ReLEx SMILE

Without Flap. All Femto. A sole procedure.

For the first time, ReLEx SMILE grants you the possibility to undergo a diopters reduction surgery, without corneal cutting and exposure, with a femtosecond laser, by means of sole procedure, with no pain and fast recovery. VisuMax® innovative system uses exclusively the high precision femtosecond laser technology, which enables a minimally invasive treatment.


What is ReLEx SMILE?

ReLEx SMILE is the most modern and safest technique for diopters reduction, the third generation of refractive surgery, performed exclusively by VisuMax Carl Zeiss Meditec femtosecond laser equipped with the SMILE platform. Our clinic, Ama Optimex is the only one in Romania where this intervention is performed. It is a minimally invasive refractive procedure, which represents the third generation of laser refractive surgery and which enables us to correct high myopia, up to 10 diopters. The great innovation is that the technique is performed without flap (in contrast to LASIK techniques) and without the removal of the corneal epithelium (as in case of PRK and LASEK). In a single step, the femtosecond laser creates a refractive lenticula and the tunnel through which the lens is extracted, without ablation and flap, painless and with fast recovery after surgery.

High precision femtosecond laser grants the possibility of a targeted correction of the refractive error, while leaving the surrounding corneal tissue unaffected. A single use component which comes into contact with the cornea, it is specially designed to fit the individual anatomy of the cornea, by enabling a customized treatment where the corneal tissue is not uselessly compressed. Therefore, temporary loss of vision due to excessive intraocular pressure is avoided.

During recent years, minimally invasive diagnosis and treatment methods set new standards in modern medicine, as minimally invasive usually means a minimal discomfort for the patient. By means of this method, ReLEx® SMILE, Carl Zeiss developed a new minimally invasive laser technique for the correction of vision defects. This innovative treatment technique offers a wide range of advantages:

  • treatment without „flap” (corneal flap);
  • the preparation of the lenticula is performed within the intact cornea;
  • the incision measures between 2 and 4 millimeters, more than 80 % less than in case of LASIK and FemtoLASIK;
  • the protective corneal layer (epithelium) is kept and the cornea resistance structure is minimally damaged;
  • glaucoma patients can benefit from laser diopters reduction;
  • a maximum number of corneal nerves responsible for lacrimation remain intact. Therefore, the incidence of dry eye syndrome is very low;
  • without pain during and after the procedure;
  • the treatment is performed by femtosecond laser (all-femto);
  • uses high precision femtosecond technology;
  • impressive predictability of results, even in cases of severe myopia up to – 10.00 diopters and myopic astigmatism up to 5 diopters;
  • anatomically designed contact component avoids unnecessary compression of the cornea;
  • without loss of vision during treatment;
  • noiseless and odorless treatment (no odor);
  • single step treatment – the whole laser correction is performed by means of a sole procedure, without changing devices during surgery;
  • short term procedure;
  • visual acuity is generally established very quickly;
  • the resumption of daily activities within 72 hours.

Why is ReLEx SMILE special?

Unlike other surgical techniques for laser diopter reduction, the corneal tissue is not removed by an excimer laser. In case of ReLEx SMILE, femtosecond laser technology is the sole technology used. A small lens is prepared inside the intact cornea, by using the femtosecond laser. This lens is removed through an access point with a width of only a few millimeters, without opening the cornea, as in case of LASIK and FemtoLASIK. The performance and unique precision of VisuMax® Carl Zeiss femtosecond laser make this technique possible.

There is no flap in case of PRK or LASEK. How are these procedures different from ReLEx SMILE?
In case of PRK and LASEK procedures, the top layer of the cornea (epithelium) is manually removed. The deeper corneal layers are exposed and subsequently processed by using an excimer laser. In what disadvantages are concerns, after the surgery, significant pain occurs and lasts about 24-72 hours, and the healing and stabilization of vision takes longer than in case of ReLEx SMILE. PRK and LASEK are not recommended for the treatment of severe myopia, of over 7-8 diopters, the risk of scars being significantly higher. ReLEx SMILE combines the advantages of PRK and LASEK (without incision for flap) with the advantages of LASIK and FemtoLASIK (minimal discomfort and fast recovery of visual acuity), but without any of their disadvantages.

