Presbyopic laser enhancement after SMILE may be possible in selected patients, but requires especially careful corneal assessment.
When it may be considered
Safety margins must remain adequate.
- Stable post‑SMILE refraction and symptoms dominated by presbyopia
- Adequate residual corneal thickness and regular topography
- No signs of ectasia or progressive shape change
- Clear crystalline lens and good retinal health
- Preference to defer lens‑based options despite presbyopia
Why caution is needed
Re‑treating a SMILE cornea is complex.
- Further ablation reduces biomechanical reserve
- Higher risk of dry eye or regression than in untouched corneas
- Multifocal profiles may exaggerate existing higher‑order aberrations
- Alternatives such as lens replacement may be safer in some cases
- Decision should be taken in a specialist centre with extensive SMILE experience
