Getting an enhancement: SMILE vs LASIK at Optimax Malaysia

Image: Stil

Three years ago, I was debating between SMILE and LASIK to correct my short-sightedness. I had so many questions – which would be safer, which would hurt less, which would give me better results? I’m happy to tell you that after getting an enhancement at Optimax, I am now one of the few people that have undergone both SMILE and LASIK – and can answer many of those questions. I can give you probably one of the most accurate SMILE vs LASIK analyses out there, so read on and feel free to leave me any questions below.

My experience with SMILE laser eye surgery at Optimax Malaysia has been one of the most popular on this site since I wrote it 3 years ago. The wow factor of going to -6.00 to perfect vision overnight has been one of the most amazing things I’ve experienced. As time has passed though, I found my vision getting slightly more blurry. It was hardly noticeable outdoors or in daylight hours, but things seemed less sharp in low light situations. In particular, I noticed that I had difficulty driving at night which prompted me to get my eyes checked out again.

Booking an eye check up at the Taman Tun branch was easy.  I mentioned that I was having trouble with my vision at night and expressed concern about being able to drive safely. My optometrist ran me through the usual tests that are part of the Optimax’s full eye examination. These included checking eye pressure, testing for dry eye, and mapping corneal topography – all of which are also part of assessing suitability for laser eye surgery.

At the vision test, it became clear that my power had increased somewhat. I was -1.00 in both eyes with a -0.25 and -0.50 astigmatism in my right and left eye respectively. I had suspected this would be the case and asked the optometrist what would be the best step to take in this situation. He said that he would check in with Dr Stephen Chung, who is one of the senior surgeons, and let me know.

The next day, Optimax rang to let me know that they would be happy to proceed with an enhancement to fine tune my vision. This procedure is free under their Vision for Life program – when you do your SMILE or LASIK or even ASA with them, they will perform enhancements (also known as corrections) at no cost. There are some limitations of course, including having enough corneal tissue, and only if it is safe to do so. I asked if it would be possible to book in a consult with Dr Stephen Chung, just to go over some of my concerns and ask some questions.

Dr Stephen looked over my records and informed me that I was a good candidate for enhancement as my power was stable. I was concerned about when I should have my surgery as I knew that there is a limit to the number of corrections that can be performed. Should I put up with blurry vision and wear glasses for a few more years, then get a correction, or should I just go for it now? I was very concerned that this would be my second and potentially my last chance to get my vision corrected, so I was happy to wear glasses at night for a few more years, but Dr Stephen did not think it necessary to wait any longer. He assured me that the second surgery is often sufficient to get patients back to near perfect eyesight, and requiring a correction is not uncommon in patients with higher levels of short-sightedness.

How many patients need an enhancement?

Around 5-10% of patients may need an enhancement. This has nothing to do with the skill of the surgeon or laser technology – it is largely to do with the fact everyone heals slightly differently. Usually, patients who have higher power are more likely to need a second correction. Younger patients are also more likely to need an enhancement as their power may change over time. This is just part of how our eyes age.

The difference with an enhancement is that the necessary treatment is almost always very minimal, and therefore more accurate.

I need an enhancement. What now?

There are a few options for patients who have some residual power after their first laser eye surgery. The first is to simply live it with, wearing glasses or contacts as necessary. The second is to have only one eye corrected – the idea being that one eye will be slightly short sighted and the second will be slightly long sighted, but your brain will compensate, blending the two together to achieve good vision. This is a sort of long term plan – people tend to become long sighted as they age so leaving a bit short sightedness uncorrected means that you may get a few extra years before you need reading glasses.

When should I do an enhancement? Should I wait a bit longer?

Most people will only be eligible for one enhancement, so it is important to wait until your power has stabilised. Having multiple surgeries can compromise the structural integrity of the eye. The maximum number of enhancements that Optimax has done for a patient is two.

Some patients with minor short sightedness may choose to wear glasses for some time; until they want to attempt their second surgery.

What does Optimax’s Vision for Life program cover?

This program provides future enhancements to maintain optimal distance vision at no cost. In my opinion, only the top end laser clinics offer a long term vision guarantee. When I researched a few years ago, many did not have enhancement programs or limited them to a certain time period. Make sure to read my other post here.

Vision for Life has certain criteria including:

• prior treatment at Optimax Malaysia
• treatment must be approved by treating Doctor
• unaided vision must be 20/40 or worse (less than legal driving standards)
• annual eye examinations must have been done at Optimax after your initial surgery (this is waived for international patients – you are allowed to send your eye results back but this must be done yearly)
• medication costs are to be borne by the patient (approx RM 80)

What should I expect during my enhancement?

