Is LASIK or SMILE a Good Idea for High Myopia?

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Ophthalmologist/ Eye Surgeon 13+ Years Exp

MBBS, MS – Ophthalmology

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If you’re squinting at your glasses prescription and seeing numbers like -6.00 or lower, you’re probably wondering if LASIK or SMILE surgery could free you from thick lenses.

You may also feel nervous about risks, long-term safety, and whether your vision is “too bad” for laser eye surgery. Let’s walk through this together, step by step, so you can make a clear, confident decision.

We’ll cover what high myopia means, how LASIK and SMILE work, how safe and effective they are for stronger prescriptions, the main risks and limits, who makes a good candidate, and what alternatives to consider. I’ll keep it simple and honest, the way I would explain it in the clinic.

Key takeaways:

High myopia often qualifies for laser vision correction, but not everyone is a candidate.
Both LASIK and SMILE are safe and effective for many people with high myopia when the cornea is healthy and thick enough.
Corneal thickness, pupil size, dry eye risk, and retinal health matter as much as your prescription.
If you’re not a candidate, options like ICL (implantable collamer lens) often work well for high prescriptions.

What Is High Myopia?

Myopia means short-sightedness: distant objects look blurry because light focuses in front of the retina. We measure myopia in dioptres (D). While definitions vary slightly, many clinicians consider:

Low myopia: up to -3.00 D
Moderate myopia: -3.00 to -6.00 D
High myopia: -6.00 D or higher

High myopia often comes with longer eyeball length (axial length). That length increases the risk of certain eye problems over time, such as retinal tears or detachment, macular changes (myopic maculopathy), and earlier cataract.

This doesn’t mean you’ll have these issues, but it does mean we examine you more carefully before recommending refractive surgery.

How Do LASIK and SMILE Work?

Both LASIK and SMILE reshape the cornea to change how light focuses on the retina. They’re types of refractive surgery aiming to reduce or remove your need for glasses or contact lenses.

LASIK for High Myopia

What happens: A femtosecond laser creates a thin flap on the cornea. The surgeon lifts the flap. An excimer laser then removes precise corneal tissue to flatten the cornea for myopia. The flap is laid back down.
What it treats: Myopia, astigmatism, and sometimes hyperopia.
Typical range: Many centres treat up to around -8.00 to -10.00 D with LASIK, depending on corneal thickness and shape.

SMILE Surgery

What happens: A femtosecond laser creates a small lens-shaped piece of tissue (a “lenticule”) within the cornea, which is removed through a tiny incision. No flap is created.
What it treats: Myopia and myopic astigmatism.
Typical range: Commonly used up to around -10.00 D in appropriate candidates.

In simple terms, LASIK uses two lasers and a flap; SMILE uses one laser and a keyhole incision. Both aim for the same result: a cornea that focuses light correctly.

Are LASIK and SMILE Safe and Effective for High Myopia?

Short answer: often, yes—when you meet the right criteria.

Effectiveness: Large real-world and clinical studies show that most patients within treatable ranges achieve 20/20 or 20/25 unaided vision after LASIK or SMILE. For high myopia, the chance of landing right on target is still good, but a touch-up (enhancement) is more likely than with lower prescriptions.
Stability: Both procedures offer stable results for most patients. High myopia carries a slightly higher chance of residual refractive error or small regression over time, especially if your cornea is borderline or if your original prescription was very strong.
Safety: Serious complications are uncommon. With modern screening and laser platforms, rates of vision-threatening issues are low. SMILE may have a lower risk of flap-related problems and may reduce dry eye symptoms for some patients, because it preserves more corneal nerves. LASIK, however, remains excellent for precision, especially in mixed astigmatism and complex profiles, and enhancements are more straightforward.

Remember: “Safe and effective” depends on you—your corneal thickness, topography, ocular surface, tear film, pupil size, and retinal health.

What Are the Risks and Limitations?

Every surgery has downsides. It’s better to face them now than be surprised later.

Dry eye symptoms: Common after LASIK in the early months; usually improves. SMILE may cause fewer symptoms for some patients, but dry eye can still happen with either.
Night vision symptoms: Glare, halos, and starbursts can occur, especially with large pupils and higher prescriptions. These usually settle over weeks to months but can persist in a small number of patients.
Under- or overcorrection: More likely in very high myopia. Enhancements can refine the result, but only if corneal thickness allows.
Ectasia (corneal weakening): Rare but serious. Risk rises with thin corneas, abnormal topography (e.g., keratoconus), or overly aggressive tissue removal. Careful screening aims to minimise this risk.
Flap-related issues (LASIK only): Dislocation, wrinkles (striae), inflammation under the flap. These are uncommon with modern techniques.
Inflammation or infection: Rare with proper post-op care.
Regression: A mild drift back toward myopia can happen, more commonly with higher starting prescriptions.
Retinal risks: High myopia carries a baseline higher risk of retinal tears or detachment—whether or not you have laser vision correction. We examine your retina carefully; sometimes we treat weak areas before surgery.

