ReLEx Smile

The ReLEx SMILE procedure is the medical and technical advancement of the Femto-LASIK method. It enables a particularly gentle and safe correction of visual impairments.

At the Bati Göz Eye Clinic, the brand-new VisuMax 800 (manufactured in 2023) is used, allowing the latest SMILE PRO technology to be performed.

Method	ReLEx SMILE PRO with the ZEISS VisuMax 800 femtosecond laser
Usage	Nearsightedness (up to -8 diopters) and astigmatism (up to 5 diopters)
Procedure	Preparation of a corneal lenticule, which is removed through a minimally invasive channel at the side of the cornea. The opening is only a few millimeters small.
Duration	Approximately 15–20 minutes for both eyes.
Cost	€2,390 for both eyes.

A specially modified femtosecond laser is used to create an ultra-thin disc (lenticule) within the cornea, which is removed through an opening at the edge of the cornea measuring just two millimeters. What remains is a reshaped cornea that provides the desired visual acuity.

With ReLEx SMILE, the eye is treated gently, as the cornea retains its stability, and potential complications from flap creation are eliminated.

ReLEx SMILE is a minimally invasive procedure and the first choice for correcting nearsightedness, astigmatism, or for patients with dry eyes.

Relex Smile vs iLASIK

When the first LASIK surgery was performed in 1990, it was a significant improvement over the previously used PRK-LASEK method at the time. Today, in the 21st century, the ReLEx SMILE procedure is undoubtedly the superior and gentler alternative to LASIK. But why is this the case?

In the LASIK method, an almost complete circular incision is made around the cornea, with a total length of approximately 20 mm. This is performed using a specialized surgical instrument called a microkeratome. In iLASIK, a femtosecond laser is used instead to make the incision.

In both procedures, a flap is created and folded back to allow the underlying corneal tissue to be treated with an excimer laser. Afterward, the flap is returned to its original position.

The vast majority of people suffer from nearsightedness with correction values between -2 and -10 diopters or, to a lesser extent, from astigmatism. The ReLEx SMILE procedure was developed for this large patient group, which accounts for around 80% of all correctable vision impairments. Additionally, patients with dry eyes, known as keratoconjunctivitis sicca, can also be treated with ReLEx SMILE.

ReLEx SMILE – Outpatient Surgery Without a Flap

At the heart of the ReLEx SMILE procedure is the VisuMax femtosecond laser from Carl Zeiss. After the patient’s pre-examination, the eye surgery takes place, lasting only a few minutes. The actual use of the femtosecond laser takes just a few seconds per eye.

The eye to be operated on is first numbed with drops, the eyelid is fixed to prevent involuntary blinking, and a contact lens is inserted to guide the laser more effectively.

Next, the VisuMax laser is used. The patient typically notices this as a series of green flashes. There is no pain, unpleasant odors, or any discomfort. During the procedure on both eyes, the patient lies on a comfortable cushioned bed.

ReLEx SMILE is one of the minimally invasive procedures, also referred to as keyhole techniques. This keeps the strain on the patient to a minimum and accelerates the healing process.

ReLEx SMILE in Use Worldwide – Experience Matters

Since the introduction of the ReLEx SMILE procedure about ten years ago, over 1.5 million operations have been performed using the VisuMax femtosecond laser. In 2017 alone, 10% of all eye laser surgeries worldwide were ReLEx SMILE procedures.

Even the world’s strictest regulatory authority, the U.S. FDA, approved the ReLEx SMILE procedure in October 2018 for the treatment of astigmatism. Previously, the procedure was only permitted for correcting nearsightedness in the United States.

The groundbreaking nature of ReLEx SMILE has also been indirectly recognized by the Nobel Prize Committee in Stockholm. In 2018, Dr. Donna Strickland and Dr. Gérard Mourou were awarded the Nobel Prize in Physics for their foundational research on CPA (chirped-pulse amplification). This principle of ultra-short optical pulses is the technology used by the ZEISS VisuMax laser, enabling the ReLEx SMILE procedure.

Today, more than 1,700 surgeons in over 70 countries use the ReLEx SMILE method, including physicians in Turkey.