The enhancement process will proceed much like the first laser eye surgery except that a different procedure may be used. Whether you had SMILE or LASIK the first time around, the same rules apply. For enhancements, LASIK will be used unless there is not enough corneal tissue, in which case your surgeon will advise you to do ASA. SMILE cannot be used for enhancements.

On the day of the enhancement procedure

Patients are asked to avoid alcohol based products such as deodorant and perfumes on the day of surgery. Makeup, moisturiser and any facial products are obviously a no-no as well. (The following is quite boring and is likely only of interest if you are thinking of giving LASIK a go. Feel free to skip ahead. Or read here to compare with the process for SMILE.)

For some reason, I was much more nervous for my second surgery. I guess with my first, my eyesight was already so bad that I accepted that surgery would most likely be an improvement, but this time I was letting someone operate on my eyes for a mere -1.00 and a tiny bit of astigmatism. Was I only getting this surgery for vanity?

I was asked to fill out some forms and pay RM80 (AUD$27) for the after care pack. As mentioned above, the enhancement procedure is covered by Optimax’s guarantee. I was still feeling a little nervous so I requested a quick vision assessment just to make sure that my power was as accurate as could be. The receptionists were very obliging and ushered me through for a quick check to reassure me. My optometrist guided me through the tests (again) and was very patient to ensure that I was happy with my vision and the correction that was going to take place.

I was taken into the surgery waiting area and given scrubs to change into. Molly, the nurse who was there for my first procedure explained the after care pack to me – there are antibiotic drops, artificial tears, pain killers and eye shields that I needed to wear (when sleeping) for a week. She placed two numbing drops into each eye. My surgeon, Dr Stephen, examined my eyes again and explained what was going to happen during the surgery and what to expect during the healing process afterwards. There were a lot of instructions – don’t worry, he says. Just remember to concentrate on looking at the green light. He then made two marks on each eye with what I think is a Sharpie (weird, I know).  Molly then returned to clean the area around my eye I was taken into the surgery room.

I was definitely more nervous this second time around. I feel much more aware of everything – the bright lights in the room, a colourful blanket on the operating table, the staff around me and the size of the machine. I remember wondering to myself why the heck did I sign up for this again when I could have probably just gotten a cheap pair of glasses. The thought of calling it quits flashed briefly through my mind. None of this happened during my first surgery, and I seem to have remembered a lot less, so I must’ve been pretty high on adrenaline for that one. (read the full account here including when I hugged my surgeon after).

Dr Stephen runs some tests with the machine before explaining to me again that I need to always do my best to look at the green light. He explained that he would be starting with the right eye and proceeded to tape my left eye shut. The upper and lower lashes of my right eye are then taped away, more numbing drops are added to my right eye and a metal device (an eye speculum) is inserted to keep my eye open. Lots of drops are added to keep my eye moist and Dr Stephen uses what seems like a sponge to remove some of the excess moisture. I’m sure that a lot of these same steps must have been done during my SMILE procedure as well, but I remembered very little of that as it turns out. I feel strangely more aware of each step for this surgery and I wonder why and if this will make it harder to make it through the process.

After making sure that I am positioned correctly for the femtosecond laser (this is the laser that will cut a flap in my eye), Dr Stephen reminded me that this is the position I need to stay in. I heard the words ‘suction on’ and saw the machine move towards my eye. I felt a bit of pressure on my eye and tried to focus on my breathing. It felt like a long time (actual time about 30 seconds) but I reminded myself to focus on my breathing. I remember hearing a staff member count down in the background, which is very reassuring as I know how much time is remaining. The machine moved upwards and Dr Stephen removed the eye speculum then taped my right eye shut. This whole process is then repeated on my left eye.

After the left eye is done, I was asked to slowly sit up. I recall still being able to see. I was gently guided to another machine about ten steps away. I am instructed to lie down and am told that Dr Stephen would lift the flap, this second machine would make a loud buzzing sound while doing its thing and then the flap would be put back in place. The whole process of taping up my eyes is done again and Dr Stephen worked to lift the flap, beginning with my right eye. There is a slight moving sensation on my eye while he was doing this and I remember him apologising for the tugging, but I feel very little. He explains that everything will be blurry when he lifts the flap. Overall, this process felt gentler and shorter than the lenticule removal during SMILE. Dr Stephen then reminds me that I will hear a buzzing, asks me to concentrate on the green light and says it will last about 10 seconds. The buzzing begins for what feels like barely three seconds. Dr Stephen then works to reseal the flap and rinse off the surface of my eye. The eye speculum and tape are removed and the process is repeated for my other eye.

