SMILE Pro: what really changes with the VisuMax 800 laser

SMILE Pro is not a new operation: it is SMILE performed with Zeiss’s latest-generation laser, the VisuMax 800. The principle does not change: a thin disc of cornea is cut with the laser and then removed through a small incision, without a flap. What changes is the speed of the laser and the automation of centring and alignment. Published studies show visual results as good as with the previous generation; the only measured gain concerns the alignment of the astigmatism correction. This is the laser Dr Tourabaly operates with at the Clinique Laser Victor Hugo.

THE LASER

SMILE, SMILE Pro, KLEx: what are we talking about?

SMILE (short for Small Incision Lenticule Extraction) corrects myopia and astigmatism in three stages. A femtosecond laser cuts, inside the cornea, a thin disc of tissue, the lenticule, whose thickness matches the correction. The surgeon separates it and then removes it through an incision a few millimetres long. As the cornea loses this volume, its curvature changes and vision is corrected. Unlike LASIK, no flap is lifted.

“SMILE Pro” is the trade name Zeiss gives to SMILE performed with its VisuMax 800 laser, which succeeded the VisuMax 500. Scientific publications increasingly use a generic term, KLEx (keratorefractive lenticule extraction), which covers all lenticule extraction techniques, whatever the make of laser. Evidence-based international guidelines were published for this family of techniques in 2025 in the journal Ophthalmology (Wang): 38 recommendations, from the choice of candidates to the management of complications.

What the VisuMax 800 changes during the procedure

A faster laser

The VisuMax 800 delivers its pulses at 2 MHz, compared with 500 kHz for the VisuMax 500. The manufacturer states that the lenticule is cut in under 10 seconds per eye. For the patient, this mainly means a shorter phase during which the eye is held by gentle suction, under a curved glass placed on the eye, and has to stay still while looking at a light. The time spent in the operating theatre is not limited to those seconds: preparation, anaesthesia with eye drops and the surgeon’s removal of the lenticule take up most of the session.

Automated centring and alignment

Two automated functions have been added. The first centres the treatment on the patient’s visual axis. The second compensates for the slight rotation of the eye that occurs between the seated position, used at the consultation, and the lying position, used for the operation. This rotation matters when correcting astigmatism, which has an axis: a treatment rotated by a few degrees corrects less well. These two adjustments were not automated on the previous generation.

The same laser is also used for LASIK: at the Clinique Laser Victor Hugo, the VisuMax 800 with which Dr Tourabaly operates cuts the LASIK flap just as it cuts the SMILE lenticule. The choice between the two techniques therefore depends not on the device but on the eye.

THE EVIDENCE

Are the results better than with the earlier SMILE?

That is the question patients ask, and the most solid answer dates from 2026. A Chinese meta-analysis (Wan, 2026) pooled nine studies comparing the two lasers, a total of 1,672 myopic eyes. It finds no significant difference in the proportion of eyes seeing 20/20 without correction, in the accuracy of the correction or in safety. The only clear difference concerns the astigmatism axis. The treatment was aligned to within 5 degrees about 1.16 times as often with the VisuMax 800, which is consistent with the automatic compensation for rotation. The authors point out that these studies are observational, with no randomised trial.

In other words, SMILE Pro makes the procedure faster and more reproducible, but it does not give better vision than the previous-generation SMILE, whose results were already very good in published studies.

What the VisuMax 800 series show

• Results at 6 months: the European and Asian multicentre study that followed the launch of the laser (Sekundo, 2025, 473 eyes) is described in detail on our SMILE page.
• Stability at one year: in a German series of 90 eyes (Messerschmidt-Roth, 2026), 96% of eyes were within 0.50 dioptre of the intended correction at 12 months, with no notable change between the 3rd and the 12th month. One patient in five was not seen again at one year.
• Safety in routine practice: in a German series of 916 eyes operated with SMILE Pro (Beckers, 2026), the procedure was completed in 99.45% of cases. Loss of suction occurred in 6 eyes: the procedure could be completed in one after re-docking, four were operated with another technique and the last one was not re-operated. A second procedure was needed in 1.54% of eyes. Adverse effects were mostly early and mild: small surface lesions and dryness. No sight-threatening complication was observed.
• Satisfaction: in the multicentre study, 226 patients completed a questionnaire at 6 months (Feucht, 2026). 98.7% said they were satisfied, and 93.8% reported no longer needing glasses or contact lenses in everyday life. 80.5% reported little or no difficulty driving at night, which means that about one in five reported more marked difficulty.
• Astigmatism: in a Turkish series of 128 eyes (İritaş, 2026), the axis was well respected, but high astigmatism remained slightly undercorrected at 3 months. The authors see room to improve the settings for these eyes.

