SMILE (Small Incision Lenticule Extraction) represents a significant advancement in laser vision correction, offering a flap-free alternative to LASIK.
Last reviewed: 2026-05-06
13 min read
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Content is educational and planning-oriented. It does not replace diagnosis, treatment, or personalized medical advice from a licensed healthcare professional. Outcomes vary by individual case.
This content is general education and does not replace evaluation by a licensed clinician. If you have symptoms, complications, or urgent concerns, seek in-person medical care.
Key takeaways
Facility accreditation and surgeon credentials are separate verifications—ask for both documentation.
WHO-style surgical checklists and time-out procedures significantly reduce preventable errors.
SMILE-specific surgeon experience may influence outcomes—ask about case volumes and training.
International patients should establish emergency communication protocols before surgery.
Day-case surgery follow-up compliance is essential for optimal healing and safety.
Why SMILE Facility Quality Matters
SMILE (Small Incision Lenticule Extraction) represents a significant advancement in laser vision correction, offering a flap-free alternative to LASIK that may appeal to patients with specific corneal characteristics or lifestyle requirements. Unlike procedures that create a corneal flap, SMILE uses a single femtosecond laser to create and extract a lenticule through a small incision, potentially reducing certain post-operative complications related to flap displacement.
The decision to undergo SMILE involves more than evaluating whether you are a candidate for the procedure—it requires careful consideration of where and by whom the surgery will be performed. Research on patient safety in eye care has consistently identified that outcomes depend on the interaction between patient factors, surgeon skill, facility standards, and post-operative care systems [S2]. A facility that excels in one area may fall short in another, making comprehensive evaluation essential.
Understanding what constitutes a quality SMILE facility can help you make an informed decision and feel confident in your choice. This guide walks you through the key criteria to evaluate, the questions to ask during consultation, and the warning signs that should prompt you to look elsewhere. Whether you are considering a facility in Istanbul or elsewhere, these verification steps apply broadly and can help you identify providers that prioritize patient safety and quality outcomes.
SMILE vs. Other Procedures
SMILE differs from LASIK and PRK in that it does not require creating a corneal flap. This distinction influences recovery patterns and may make SMILE suitable for patients with specific corneal thicknesses or those in occupations or activities with higher eye injury risk.
Core Facility Verification Criteria
When evaluating a SMILE facility, you should consider multiple verification layers: accreditation status, surgeon credentials, equipment standards, and emergency response capabilities. Each layer addresses different aspects of safety and quality, and no single factor should be considered sufficient on its own. You can compare accredited facilities using our facility information resources to understand what standards to expect.
Accreditation Bodies and Standards
Facility accreditation indicates that an independent organization has evaluated the facility against established standards for safety, equipment, staffing, and protocols. Major accrediting bodies in the ambulatory surgical facility space include AAAHC (Accreditation Association for Ambulatory Health Care), The Joint Commission (TJC), AAAASF (American Association for Accreditation of Ambulatory Surgical Facilities), and HFAP/ACHC [S4]. Each organization has slightly different standards and focus areas, but all address fundamental aspects of surgical safety.
For a facility to receive accreditation, it must typically demonstrate compliance with requirements for qualified personnel, clean operating environments, appropriate equipment, and capacity to respond to emergencies [S4]. When reviewing accreditation, consider when the facility was last surveyed, whether any conditions were noted, and whether the accreditation is current. Some facilities may hold multiple accreditations, which can indicate a broader commitment to quality standards.
In Turkey, surgical facilities should meet Turkish Ministry of Health standards for healthcare facilities. International accreditations such as JCI (Joint Commission International) are also common among facilities serving medical tourists. If a facility claims international accreditation, ask for documentation and verify the accreditation status directly with the accrediting body when possible. Accreditation provides baseline assurance but does not guarantee individual surgeon performance or specific outcomes [S5].
Surgeon Qualifications and Experience
Surgeon credentials and experience are distinct from facility accreditation. A well-accredited facility may have multiple surgeons with varying levels of experience and training. For SMILE specifically, surgeons should have completed procedure-specific training beyond general refractive surgery credentials, as the technique requires skills that differ from flap-based procedures.
Research in ophthalmic surgical quality indicates that training and experience significantly influence outcomes [S2]. When evaluating a surgeon, consider their refractive surgery fellowship training, SMILE-specific certification or training, and how long they have been performing the procedure. Case volume may be relevant, as surgeons who regularly perform SMILE may develop more consistent technique, though the relationship between volume and outcomes is not always straightforward and individual results may vary.