After the second eye is done, Dr Stephen reassured me the procedure went okay. I remember his choice of words because I recall thinking that I was hoping for better than okay, but I guess I’d take okay. I was guided out of the surgery room and told that I could change back into my clothes. My eyes are examined one last time before I leave. I guesstimate that I could see at about the same level as I did before the surgery, but everything is a little foggy – a bit like peering out of a steamy shower. There’s not the wow effect of being able to see more than I did before like with my first surgery, but that was for a much higher correction from -6.00. The staff at reception kindly make sure that I have a way to get home.

After the surgery

Dr Stephen had cautioned me that the pain would last for about 3-6 hours and I should try to sleep through it. Upon arriving home, I felt pretty good. My vision didn’t feel too different from before. I knew that I needed to rest my eyes, so I put on my eye shields and tried to have a nap. I was not in much pain at all, though my eyes were tearing up a lot. As I napped, the stinging sensation got worse and my eyes would not stop tearing up, even when closed. In a groggy state and with my eye shields still on I rummage through the after care kit for painkillers and thank my lucky stars that I left a glass of water on my bedside table.

With SMILE it was more of a discomfort (like grit in your eye) and I did not need pain meds, but with LASIK I felt more of strong stinging pain. If I had one piece of advice for LASIK patients, it would be to take the painkillers when you get home and avoid the pain altogether. After all, if you can take Panadol for hangovers, why skimp on the pain meds for eye surgery? The medication didn’t seem to help and I drift in and out of sleep for a few hours. I awaken about three and a half hours later, in no pain at all and with better eyesight than before surgery. I have to say that being able to see clearly such a short time after surgery is one the best feelings ever. It feels so miraculous and there is so much detail to enjoy. Leaves on trees, buildings in a distance and the shapes of clouds – everything is really clear. It is much clearer and in less time than when I did SMILE. I can finally sort of understand why some patients think they have gained an ability to see in high-definition post LASIK.

The day and week after

At my one day check up, I am a little disappointed to find that my eyes are at -0.25 and -0.50. The vision in my left eye is a little more blurry than in the right. Definitely better than before my enhancement, but I was hoping to get back to 0 as it was such a small correction. Dr Stephen assures me that it is barely 24 hours after surgery and my vision will continue to adjust as my eyes heal. He is also confident that this enhancement will stabilise my vision.

In the days after LASIK, I find that my distance vision is much improved but I have problems focusing close up either due to glare or just my eye readjusting. There seems to be more noticeable glare when indoors, something I did not notice with SMILE. My vision is pretty good and I have minimal dry eye, so much so that I have to constantly remind myself to rest my eyes and take it easy. I notice that I can see a lot better at night. Halos are prominent with night driving and they appear differently to post SMILE. With LASIK, they appear more as a circle of diffused light around the light source, where with SMILE they appeared as starbursts. I do feel that my long distance vision is much better than I ever achieved with my first surgery and I can see detail that I have not been able to see before.

At my one week assessment, I’m thrilled to find that my eyes are at 0.0 and -0.25. The -0.25 is barely noticeable and it’s as close to perfect as I could’ve hoped for. With both eyes open, I can read the 20/15 line. Dr Stephen tells me that my eye will take a few months to heal completely, but this is a good start.

Update: 3 months on, my vision is perfect! 0 in both eyes with a tiny amount of astigmatism (0.25) in my left eye. I’m so happy that I went through with this enhancement procedure. 

Today is one week since I had my enhancement and I’m really glad I did it. It’s a small investment of time and the results have been amazing. I am still noticing some glare and halos at night, but they are supposed to be temporary side effects can take up to three months to subside. The halos are not much of an issue to me and worth it because my vision has improved significantly I can now drive comfortably at night.

If I had one takeaway message it is that everyone heals differently – your results may be different, just be patient and remember that very, very few people end up with worse vision after surgery than they had before. Keep up your regular eye check ups and consult your surgeon if you feel that you might need an enhancement.

EXCLUSIVE PROMO CODE: Optimax are offering RM 200 off per eye for all A Kitchen Cat readers who book in with the referral code #tashLASIK or show a screenshot of my Instagram. This discount is applicable to all LASIK treatment except TESA. Fees for complete eye examination still apply.

Disclaimer: My laser eye surgery was sponsored by Optimax Eye Specialist, Malaysia. All opinions are my own. This year, my partner also had his eyes done at Optimax (not sponsored) and is happy with the result.