Presbyopic laser enhancement on a post‑SMILE cornea may be possible in selected patients, but is technically demanding.
When it may be considered
Stability and corneal reserve are key.
- Stable post‑SMILE refraction with symptomatic presbyopia
- Adequate residual corneal thickness and regular shape
- No evidence of ectasia or structural compromise
- Clear lenses and good retinal health
- Desire to delay lens‑based surgery despite presbyopic symptoms
Why extra caution is needed
Re‑treating SMILE corneas is complex.
- Additional ablation further alters corneal biomechanics
- Increased risk of dry eye or night‑vision disturbances
- Limited published data compared with primary procedures
- Requires detailed discussion of alternatives, including lens replacement
- Should only be undertaken in centres with substantial SMILE and enhancement experience
