Next Generation Refractive Surgery to LASIK and SMILE Now Available for Clinical Review
SINGAPORE, Aug. 18, 2025 /PRNewswire/ -- Dr. Natasha Lim, an internationally renowned surgeon in Ophthalmology, has introduced an alternative to established refractive surgery techniques for medical practitioners in Singapore to explore. Smooth Incision Lenticule Keratomileusis (SILK), a recent advancement in laser vision correction, offers a potentially improved approach to correcting myopia and astigmatism. SILK is a flapless refractive surgery that uses a more recent iteration of the femtosecond laser to create and extract a lens-shaped piece of corneal tissue, called a lenticule, to reshape the eye. A pioneer surgeon in Singapore for the SILK procedure, Dr. Natasha Lim is opening her eye centre for professional discussion and clinical review of the technology and technique behind it.
Comparing SILK to Existing Procedures: LASIK, SMILE
LASIK, a widely established refractive surgery for myopia and astigmatism, involves the creation of a corneal flap. Clinically, LASIK has demonstrated efficacy in correcting myopia up to -12.00DS[1] and astigmatism up to -6.00DC[1]. SILK, a flapless procedure, has since been shown to replicate LASIK's treatable range for myopia up to -12.00DS[2] and astigmatism up to -6.00DC[2].
SILK is not indicated for the correction of hyperopia. However, its minimally invasive nature sets it apart from LASIK—the former does not create a corneal flap, but instead forms a thin lenticule within the cornea.
This suggests that flapless refractive surgeries, such as SILK, can potentially reduce the onset of risks associated with flap complications—such as wrinkles, displacement, and conditions such as corneal ectasia and dry eye syndrome[2]—which can affect visual outcomes and necessitate further correction.
Preceding SILK surgery is Small Incision Lenticule Extraction (SMILE), introduced in 2009. SILK incorporates further technological advancements to the SMILE procedure, including a submicron precision laser system, which delivers lower energy per pulse (at 40 to 90 nanojoules) compared to other laser systems, and is meant for easier and faster tissue dissection time with less post-operative inflammation[3] and faster vision recovery time. Furthermore, SILK employs a proprietary biconvex lenticule shape designed for faster, more optimal healing and better quality of vision, as compared to the asymmetrical shape used by SMILE.
The targeted result is a smoother corneal surface and potentially reduced surgical time, hence enabling faster post-operative visual recovery.
SILK Surgery Operating Procedures
Preoperatively, patient-specific data, including corneal pachymetry and refractive error measurements, are entered into the SILK laser system. The system machine will process this data to inform the automated calculation of lenticule parameters, including the thickness and diameter of corneal tissue (lenticule), for precise tissue extraction during myopia and astigmatism correction.
During the procedure, the patient is positioned under the surgical microscope and cold diode laser delivery system. A fixation light is presented to the patient to ensure stable ocular alignment. The cold diode laser then executes a pre-programmed cutting pattern, creating a lenticule within the corneal stroma and an approximately two-millimetre peripheral incision, allowing the lenticule to gently be removed from within the cornea.
Following laser application, the ophthalmologist proceeds with controlled lenticule dissection and extraction.
Post-Procedure Results
Smooth Incision Lenticular Keratomileusis takes around two minutes to perform, with 85.3%[4] of eyes requiring no or only mild dissection. Patients report an average of one (1) day of downtime for the cornea to reshape by itself.
Clinical studies of the Smooth Incision Lenticule Keratomileusis (SILK) procedure, utilising a femtosecond laser system, demonstrate favourable outcomes: In a 2023 study of SILK surgery, 65.9% achieved a monocular uncorrected distance visual acuity (UDVA) of 20/20 or better at postoperative day one, increasing to 85.4% at one week and 96% at six months. At six months, 100% of eyes achieved a monocular UDVA of 20/40 or better, and no eyes lost any lines of corrected distance visual acuity (CDVA)2.
Refractive stability, as measured by mean refractive spherical equivalent (MRSE), was achieved by three months and maintained at an MSRE predictability of 91.1% through six months[4].
"As an updated version of SMILE, SILK has the potential to be a more effective option for refractive surgery with possibly reduced downtime. Ophthalmologists may soon advise SILK surgery for patients to have a more comfortable and quicker path to clear vision," said Dr Natasha Lim, one of the pioneer surgeons in Singapore for the SILK surgery and the director of Dr Natasha Lim Eye Centre.
As an internationally renowned pioneer LASIK surgeon in Singapore, Dr Natasha Lim has been recognised for her extensive contributions to refractive surgery. She is the only ophthalmologist from Singapore elected to publish her LASIK results on the worldwide AMO iDesign Registry, providing clinical guidance to other LASIK surgeons globally.
Dr. Natasha Lim Eye Centre offers a full range of in-house laser systems, providing diverse refractive surgery options tailored to patients' varying ophthalmological conditions.
[1] LASIK and Laser Vision Correction. Healthhub
[2] Sachdev MS, Shetty R, Khamar P, Malik R, Schwam BL, Wang Y, Fu H, Voorhees AP, Laron M. Safety and Effectiveness of Smooth Incision Lenticular Keratomileusis (SILKTM) Using the ELITA(TM) Femtosecond Laser System for Correction of Myopic and Astigmatic Refractive Errors. Clin Ophthalmol. 2023 Dec 8;17:3761-3773. doi: 10.2147/OPTH.S432459. Erratum in: Clin Ophthalmol. 2024 May 11;18:1287-1288. doi: 10.2147/OPTH.S476560. PMID: 38089649; PMCID: PMC10715007.
[3] Uslu MÖ, Eltas A, Marakoğlu İ, Dündar S, Şahin K, Özercan İH. Effects of diode laser application on inflammation and mpo in periodontal tissues in a rat model. J Appl Oral Sci. 2018 Jul 16;26:e20170266. doi: 10.1590/1678-7757-2017-0266. PMID: 30020350; PMCID: PMC6089569.
[4] Sachdev MS. Smooth Incision Lenticular Keratomileusis (SILKTM). Indian J Ophthalmol. 2024 Apr 1;72(4):464-467. doi: 10.4103/IJO.IJO_620_24. Epub 2024 Mar 28. PMID: 38546465; PMCID: PMC11149504.
About Dr Natasha Lim Eye Centre
Dr Natasha Lim Eye Centre is a leading provider of advanced eye care in Singapore. Founded by Dr. Natasha Lim, a highly experienced ophthalmologist and pioneer in refractive surgery, the Centre offers a comprehensive range of services, including LASIK, SILK, presbyopia correction and cataract surgery. Dr Lim is dedicated to providing personalised care and utilising the latest technologies to help patients achieve optimal vision.
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