Our patient Wioletta after her ReLEx SMILE surgery at the Bati Göz Eye Clinic:

The application of ReLEx smile – a wide field

With ReLEx SMILE, nearsightedness and astigmatism can be corrected to a greater extent than with Femto-LASIK. The indication range for myopia (nearsightedness) and astigmatism (corneal curvature) in ReLEx SMILE is as follows:

• Spherical: -1,00 to -9,00 diopters
• Astigmatism: 0 bis 5,00 dpt

This means that, theoretically, nearsightedness from -1,00 to -9 diopters and astigmatism up to 5 diopters can be treated surgically.

Unfortunately, farsightedness cannot be corrected with the ReLEx SMILE method.

While Femto-LASIK can correct up to -8.00 diopters, ReLEx SMILE is effective for vision impairments of up to -9.00 diopters. Another advantage is that laser eye surgery is still possible even if the cornea is not thick enough for a LASIK procedure.

Today, approximately 2 billion people worldwide suffer from nearsightedness. By 2028, various forecasts predict that every third person will be nearsighted.

ReLEx SMILE – Low-Risk and Gentle

The benefits of the ReLEx SMILE procedure are remarkable:

1. Minimal incision of 2 mm in length on the cornea.
2. The creation of a flap is eliminated, reducing the cutting area by 85%, which also practically eliminates the risks of flap displacement or epithelial cell ingrowth.
3. The tear flow of the eye is not affected, which is why ReLEx SMILE is also highly suitable for dry eyes.
4. It is a completely painless procedure.

Since the introduction of ReLEx SMILE, only a few years have passed, yet a long-term study has already been conducted, in which the results of the surgery were examined at intervals of 6 months and again after 5 years.

As published in the British Journal of Ophthalmology, a ReLEx SMILE procedure was performed on 91 eyes in 2008/2009. The correction of nearsightedness was done with an average value of -4.75 diopters. The authors of the study had the opportunity to examine 56 of the 91 operated eyes at intervals of 6 months and again after 5 years.

It was also found that the occurrence of dry eyes, a problem that sometimes arises with the LASIK method, was hardly observed with ReLEx SMILE. Preventive treatments to prevent dry eyes could be discontinued in all examined patients within three months at the latest. The authors believe that, in the case of myopia, ReLEx SMILE will eventually replace both LASIK and iLASIK.

Recovery after ReLEx SMILE

Thanks to the gentle, minimally invasive method, the expected visual acuity is achieved in a short period of time. As early as the day of the surgery, up to 90% of the vision that was previously possible with glasses or contact lenses is restored. Full vision is typically achieved after about three days.

Just as a high standard of hygiene is crucial for a successful surgery, it is important for the patient to follow the instructions and “drop schedule” prescribed by the doctor. This ensures that the healing process goes smoothly.

The Costs of ReLEx SMILE

Private health insurance companies reimburse the costs of laser eye surgery under certain conditions, while public health insurance generally only covers it in very few exceptional cases. The vast majority of people suffering from nearsightedness or astigmatism must either rely on corrective lenses or pay for the surgery out of their own pocket.

In European countries, the prices for ReLEx SMILE surgery are relatively high, with additional costs for pre- and post-operative exams and tiered fees based on the number of diopters that need to be corrected. Below are some guidelines regarding these costs:

A look beyond the borders of these countries shows that it is also quite affordable abroad. In particular, “laser eye surgery in Turkey” stands out positively. This is true both in terms of cost and the quality, care, and experience. Here are the guidelines for a ReLEx SMILE procedure in Istanbul:

Round-trip flights to the metropolis of Istanbul, which take about two and a half hours each way, are available from any international airport in Europe starting at €200.

By choosing the right provider, you can opt for an all-inclusive package that includes the pre-examination, the ReLEx SMILE surgery, the post-operative examination, and the hotel. Compared to prices in Germany, Switzerland, or Austria, this can save around 50% of the costs.

The Alternative for the Cost-Conscious: Turkey

Every person has the legitimate interest in obtaining the best possible value for money for a service or product. This applies in the healthcare sector just as it does in other areas.

In this regard, it makes sense to compare services. For example, it is evident that the Bati Göz Clinic in Istanbul can easily compete with hospitals and ophthalmology practices from Switzerland, Austria, or Germany.