Limitations to keep in mind:

Tissue budget: To correct high myopia, more corneal tissue must be removed. If your cornea is thin or shaped in a concerning way, LASIK or SMILE may not be safe.
Astigmatism levels: Very high or irregular astigmatism may not be ideal for SMILE; LASIK or other options might be better.
Future changes: Your eyes can still change with age (e.g., presbyopia in your 40s+ and cataract later). Surgery doesn’t “freeze” your eyes in time.

Who Is a Good Candidate?

You may be a good candidate for LASIK for high myopia or SMILE surgery if:

Your prescription is stable for at least 12 months.
Your corneas are thick enough, with normal topography (no signs of keratoconus or ectasia risk).
Your myopia and astigmatism fall within the clinic’s safe treatment range.
Your ocular surface is healthy (manageable dry eye is okay).
Your pupils are not excessively large in dim light, or the laser profile accounts for it.
Your retina is healthy, or any weak areas are treated first.
You understand realistic outcomes: likely excellent vision without glasses for most activities, but not a guarantee of “eagle vision,” and you may still need glasses for fine tasks or night driving.

When I examine someone with high myopia, I pay close attention to:

- Corneal thickness (pachymetry) and residual stromal bed after planned treatment.
- Corneal shape (topography/tomography) to exclude subtle ectasia risk.
- Tear film and meibomian gland health to reduce dry eye problems.
- Pupil size in low light for night vision planning.
- Axial length and a thorough retinal check.

LASIK vs SMILE: How Do We Choose?

Dry eye concerns: SMILE may be gentler on corneal nerves. If you already struggle with dry eye, SMILE could be preferable.
High astigmatism or complex profiles: LASIK often allows more customised treatments and can be better for certain astigmatism patterns.
Enhancements: LASIK enhancements are usually simpler. SMILE enhancements are possible but may require PRK or a thin flap later.
Occupational or sports risks: SMILE avoids a flap, which some people prefer if they have a trauma risk (e.g., contact sports, military).

Both are excellent. The “best” option is the one that fits your eyes and lifestyle after a detailed work-up.

Alternatives If LASIK or SMILE Isn’t Suitable

If refractive surgery on the cornea isn’t safe or ideal, you still have strong options for vision correction:

ICL (Implantable Collamer Lens): A thin lens placed inside the eye, in front of your natural lens. It’s popular for high myopia (even beyond -10.00 D) and for thinner corneas. Vision quality is often excellent. It’s removable, which some patients like. Risks include cataract formation, increased eye pressure, and rare complications, but overall safety is very good in experienced hands.
PRK (Photorefractive Keratectomy): No flap; the surface epithelium is removed, then the excimer laser reshapes the cornea. Healing takes longer, with more early discomfort, but it’s useful when corneal thickness is borderline for LASIK. For very high myopia, PRK may not be ideal due to tissue limits and haze risk.
Phakic or clear lens exchange: Similar to cataract surgery; your natural lens is removed and replaced with an artificial lens. We consider this for extreme prescriptions or when there’s early lens change. It’s less common for younger patients due to loss of natural focusing.
Contact lenses and spectacles: Modern high-index lenses and custom contact lenses can provide sharp, comfortable vision if surgery isn’t right for you now.

What to Expect During Evaluation and Recovery?

Pre-op evaluation: Expect detailed measurements—refraction, corneal scans (topography/tomography), pachymetry, tear film testing, pupil size, and a retinal exam. These tests decide if LASIK for high myopia or SMILE surgery is safe and which option fits you best.
The procedure: Both LASIK and SMILE are quick—usually minutes per eye—with numbing drops. You’ll feel pressure but no sharp pain.
Recovery: LASIK often gives clearer vision within 24–48 hours. SMILE is also quick, though some patients sharpen over several days. Use prescribed drops, avoid eye rubbing, and follow your post-op schedule.
Results: Most high-myopia patients enjoy life-changing clarity. Some may still need thin glasses for night driving or fine detail.

So, Is LASIK or SMILE a Good Idea for High Myopia?

For many people with high myopia, yes—provided your corneas and retina look healthy and your plan is tailored to you. If tissue limits or risk factors pop up, ICL often becomes the front-runner. The safest path is a thorough assessment and an honest conversation about benefits and trade-offs.

If you’re feeling anxious, that’s normal. We’ll map your eyes, show you your numbers, and talk through the options. The goal isn’t just to be glasses-free—it’s to protect your long-term eye health while giving you vision you can rely on.

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