Reinstein DZ, et al. - In this investigation, researchers reported the incidence and outcomes of suction loss during small incision lenticule extraction (SMILE). Suction loss incidence was measured over 4,000 consecutive SMILE procedures and categorized by cause, the interface in which suction was lost and management (restart/continue SMILE, re-SMILE thinner cap, convert to laser in-situ keratomileusis [LASIK]). Data reported that there were 20 cases of suction loss. Investigators found that suction loss was caused by a Bell's reflex in 10 eyes, fixation light tracking in six eyes, patient anxiety in two eyes, a nociceptive reflex in one eye and false suction in one eye. Depending on the interface during which suction is lost, the suction loss can be managed. In all cases, the treatment was completed on the same day. Compared with the fellow eye in this series, visual and refractive outcomes were unaffected.