The range of services offered by the clinic in relation to laser eye surgery includes the following points:

• Own clinic building, fully air-conditioned
• The lasers used are state-of-the-art devices from Carl Zeiss, Germany
• Title: Center of Excellence
• Quality management ISO-9001:2000
• TÜV Rheinland certified
• $50 million investment over the past 15 years
• Laser procedures and other surgical interventions performed: ReLEx SMILE, Femto-LASIK, iLASIK, LASEK, PRK, Presbyond Laser Blended Vision, Retina, lens implants, strabismus surgery, corneal transplants
• Trilingual support available in German, English, and Turkish
• Over 1,000 eye surgeries performed annually
• Own shuttle service from the airport to the hotel and clinic
• Pre- and post-operative examinations included in the price
• Fixed price with no variable cost calculations for different diopter corrections
• Eight doctors, along with the appropriate nursing staff, take care of patients, primarily from German-speaking countries, who come to Istanbul for eye surgery at the Bati Göz Clinic.

Patients are welcomed at the airport and typically taken to the hotel first, before heading to the nearby clinic for the pre-examination.

The medical professionals at the clinic have each successfully performed hundreds, sometimes over a thousand, eye surgeries. Experience from many years, combined with state-of-the-art equipment, ensures that patients with nearsightedness or astigmatism are transformed into people with full vision, often in a very short time with ReLEx SMILE.

Few people miss the opportunity to get to know the metropolis of Istanbul better, which is why stays are often extended by two or more days beyond the minimum three-day duration.

This process runs smoothly thanks to the agency Health Travels.

Health Travels – Everything from One Source

The agency Health Travels, led by brothers Mathias and Clemens Weber, with offices in Frankfurt am Main and Istanbul, offers complete organization services.

From hotel bookings and the arrangement of all transfers to, of course, communication with the clinic—the most important part. This service is worthwhile, as it draws on the experience that an individual patient may lack and could be overwhelmed by when handling the logistics on their own.

Ultimately, other factors also count. For example, invoicing in German, as even if health insurance does not cover the costs, the expenses can still be claimed for tax purposes.

It is also always reassuring to have a contact person available at any time, someone who can provide competent answers to questions and is always willing to do so.

Frequently Asked Questions & Answers

Question 1: What is ReLEx SMILE?

Answer: ReLEx SMILE is a minimally invasive method in refractive eye surgery. A modified femtosecond laser is required to perform it, which is currently only produced by Carl Zeiss in Germany.

Question 2: Who offers ReLEx SMILE?

Answer: Since its introduction about ten years ago, ReLEx SMILE has been successfully performed on all continents, including in Germany, Austria, Switzerland, and Turkey.

Question 3: When can sharp vision be achieved after the ReLEx SMILE procedure?

Answer: On the same day as the surgery, the eyes achieve about 85 to 90% of the visual acuity that was previously possible with corrective lenses.

Question 4: When is full vision achieved with ReLEx SMILE?

Answer: On average, it takes three days to reach the predicted visual acuity. However, it can happen faster, depending on various factors such as personal constitution.

Question 5: At what diopter level is ReLEx SMILE surgery possible?

Answer: Although ReLEx SMILE can be performed at -0.5 diopters, doctors recommend the procedure starting at -1.5 diopters. This also applies to astigmatism, which can be treated from 0.5 diopters, but it is better to wait until 1.5 diopters for surgery.

Question 6: When can cosmetic products be used or sports be resumed after ReLEx SMILE surgery?

Answer: Physical activities, at least endurance sports, can be resumed two weeks after ReLEx SMILE surgery. The use of cosmetics (makeup) near the eyes should be avoided for three weeks after the surgery.

Question 7: Can complications occur with ReLEx SMILE?

Answer: Due to high hygiene and quality standards, as well as the keyhole technology used in ReLEx SMILE, the complication rate is extremely low. Of course, it is the patient’s responsibility to follow the doctor’s aftercare instructions diligently to avoid negatively affecting the healing process.

Question 8: Is there an age limit for ReLEx SMILE?

Answer: The minimum age is 18 years. There is no upper age limit in principle.