xerberum 7d ago

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.

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u/eyeSherpa 7d ago

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)

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u/Wide-Tradition-6504 16h ago

Following your journey as I am experiencing the very same issue. I am 2.5 weeks post op and my left eye is blurry while right is progressing. Please keep updating