Ask about the surgeon's overall refractive surgery experience and specifically their SMILE case volume. Some facilities track and share surgeon-specific outcome data, which can provide additional context. Be cautious of facilities that cannot or will not provide this information, as transparency about experience is a reasonable expectation.
Training Verification
You may ask to confirm surgeon credentials directly or request copies of certification documents. Fellowship training in cornea and refractive surgery represents advanced specialization in these procedures. You can also use our surgeon directory to verify credentials where available.
Equipment and Technology Requirements
SMILE requires specialized femtosecond laser technology designed specifically for the procedure. The equipment used can influence precision and outcomes, and facilities should maintain documentation of equipment maintenance, calibration schedules, and staff training on device operation [S3]. Ask what laser platform the facility uses and how often it is calibrated or serviced.
Equipment age and maintenance history may be relevant factors in your evaluation. Newer technology platforms may offer features that improve precision or safety, though established platforms with proper maintenance can also produce good outcomes. The key indicator is whether the facility has rigorous protocols for ensuring the laser is functioning correctly before each procedure.
Safety Systems and Protocols
Safety systems in surgical facilities represent the protocols and checklists designed to prevent errors at every stage of the surgical process. Evidence-based protocols have been shown to significantly reduce complications, and structured communication procedures help prevent wrong-site surgery and other preventable events [S3].
Pre-Operative Verification Processes
Before SMILE surgery, the facility should have systematic processes to verify patient identity, intended procedure, surgical site, and any special considerations. These verification steps typically occur at multiple points: during initial consultation, on the day of surgery before entering the operating room, and immediately before the procedure begins.
Pre-operative verification should include confirming your medical history, current medications, allergies, and any factors that might affect the surgery or anesthesia. The facility should have clear protocols for what happens if discrepancies are identified during verification. Ask during your consultation how these processes work and what your role will be in confirming information.
Surgical Time-Out and Checklists
The surgical time-out is a final verification moment that occurs immediately before the procedure begins, with the entire surgical team present. During the time-out, the team confirms the correct patient, correct procedure, correct site, and any other critical safety items [S3]. This practice, adapted from WHO surgical safety protocols, has become standard in quality surgical facilities.
The checklist approach extends beyond the time-out to encompass the entire surgical pathway, from pre-operative assessment through post-operative monitoring. Research on patient safety incidents has found that communication breakdown and system failures contribute to adverse events, making robust documentation and verification processes essential [S6]. When visiting a facility, observe whether staff follow these protocols consistently—not just whether they have them documented.
Your Role in Safety
Patients can participate actively in safety by confirming information when asked, speaking up about any concerns, and following pre-operative and post-operative instructions carefully.
Questions to Ask During Consultation
Preparation for consultation should include a list of questions tailored to your priorities. The answers you receive—and how they are communicated—can reveal much about a facility's culture, transparency, and commitment to patient education.
Facility Verification Questions
When inquiring about facility credentials, consider asking about the facility's accreditation status and the specific accrediting bodies involved. Request information about how long the facility has held accreditation and whether any conditions or recommendations resulted from recent surveys. Ask about the facility's emergency response capabilities and what protocols exist for managing unexpected events during or after surgery.
You might also ask about the facility's volume of SMILE procedures and how outcomes are tracked. Quality facilities typically monitor complication rates and patient satisfaction, and they should be able to discuss these metrics in general terms. Be wary of facilities that claim perfect outcomes or are unable to discuss any aspect of their safety record.
Surgeon-Specific Questions
Regarding the surgeon, ask about their specific training in SMILE, including when they completed training and how many procedures they have performed. Inquire about their overall refractive surgery experience and whether they perform other procedures such as LASIK or PRK as well. Ask who will be involved in your care during the procedure and what role each team member plays.
Consider asking about the surgeon's approach to cases that are borderline candidates or present complicating factors. How they handle situations where the expected outcome is uncertain can reveal their commitment to appropriate patient selection rather than proceeding with every potential surgery.
Protocol and Safety Questions
Protocol questions should address the verification and time-out processes described above. Ask the facility to explain their pre-operative verification steps and what happens if inconsistencies are identified. Request information about their sterilization and infection control practices, as these are critical for preventing post-operative complications.
Post-operative care questions should cover the follow-up schedule, what symptoms would warrant immediate contact, and how the facility handles patients who develop complications. For international patients, clarify how follow-up will work after you return home and what communication channels exist for questions or concerns.
Red Flags and Warning Signs
Certain patterns during your research or consultation should prompt caution. While no single indicator guarantees problems, multiple concerns should lead you to seek alternatives.
