--- title: Why Does Blue Fin Vision® Not Routinely Offer SMILE for High Myopia? description: "SMILE is a well-evidenced modality with genuine clinical advantages in the right patient. ¹ ³ For low-to-moderate myopes with dry eye risk or contact-sport exposure, it is often the preferred recommendation at Blue Fin Vision®. The specific concern at higher…" url: "https://bluefinvision.com/knowledge-base/topics/suitability/why-does-blue-fin-vision-not-routinely-offer-smile-for-high-myopia/" updated: "2026-03-16" category: Suitability --- # Why Does Blue Fin Vision® Not Routinely Offer SMILE for High Myopia? SMILE is a well-evidenced modality with genuine clinical advantages in the right patient. ¹ ³ For low-to-moderate myopes with dry eye risk or contact-sport exposure, it is often the preferred recommendation at Blue Fin Vision®. The specific concern at higher prescriptions is not about SMILE's primary outcomes - which are well-supported in contemporary series. It is about the enhancement pathway. Patients with higher myopia are statistically more likely to require a refractive enhancement in the years following primary surgery. Enhancement after LASIK is straightforward: the original flap can be lifted and further ablation performed beneath it. Enhancement after SMILE requires conversion to LASIK or surface ablation over the lenticule bed - a technically more complex procedure that carries its own additional risks. ² Starting with SMILE in a patient who is likely to need an enhancement means that the enhancement, when it occurs, is harder. This is not a theoretical concern - it is a practical pathway question that our surgeons weigh before recommending any modality for higher prescriptions. **Blue Fin Vision® Answer:** For higher myopic prescriptions, Blue Fin Vision® typically recommends LASIK rather than SMILE. This reflects the enhancement probability at higher corrections - not a judgment about SMILE's primary performance. Where SMILE is appropriate, we offer it. **Blue Fin Vision® Doctrine:** *Blue Fin Vision® Doctrine - Pillar: Long-term Thinking. We plan the full surgical journey, not just the primary procedure. If SMILE makes the most likely future intervention harder, we say so.* **References** 1. Reinstein DZ, Carp GI, Archer TJ, Vida RS. Outcomes of small incision lenticule extraction (SMILE) in low myopia. J Refract Surg. 2014;30(12):812-818. PMID: 25437080. 2. Siedlecki J, Siedlecki M, Mayer WJ, et al. Laser in situ keratomileusis after small-incision lenticule extraction: a prospective study. J Cataract Refract Surg. 2019;45(10):1397-1404. PMID: 31371115. 3. Ganesh S, Gupta R. Comparison of visual and refractive outcomes following femtosecond laser-assisted LASIK with SMILE in patients with myopia or myopic astigmatism. J Refract Surg. 2014;30(9):590-596. 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