SMILE vs. LASIK: Comparing Vision Correction Surgery Options

LASIK and SMILE eye surgery present two reliable options for patients looking for a vision correction procedure. While LASIK remains the most popular laser procedure, SMILE eye surgery presents a newer approach.

When evaluating SMILE vs. LASIK, patients should consider the pros and cons of each unique procedure to make a choice that best fits their eye care needs.

LASIK is a laser-assisted refractive surgery that dramatically improves vision and eliminates refractive errors such as near-sightedness, far-sightedness, and astigmatism. It is popular among patients with vision problems who no longer wish to wear glasses or contact lenses.

The corrective procedure is safe and effective, with a track record of reliable results. After LASIK surgery 94% of patients end up with 20/20 vision or better after three months.

LASIK corrects refractive errors in the eye. Refractive errors are caused by imperfections in the shape, smoothness, or transparency of the cornea, making it difficult for the eye to bend light and focus on objects properly.

During LASIK surgery, an eye doctor uses a laser to reshape the cornea and smooth irregularities on the eye's surface, correcting natural errors or flaws. They do this by creating a flap on the surface of the cornea.

The flap is then moved to the side to operate on the stroma—the deep layers of the cornea. Once the procedure is complete, the doctor will put the flap back in place.

The procedure itself is fast and effective. Most LASIK surgeries take 15 to 20 minutes to complete, and a patient can expect quick results the same day.

SMILE (small incision lenticule extraction) is a laser eye surgery used to treat refractive errors such as myopia and astigmatism. The procedure is a relatively new refractive eye surgery. It was introduced as a LASIK alternative in 2007.

Like LASIK, SMILE eye surgery is popular among patients looking for clearer vision and freedom from glasses and contacts.

During SMILE eye surgery, the eye doctor uses a femtosecond laser to create a corneal lenticule in the patient's eye. Lenticules are tiny disc-shaped pieces carved into the cornea.

The doctor will then make an additional incision to remove the lenticules. The process of removing these pieces changes the shape of the patient’s cornea—allowing them to enjoy clearer, crisper vision.

This precise procedure avoids the large corneal flap that must be repositioned following LASIK surgery.

LASIK and SMILE eye surgery are both safe and effective refractive surgeries that share many of the same benefits.

Both LASIK and SMILE eye surgery are considered safe and reliable procedures. Qualified candidates for both procedures can expect to undergo either surgery with minimal complications.

Following LASIK surgery, some patients may experience mild side effects such as grainy vision, mild irritation, or a foreign body sensation. But recovery from these side effects should happen quickly, with discomfort ending shortly after surgery.

Most patients who elect to have either LASIK or SMILE eye surgery can enjoy a swift recovery and expect to return to day-to-day activities quickly.

For both procedures, visual recovery begins almost immediately after surgery. On the day following LASIK, most patients’ vision is clear and normal. They can usually resume normal activities—but should avoid strenuous activity, as well as swimming or submerging the eyes for two weeks.

Patients can expect a high success rate with both surgeries. In the overwhelming majority of cases the two procedures will dramatically improve vision and eliminate certain refractive errors.

To provide some perspective, following LASIK surgery 98.5% of people are happy with their outcome. Around 94% end up with 20/20 vision or better at three months, and 100% were 20/40 or better at three months.

Both LASIK and SMILE eye surgery cost around the same amount. Patients can expect to pay anywhere between $1,500 to $3,000 per eye ($3,000 to $7,500 for both eyes).

Various factors contribute to the range of prices. Surgery will usually be more expensive in places with a higher cost of living and in cases where surgeons lease their equipment. The experience of the eye doctor and the prestige of the clinic will also determine the final price of both surgeries.

Unfortunately, patients cannot rely on their insurance to pay for either procedure. Both procedures are considered elective surgeries. This means neither procedure is considered a medical necessity as glasses and contacts can provide similar results.

However, there are flexible payment options through programs like HSAs and FSAs.

While LASIK and SMILE eye surgery are both safe, reliable procedures that share a number of key similarities, there are a number of relevant differences patients should be aware of.

There are notable differences in the surgical procedure for LASIK and SMILE eye surgery. In LASIK the doctor reshapes the cornea by making an incision in the corneal flap. This flap is then mended over the eye at the end of surgery.

In SMILE eye surgery the doctor cuts out pieces of tissue called corneal lenticule and then removes them from the patient's eye. This does not involve removing or replacing the corneal flap.

SMILE eye surgery may be less invasive than LASIK for some patients. LASIK involves creating a corneal flap. SMILE eye surgery, on the other hand, requires only a small incision, reducing the risk of corneal surface complications.

This less invasive procedure may be preferable for certain types of patients. Similar to surgeries like PRK, patients with thin corneas, high risk of eye injury, or active jobs may be better suited for SMILE eye surgery.

Patients undergoing either procedure will typically enjoy a swift recovery, but the recovery time is slightly longer for SMILE eye surgery.

However, SMILE eye surgery patients still recover their vision quickly, often seeing significant improvements within 24 hours post-surgery. Long-term visual recovery is similar for both surgeries at around three to six months.

The removal of the corneal flap presents a greater risk of dry eye for LASIK patients.

As SMILE eye surgery does not require creating a corneal flap, patients will have a decreased risk of dry eye following surgery.

LASIK can correct a broader range of vision problems, including myopia, hyperopia, and astigmatism, making it suitable for a wider range of patients.

SMILE eye surgery is often recommended for patients with myopia and astigmatism, particularly those with concerns about corneal strength or dry eyes. At this time it is not recommended for patients with hyperopia.

Most patients can expect satisfying results with either procedure. LASIK is an ideal choice for patients that want a refractive surgery with a longer track record of proven results and a slightly faster recovery time.

Patients with thin corneas or concerns about dry eye symptoms may be better suited for SMILE eye surgery. Additionally, patients with active jobs or lifestyles may prefer to avoid flap-related complications that may occur with LASIK.

If patients are unsure which surgery is right for them, they should consult their eye doctor to get a more personal, informed opinion.