Red Flags to Watch For
Guarantees of specific visual acuity outcomes or "perfect" results
Reluctance to provide surgeon credentials or facility accreditation details
Pressure to book quickly without thorough evaluation
Inconsistent information between consultations or staff members
No clear plan for emergency situations or post-operative complications
Inability or unwillingness to discuss complication rates or revision surgery data
Research on patient safety incidents has found that "insufficient care" and "delayed diagnosis" are among the most frequently reported categories of incidents in eye care [S6]. Patterns such as dismissive responses to concerns, rushed consultations, or difficulty obtaining straightforward information may indicate broader organizational issues.
Trust your observations during the consultation process. How staff communicate with you, whether your questions receive thoughtful answers, and whether you feel respected as a patient all provide relevant information. A quality facility should make you feel comfortable asking questions and confident that your concerns are taken seriously.
International Patient Considerations
Patients traveling internationally for SMILE face additional considerations related to travel timing, post-operative care coordination, and emergency protocols across borders.
Pre-Travel Planning and Documentation
Before booking travel, confirm that the facility can provide comprehensive documentation of your pre-operative evaluation, surgical procedure, and post-operative care plan. This documentation should be in a format that your home-country eye care provider can review if questions arise. Request copies of any diagnostic measurements or imaging performed during consultation.
Establish clear communication channels with the facility before surgery. Identify who to contact with questions, what response times to expect, and how urgent concerns are handled. Some facilities provide coordination services for international patients that include communication support and care coordination with providers at home.
Post-Operative Timeline and Travel Timing
SMILE, performed as a day-case procedure, offers certain advantages for international patients including reduced facility time and potentially faster initial recovery [S1]. However, you should plan to remain in the area for sufficient follow-up visits as recommended by your surgeon. Premature travel may complicate the detection and management of early post-operative issues.
Discuss the recommended post-operative schedule with your surgeon before committing to travel dates. Factors such as the number of post-operative visits required, when protective eyewear can be discontinued, and when flying is considered safe all influence your planning. The facility should provide clear guidance rather than deferring entirely to your judgment.
Emergency Protocols
Before surgery, establish how to access emergency care if symptoms develop after you return home. This may include contact information for the treating facility, protocols for reaching on-call staff, and guidance on when to seek immediate local care versus contacting the surgery facility.
Coordination with Home-Country Providers
If you have an existing relationship with an eye care provider at home, consider sharing your surgical plans and post-operative documentation with them. They can help monitor your recovery and may be able to address routine follow-up needs, reducing the burden on the treating facility while ensuring continuity of care.
Ask the treating facility whether they coordinate with home-country providers and how such coordination typically works. Some facilities have established relationships with providers in common source countries for medical tourism, which can facilitate communication and reduce uncertainty.
Your Facility Evaluation Checklist
Use this framework to systematically compare facilities and make a decision aligned with your priorities.
Feature
Verification Item
What to Look For
Facility Accreditation
Current accreditation from recognized body (AAAHC, TJC, AAAASF, or equivalent)
Turkish Ministry of Health compliance for local facilities
JCI accreditation common for international facilities
Surgeon Credentials
Refractive surgery fellowship training
SMILE-specific certification
Documented case experience
Equipment
FDA/CE-approved femtosecond laser
Documented maintenance and calibration protocols
Safety Protocols
WHO-style checklist implementation
Time-out procedures
Emergency response capabilities
Transparency
Willingness to discuss outcomes and complications
Clear answers to all questions
Written documentation provided
Post-Operative Care
Clear follow-up schedule
Communication protocols for questions
International patient coordination
After completing your evaluation, if you feel confident about the facility's credentials, safety protocols, and care coordination, you may be ready to proceed. Remember that facility quality is only one factor in your overall SMILE experience—your individual candidacy, realistic expectations, and commitment to post-operative care all influence outcomes. Consult with your regular eye care provider before making surgical decisions.
If you would like assistance evaluating SMILE facilities in Istanbul or planning your medical travel, our team can help coordinate your journey.
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1.International Journal of Ophthalmology. “Evaluation of the safety and quality of day-case cataract surgery based on 4151 cases.” 2019. Accessed 2026-02-19.https://pmc.ncbi.nlm.nih.gov/articles/PMC6376245/
2.Springer (NCBI Bookshelf). “Patient Safety in Ophthalmology - Textbook of Patient Safety and Clinical Risk Management.” 2020. Accessed 2026-02-19.https://www.ncbi.nlm.nih.gov/books/NBK585628/