What does not change

The indications. SMILE Pro corrects myopia and myopic astigmatism. In the VisuMax 800 studies, this meant myopia up to -10 dioptres and astigmatism up to 5 dioptres. For hypermetropia, LASIK remains the reference technique, with the longest track record. Presbyopia calls for other solutions, such as PresbyLASIK. The operation is possible from the age of 18, provided that vision is stable.

The preoperative assessment. The thickness and shape of the cornea, the state of the ocular surface and the stability of the correction decide the technique, not the device. This preoperative assessment takes place at the Cachan practice or at the Cabinet ophtalmologique Sorbonne Saint-Michel (Paris 5th), both of which have corneal topography. Depending on the eye, it may lead to SMILE, to LASIK, to PRK or to another solution. The strength of the cornea, often presented as an advantage of SMILE, has not been shown to differ: a meta-analysis of 16 studies (Chen, 2023) finds no significant difference in corneal biomechanics between SMILE and femtosecond laser LASIK. A comparison of these techniques is better made in our article LASIK or SMILE.

Recovery. It is the same as for SMILE. SMILE does not require a protective shield after the procedure. The check-up takes place the next day, then at one month, at the Cachan or Paris 13 practice. Temporary dry eye is possible. A Canadian meta-analysis (Sambhi, 2020) showed that tear film stability fell significantly after LASIK, but not after SMILE or PRK. Two more recent meta-analyses point the same way: corneal nerves are better preserved after SMILE in the first months (Jiang, 2022, 12 studies), and the tear film remains more stable at 3 and 6 months than after LASIK, with no significant difference in how patients felt, as measured by questionnaire (Chen, 2025, 18 studies). Because refractive surgery is an elective procedure, it does not give rise to sick leave: recovery is taken as annual leave or RTT days (French working-time reduction days) (see sick leave after LASIK, PRK or SMILE).

Location and cost. The procedure is performed at the Clinique Laser Victor Hugo (Paris 16th), where the VisuMax 800 is located. Every SMILE that Dr Tourabaly performs there is therefore a SMILE Pro, at the SMILE price: €3,300 for both eyes. The details of what the fee covers and what is charged separately are on the page on refractive surgery prices. French national health insurance (Assurance Maladie) does not reimburse the procedure; some top-up health insurance policies (mutuelles) provide an allowance (see what does my mutuelle reimburse).

Like any surgery, SMILE Pro carries risks, which are presented in detail at the consultation and on the SMILE page. In the series of 916 eyes cited above (Beckers, 2026), adverse effects were mostly early and mild.

Frequently asked questions

Consultations in Cachan, in Paris 13 and at the Sorbonne Saint-Michel practice (Paris 5th) · Tel. +33 1 45 47 08 11

Scientific sources

• Wan Q, et al. Comparison of VISUMAX 800 and VISUMAX 500 femtosecond laser systems for myopia: a systematic review and meta-analysis. J Clin Med. 2026. PMID 42513431
• Sekundo W, et al. Keratorefractive lenticule extraction for myopia and myopic astigmatism with the VISUMAX 800: 6-month outcomes of a prospective multicenter study. J Refract Surg. 2025. PMID 40067668
• Messerschmidt-Roth A, et al. Keratorefractive lenticule extraction for myopia and myopic astigmatism using a 2 MHz femtosecond laser: 12-month refractive outcomes. J Cataract Refract Surg. 2026. PMID 41739953
• Beckers D, et al. Intraoperative safety and postoperative complications after SMILE Pro: a retrospective case series of 916 eyes. J Clin Med. 2026. PMID 42355753
• Feucht N, et al. Patient-reported outcomes after keratorefractive lenticule extraction using the VISUMAX 800 laser in a prospective multicenter post-market clinical follow-up study. J Refract Surg. 2026. PMID 42261934
• İritaş İ, et al. Enhanced predictability and axis precision of SMILE Pro, a retrospective analysis of myopic astigmatism correction. Int J Ophthalmol. 2026. PMID 42639215
• Wang Y, et al. Evidence-based guidelines for keratorefractive lenticule extraction surgery. Ophthalmology. 2025. PMID 39577672
• Sambhi RS, et al. Dry eye after refractive surgery: a meta-analysis. Can J Ophthalmol. 2020. PMID 31712000
• Jiang X, et al. Influences of SMILE and FS-LASIK on corneal sub-basal nerves: a systematic review and network meta-analysis. J Refract Surg. 2022. PMID 35412925
• Chen KY, et al. How effective is keratorefractive lenticule extraction surgery (KLEx) in reducing dry eye outcomes compared to LASIK? A systematic review and meta-analysis. J Refract Surg. 2025. PMID 40778870
• Chen S, et al. Corneal biomechanics after small incision lenticule extraction and femtosecond laser in situ keratomileusis: a systematic review and meta-analysis. Medicine (Baltimore). 2023. PMID 37565903

This article is for information purposes and does not replace a medical consultation. Indications, expected benefits and risks depend on each individual situation. For any question about your vision, consult an ophthalmologist.