Interview with Allon Barsam | SmartSight

Hi Allon, and thank you for joining us today to discuss your expertise and the innovative procedure SmartSight™! Let us dive straight into some questions to give our readers a better insight into your profession and how you can help them.

What are the critical differences between SmartSight™ laser eye surgery and other procedures such as LASIK or LASEK?

LASIK involves making a flap in the cornea with a precise laser; however, with SmartSight™, there is no flap in the cornea, meaning it is a flapless procedure. With LASEK (a surface procedure), the cornea’s surface needs to be given time to heal afterwards. So, although LASEK or surface procedures are painless, the recovery is considered more painful. The advantage of LASIK is that recovery is painless and fast, but there is a flap there. With SmartSight, there is no flap, and you have fast visual recovery.

Having no flap is very beneficial to those patients who partake in contact sports, for example, because they do not have to worry about poking or knocking the eye in the early period after surgery. We describe this as a keyhole procedure. The procedure it is most similar to is Smile™. Smile™ is thought to have a less accurate way of tracking the pupil and no way of digitally/most accurately correcting for astigmatism. Astigmatism is where the cornea, the clear natural watch crystal of the eye, is shaped more like a rugby ball rather than a football. Often, for people with glasses, they will have two prescriptions. One is for the sphere, which is the overall power of the glasses, and the other is for the astigmatism.

SmartSight™ has what is known as a cyclotorsion tracker, which tracks the eye and can treat astigmatism accurately. One of the things many people do not know is that when we lie down, our eyeballs rotate. With astigmatism, there is an axis, and there will always be an angle at which you can correct the astigmatism. Nevertheless, when the angle moves (when you lie down), you cannot treat it accurately without a tracker.

SmartSight™ has taken much technical adaptation from procedures like LASIK and advanced the procedure. This ensures that things like night-time vision are good, astigmatism is corrected, and it can all be incorporated with a flapless keyhole procedure.

The main proven benefit of it is that recovery from dry eye is much quicker. Generally, patients will have concerns about dry eyes, as this can be common with LASIK or laser vision correction. Patients who have SmartSight™ will have dry eyes for less time –typically just for a few weeks – but this will soon alleviate.

How long does the SmartSight™ procedure typically take from start to finish? Does it require any specific pre-operative preparations?

It takes about 15 minutes to do both eyes. That is the amount of time we allow for surgery. However, the actual procedure time of the laser is around a minute, so to complete both eyes usually is about two minutes of actual laser time.

Can you explain the criteria for determining a patient’s suitability for SmartSight™ laser eye surgery? 

It can be difficult for patients to know the ideal procedure they need when they attend a consultation with us. I recommend that patients trust their consultant to select the best treatment after a discussion. As consultants, we always discuss the options for our patients and explain our reasoning as to why we may choose one procedure over other options. We consider many things, including measurements, the thickness and shape of the cornea, and the size of their prescription. Not every patient is suitable for SmartSight™, and other fantastic procedures exist, such as LASIK.

What are the advantages of SmartSight™ for patients with high prescriptions?

The potential benefit of SmartSight™ is the long-term stability for high prescriptions. For those with prescriptions as high as -9, this can be incredibly beneficial as the cornea is thought to be stronger after SmartSight™ compared with LASIK  meaning they are less likely to become near-sighted again in the future.

How does SmartSight™ cater to individuals who engage in contact sports? 

The recovery time for SmartSight™ is rapid. Generally, a patient’s vision is good enough that they can drive the next day. Sight tends to get very sharp within the week. Patients also do not have much discomfort afterwards, and the procedure is painless. The hours that follow the procedure are also generally comfortable as the size of the keyhole we use is only 3mm.

Are there any potential risks or complications associated with SmartSight™? How do you address these during the treatment and follow-up visits?

The risks of LASIK also apply to SmartSight™. The main downside of this procedure is that whilst with LASIK perfect vision is nearly guaranteed on the first day, it takes a few days for a SmartSight™ procedure to catch up. Patients will have to wait a few days for perfect vision, although they can still do everything, such as driving, going to work and running errands the following day.

What ongoing care or post-operative measures do you recommend to patients after SmartSight™ surgery? How often do they need to visit for follow-up examinations?

At OCL Vision, we see our patients the following day and again the following week. After these two follow-ups, we see them again after three months. We also require our patients to use their drops correctly and we have an app that sends them reminders to make this easy..

In your experience, what have been the most significant success stories or transformative outcomes you have witnessed with SmartSight™ laser eye surgery?

I was the first surgeon in the UK to carry out a SmartSight™ procedure in September 2022. Since then, I have completed over 100 and now carry out SmartSight ™ around 15 times every month. I remember completing the procedure on a patient who was the son of a surgeon who himself had completed many keyhole surgeries. He loved the idea of his son also having a keyhole procedure. The procedure was a success, and the patient is doing very well.

I also carried out SmartSight™ on a patient who was profoundly deaf, so vision was essential to them. When we lose one sense, our other senses become more vital – he was over the moon with his results.

Do you find it challenging when performing surgery on other surgeons?

I see performing eye surgery on another surgeon as a tremendous honour. Different from being chosen by a private/lay client, someone already in the industry will choose more carefully. I am proud to have carried out laser vision correction on many other eye surgeons including several Consultants who specialise in vision correction surgery themselves.

Looking ahead, do you anticipate any further advancements or refinements in the field of laser eye surgery, specifically related to SmartSight™?

Yes, I think the treatments will continue to get quicker, and recovery will continue to get faster. The lasers we use will always continue to improve. However, the laser we have at OCL Vision is the only one of its kind in London (the Schwind ATOS laser).  With this technology, we became the first clinic in the UK to have it. The laser is very low energy and offers a gentle laser, which can deliver treatment quickly. Technology continues to get quicker and gentler with quicker recovery times. The machine we have is already excellent. Nevertheless, laser technology and techniques continue to improve

Thank you, Allon, for taking the time to talk to us and for helping our readers understand more about SmartSight™ and how this procedure could work for them!