On how much experience is ReLEx SMILE based?
As of 1846, the name of Carl Zeiss represented quality and precision in the field of optics. In 1986, Carl Zeiss presented the first excimer laser for the correction of eye refraction. In the last 25 years, the company has been at the forefront of new discoveries regarding laser correction of refractive errors.

Femtosecond laser technology was subject to extensive studies and for many years it has proven its value. The refractive lens extraction, in ReLEx SMILE technique, has been performed since 2006, and the first patients have received post-treatment monitoring for more than 8 years.

How many diopters can be corrected?

  • myopia up to -10 diopters;
  • myopic astigmatism up to – 5 diopters;
  • myopia and myopic astigmatism up to -15 combined diopters;

What are the investigations required for this surgery and where can they be performed?

All starts with an examination and a set of medical tests, based on which it is established if you are a candidate for laser surgery and the technique that suits you the best. The type and number of diopters, the curvature and thickness of the cornea, as well as other factors are important. The investigations shall be performed within Ama Optimex clinic. The ophthalmologist will advise you after a detailed examination. The required investigations are the following:

  • establishing the visual acuity with the best optical correction;
  • kerato-refractometry;
  • establishing the pupil and cornea diameters;
  • corneal pachymetry;
  • corneal topography;
  • Pentacam corneal tomography;
  • ocular biometry with IOL Master 500;
  • visual field testing;
  • determination of intraocular pressure;
  • cycloplegic examination. Caution, it is not recommended that the patients drive under the influence of drops!
  • fundus examination.

Before surgery


Who CANNOT undergo the surgery?

You cannot undergo the surgery if you suffer from one of the following diseases or if you find yourself in one of the following situations:

  • you are under 18 years old;
  • your diopters have suffered changes in the last 12 months;
  • you suffer from Keratoconus;
  • you suffer from a residual, recurrent or active eye disease or eye abnormality;
  • you suffer from autoimmune disease, connective tissue disease or diabetes mellitus;
  • you suffer from irregular astigmatism;
  • you have a history of viral keratitis with simplex herpes or herpes zoster;
  • you were prescribed systemaic medication that affects wound healing, such as corticosteroids or antimetabolite agents;
  • you underwent ocular or corneal surgeries of any type performed on the eye to be treated;
  • (in case of women) you are pregnant or nursing mother.
Required investigations

What should I do before surgery?

If you wear contact lenses, you must stop wearing them 7-10 days before the required investigations are performed and of the actual surgery.

A treatment with antibiotic drops and vitamin C shall be administered 2 days before the surgery C.

Relex Smile


What does the surgery consist of?

The intervention is ambulatory (without hospitalization) and is performed free of pain and discomfort. The minimally invasive method of removing the lenticule changes the curvature radius of the cornea, thus correcting the eye refractive error. The biomechanics of the cornea are minimally damaged due to the fact no flap is created.

Here is how a normal ReLEx SMILE procedure is performed:

No Flap (corneal flap) treatment

  • in order to be prepared for the surgery you will be administered anesthetic drops (topical anesthesia);
  • we apply an eyelids retractor;
  • you are laid on the laser bed in a correct and comfortable position;
  • by means of femtosecond laser, a lenticule is created in the corneal thickness, then an incision of 2-4 mm is created in order to access the lenticule – this procedure takes about 24 seconds;
  • by means of a special instrument, the surgeon extracts the lenticula by means of a procedure which takes about 1 minute;

How am I going to feel after the surgery?

After the surgery, the vision is blurry and there is no pain, only a slight burning or discomfort sensation can occur. The vision is recovered hour by hour. The healing process varies from one person to another.

You will go home immediately after the surgery. You can resume most of the regular activities within 72 hours after the surgery.

Relex Smile

What should I do after the surgery?

