In 2017, another laser corneal sculpting option became available for nearsighted individuals. The VisuMax femtosecond laser manufactured by Zeiss of Dublin, California was approved in September 2016 for the use of the SMILE procedure. SMILE is an acronym for Small Incision Lenticular Extraction.

As in Femto-Flap Creation, a million or so laser pulses are placed in a circular pattern inside of the cornea. However, rather than creating a side cut to complete a flap, a second pass of femto-pulses is delivered to create a disc of tissue inside the cornea. Its shape is comparable to the amount of tissue removed during the second step in LASIK. The laser then makes a small connecting side-cut tunnel to access the disc through which it is removed and discarded. The center of the cornea flattens and corrects the prescribed amount of nearsightedness.Although not currently as accurate as LASIK, because no flap is created, SMILE offers an alternative for those at high risk of eye trauma. And, since there is no flap, is spares even more of the corneal nerves responsible for reflex tearing and so may be preferable in those with existing dry eye issues.

The initial approval of this laser by the FDA was for simple myopia of up to -8 diopters. Trials are under review for myopia astigmatism.