SMILE Expands Refractive Surgery Options at UPMC Vision Institute

Advances in refractive eye surgery continue to expand the range of patients who may benefit from surgical vision correction. Newer laser platforms and corneal techniques have introduced options that were not previously available, allowing surgeons to reconsider candidacy for some individuals who were once advised against surgery.

“Technology has changed dramatically over the past 15 to 20 years. Many people who were told in the past that they were not candidates may now have options that simply did not exist at that time,” says Deepinder K. Dhaliwal, MD, L.Ac, vice chair of Communications and Wellness and Division chief, Refractive Surgery Service at the UPMC Vision Institute.

Dr. Dhaliwal also is professor of Ophthalmology; director and founder, Center for Integrative Eye Care; clinical co-director, Corneal Stem Cell Task Force; associate medical director, Charles T. Campbell Ocular Microbiology Laboratory; medical director, UPMC Laser Vision Center; past president, International Society of Refractive Surgery; and current president, Cornea Society.

UPMC Vision Institute began offering small-incision lenticule extraction (SMILE) in November 2025. The procedure expands the refractive surgery options available within the Institute and is incorporated alongside all the existing corneal and lens-based techniques that exist. For any patient considering vision correction surgery, treatment selection continues to depend on the individual patient’s refractive error, corneal anatomy, overall ocular findings, ability to tolerate postoperative recovery requirements, and if their overall health is such that surgery does not pose undue amounts of risk, for example, with comorbidities that could negatively affect long-term outcomes.

SMILE is A Flapless Approach to Corneal Reshaping

SMILE differs from laser-assisted in situ keratomileusis (LASIK) in how corneal tissue is accessed and reshaped. The LASIK procedure requires creation of a corneal flap before excimer laser ablation sculpts the underlying corneal stromal tissue. SMILE, on the other hand, eliminates the need for a flap creation. Instead, a femtosecond laser forms a precisely shaped lenticule within the cornea corresponding to the refractive correction, and that lenticule is removed through a small peripheral incision. The cornea then assumes a new curvature while the surface layers remain largely intact. The laser portion of the procedure typically lasts fewer than 10 seconds per eye.

“Because we are not lifting a flap, the eye remains more stable during healing,” Dr. Dhaliwal says. “That difference changes the recovery experience for many patients. And think about the length of laser treatment: less than 10 seconds per eye. That is a scientific and technological marvel.”

SMILE procedures are typically performed on both eyes during the same visit. Each eye is treated sequentially using separate sterile instrument sets, and the operative workflow surrounding the brief laser phase follows standardized safety protocols.

Because SMILE does not require the creation of a corneal flap, it dramatically changes the early postoperative period for patients in practical ways. Activity restrictions are generally less burdensome than LASIK, and accidental eye rubbing is far less likely to cause a severe complication. Preserving the corneal surface also limits disruption of corneal nerves, which translates to less postoperative dryness for many patients.

“If someone rubs their eyes after LASIK, it can affect the flap we just repositioned,” Dr. Dhaliwal says. “With SMILE, there is no flap to displace. We are correcting vision while preserving more of the cornea’s natural structure with greater stability and less dryness.”

Procedure Selection Within a Comprehensive Refractive Program

SMILE is not intended to replace existing refractive procedures. It is one option within a broader surgical framework that includes LASIK and lens-based techniques. Some patients remain better suited for LASIK, while others may not be candidates for corneal laser surgery and instead benefit from implantable collamer lens (Evo ICL) placement. The treatment selection process at the UPMC Vision Institute relies on a complete assessment of each patient and the clinical findings rather than procedural availability alone.

“We are not a one-procedure center,” Dr. Dhaliwal says. “Our goal is to match the right technology to the right patient rather than trying to fit everyone into the same approach. For example, SMILE is only approved to correct myopia and astigmatism. It cannot correct for farsightedness. Guiding patients toward the best option for their unique vision correction needs is where we spend most of our time. Yes, we can perform all of the existing modalities with the highest degree of safety and efficacy, but only when we use an approach that is optimal for the patient.”

Subspecialty Corneal Expertise and Surgical Training

SMILE requires technical skills that extend beyond standard excimer laser refractive procedures. The operation is performed entirely within the cornea and depends on precise tissue dissection, controlled lenticule manipulation, and careful preservation of surrounding corneal architecture. Those demands align closely with techniques used in lamellar corneal surgery rather than with flap-based refractive procedures alone.

At the UPMC Vision Institute, the surgeons performing SMILE are fellowship-trained cornea specialists whose routine surgical practice involves operating within corneal layers. That background provides familiarity with tissue handling, interface management, and microdissection techniques that are directly applicable to lenticule extraction required in SMILE.

“For corneal surgeons like me and my colleagues at the UPMC Vision Institute, the adoption of SMILE was a natural extension of what we do every day.” Dr. Dhaliwal says. “We already operate within the cornea for highly complex conditions using similar principles, so incorporating this technology fits seamlessly into our surgical practice.”

Adoption of SMILE at the UPMC Vision Institute included formal SMILE certification courses, laboratory-based surgical training, and hands-on instruction prior to clinical implementation for the Zeiss VisuMax 800 platform.

Regional Access and Program Infrastructure

The UPMC Vision Institute is currently the only center in the region able to offer SMILE Pro to well-selected patients, and the only program in Pennsylvania equipped with the Zeiss VisuMax 800 laser platform required to perform it.

However, availability alone is not the definition of a successful, scalable, and safe program structure. Patients are evaluated, treated, and followed by the same surgeons across the full episode of care rather than moving between screening clinics and procedural centers. This continuity that the UPMC Vision Institute offers patients supports consistent decision-making, procedural planning, and postoperative management within a single integrated refractive service.

“We do not look at SMILE as a commodity procedure,” Dr. Dhaliwal says. “The surgeon’s experience and involvement at every step are critical to achieving good outcomes.”

Patient Referrals and Consultations

To learn more about SMILE vision correction surgery, or to refer a patient for a complementary refractive surgical consultation please call 412-642-5421.