The first and the most important thing is to observe the instructions of the physician and to contact him as soon as there is a change in symptoms. The burning and/or intense tearing can be normal during the first 24 hours.

During the first 3 days, you have to clean your eyes with sterile wipes, to have someone to help you in washing your hair to avoid eye contact with water or other substances, except those prescribed by the ophthalmologist. During the first 72 hours, you shall not be allowed to apply cream around the eyes, to wear make up, you must avoid intense physical efforts and dusty areas.

During the first month, you should wear quality sunglasses when you expose yourself to the sun. Although rarely, during the first 3 months, you may be bothered by the light, you may experience reading difficulties or vision oscillations.

During the first 72 you are allowed:

  • to exercise, to walk out of the house;
  • to watch TV, to work on the computer and to read, if the vision is stabilized and you are able to do soe;
  • visual effort is allowed and recommended;
  • to take a shower (from neck down), as of the first day after the surgery;
  • to consume any type of food and beverage, including alcohol, but in small quantities;
  • to smoke, but you have to avoid the contact of the eyes with the smoke;
  • to take other medicines, for other diseases, but you must inform the ophthalmologist and to make the decision together.

Relex Smile

Access postoperative instructions HERE


How will I see after the surgery?

Every healing process is different. In most of the cases, visual acuity is very good within one or two days after the intervention and is stabilized within two up to three months. There are very rare cases when visual acuity recovery is slow and takes up to 12 months. After ReLEx SMILE, in most of the cases, you will be able to drive, work, do sports without glasses or contact lenses in just a few days after the treatment.

How long does the postoperative treatment last?

The postoperative treatment lasts 4 weeks. Depending on the evolution, the treatment and its term can be modified. The administration of artificial tear drops can be required up to 3 months after the surgery.

What are the complications which can occur?

As in case of other laser techniques, certain complications can occur following ReLEx SMILE, although with a low incidence. Only your physician can explain you the risks and the potential side effects and can decide if ReLEx SMILE is the appropriate option for you.
Generally, the complications can be summarized as follows:

  • complications of the lenticule – for some reasons, the complete cutting of the lenticule cannot be performed or the lenticula cannot be totally extracted. In this case, the cornea heals in about two or three days. A new procedure can be performed 6 months later, by means of an excimer laser, PRK technique. The incidence of this type of complication is of 1:3000;
  • infections are extremely rare, with an incidence of 1:10000. In case of infection, your cooperation in the administration of the treatment and the observance of the physician recommendations are extremely important;
  • the scope of the intervention is to correct completely or to reduce diopters by means of a single procedure and in more than 95% of the cases this scope is achieved. There are situations when the reaction of the corneal tissue may lead to the under correction or overcorrection. In case of remaining diopters, a second intervention can be performed by an excimer laser, PRK technique, within more than a year after ReLEx SMILE;
  • corneal ectasia – there are extremely rare cases when the corneal tissue does not tolerate the surgery and its resistance is affected. In this case, the cornea begins to bulge, even after many years as of the operation. The corneal ectasia is an extremely serious disease which can be treated by crosslinking, the need to wear hard contact lenses, corneal ring implantation or in the worst case, corneal transplant.

Can I lose vision?

If the intervention goes well and you strictly observe the instructions of the physician, this risk is inexistent.

When should I come back for investigations?

We will be waiting for you for further investigations:

  • the second day after the surgery;
  • one week, 1 month, 3 months, 6 months, 12 months after the surgery or according to the physician’s recommendation. Corneal topography and pachymetry shall be performed during the investigations which occur 3 month, 6 months and 12 months after the surgery;
  • anytime you feel something is wrong.

How stable are the diopters after ReLEx SMILE?

Of all laser techniques for diopters reduction, ReLEx SMILE has the lowest incidence of diopter regression, being deemed the technique with the highest stability of the diopters after surgery.

WARNING! In case complications occur, your cooperation in the administration of the treatment and the observance of the ophthalmologist’s recommendations are extremely important!!! On the contrary, the physician assumes no responsibility for the results.

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