A patient from Santa Maria that I just saw in my San Luis Obispo office asked me about SMILE laser eye surgery. SMILE, or small incision lenticular extraction, is a new laser vision correction eye surgery. It involves using a femtosecond laser to sculpt a contoured disc of tissue from within the cornea. The same laser is also used to make a small incision on the side of the cornea and the disc of corneal tissue is removed. The top of the cornea, after the disc is removed, conforms down to the cornea layer under the removed disc, changing the overall shape of the cornea to correct nearsightedness (myopia). As this is a very new technique, I frequently get questions from patients about how SMILE compares to our current “gold standard” of customized wavefront LASIK. The data shows that customized wavefront LASIK continues to outperform SMILE. A medical article appeared two days ago in Primary Care Optometry News reiterating the fact that customized wavefront LASIK still gives better results than SMILE. The article discussed a study of 110 patients with nearsightedness (myopia) or nearsightedness and astigmatism. In this study, the VISX S4 IR laser was used for LASIK — the same laser which I use and consider to be the state of the art. SMILE procedures were performed with the Zeiss VisuMax laser. 90.20% of the wavefront LASIK eyes achieved 20/20 vision without glasses compared to 77.97% of eyes undergoing SMILE. Of concern, 6.8% of eyes in the SMILE group lost the ability to achieve their full pre-operative correction with glasses. No eyes in the customized wavefront group had this problem. Higher order aberrations (complex distortions) of the cornea were significantly higher in the SMILE group and contrast vision was correspondingly worse in the SMILE group. Overall, these data again confirm that customized wavefront LASIK remains the state of the art for laser vision correction in my opinion. However, SMILE is a relatively new technique and likely will continue to evolve over time.