Can ReLEx SMILE cause glaucoma?

in itself, it is almost impossible for ReLEx SMILE to cause glaucoma.

Glaucoma means optic nerve damage, associated with an eye pressure that is too high to be tolerated by that particular nerve.

For the damage to occur, the pressure must be too high for a substantial period of time.

The SMILE operation does not affect the plumbing of the eye (fluid flows in and out of the eye), and any induction of higher pressures than normal is very short duration during the procedure itself.

If there is high eye pressure after ReLEx SMILE, it would most likely be related to steroid drop usage rather than the operation. Having said that, most people have no problems using steroid eyedrops for 1-2 weeks.

So it is not likely that your blurred vision, starburst glares and halos are due to glaucoma. Glaucoma is diagnosed by looking at several parameters, the most important being the eye pressure, optic disc/nerve appearance, retinal nerve fibre layer thickness (from OCT scanning) and visual field testing.

It is much more likely that your symptoms are due to issues with the corneal shape (topography) or cap interface.

I would advise you to go back and speak with your doctor about your concerns. This is because your concerns about glaucoma, and your visual problems, can only be fully addressed with a clinic consult and the relevant testing. If your doctor cannot fully explain why your vision is blurred and you are having starburst glare and halos, then you may want to consider getting a second opinion.

Best wishes.

Glaucoma is a disease of the eye nerve and usually caused by eye pressure that is higher than what the eye nerve can withstand. There is a large genetic component for glaucoma. Glaucoma is diagnosed by at least 3 tests: (1) eye pressure (2) visual field, which is the area that your can see, tested one eye at a time (3) examination of the optic nerve head, which is the part of the eye nerve that can be damaged from elevated eye pressure.

Glaucoma is subdivided into a few types, and the eye pressure may not necessarily be elevated in glaucoma. So, the details are not so straightforward.

It is highly unlikely that SMILE itself causes glaucoma, as the procedure is usually very quick, and any pressure exerted on the eye during laser application is transient. In fact the Zeiss Visumax laser is one of the gentlest femtosecond laser around at the moment.

However, most patients need to have steroid eyedrops for about 2 weeks post-SMILE, and patients who are sensitive to these eyedrops may get elevated eye pressure, especially if steroid treatment is prolonged, for whatever reason.

So it will be wise to have a thorough check if you are worried.

I also hope you managed to discuss your vocational aspirations with your SMILE surgeon before the operation.

Best wishes there! Cheerio!

Dr Daphne

Indeed, starburst, glare and haloes are known, though uncommon, side effects of laser vision correction (e.g. PRK, LASIK and ReLEx SMILE).

The risk tends to be greater in patients with features such as larger than average pupils or high pre-operative refractive errors.

ReLEx SMILE is not associated with an increased risk of glaucoma. Though glaucoma can occur in people regardless of whether they have had LVC or not.

Should you have any concerns about your post-operative results, I would encourage you to see your surgeon sooner rather than later as some side effects may be reversible with earlier intervention.

Read more about ReLEx SMILE in the guide that I've written here.