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SMILE vs. LASIK: Comparing Laser Eye Surgery Options

Max Parikh, M.D.

Medically Reviewed by Max Parikh, M.D.

Fact Checked
8 sources cited

Last Updated

LASIK is one of the first laser-guided operations to reshape the cornea, and this procedure works for all types of refractive errors. SMILE is a newer version with fewer side effects. It is even less invasive than LASIK, but it only works for people with myopia (nearsightedness) and astigmatism.

While there are some important differences between SMILE and LASIK, the pros and cons overlap. They are roughly the same cost, have similar healing times, have similar side effects, and correct refractive errors within about the same range.

However, depending on your needs, you may be a better candidate for SMILE than LASIK.

SMILE vs. LASIK: Understanding Both Procedures

SMILE (Small Incision Lenticule Extraction) and LASIK (Laser-Assisted In Situ Keratomileusis) are laser-based surgeries designed to correct common vision problems associated with refractive errors in the cornea. 

LASIK, approved by the FDA in 1995, is a widely accepted and utilized procedure capable of correcting nearsightedness, farsightedness (hyperopia), and astigmatism. This procedure is indicated for those 18 years or older with moderate prescriptions and thick corneas and otherwise healthy eyes.

Considering LASIK? Find out if you’re a good candidate for this life-changing surgery by answering a few simple questions. Visit our LASIK candidate quiz.

On the other hand, SMILE,  approved by the FDA in 2016, is a newer procedure that doesn’t require a corneal flap. It is primarily used to treat myopia (nearsightedness) and astigmatism, and is typically suitable for individuals 22 years and older with stable prescriptions.

Considering SMILE? Contact NVISION Eye Centers. With talented surgeons ready to serve you in multiple locations, we’re your best choice for a life-changing procedure. Find out about SMILE at NVISION.

Key Facts About SMILE vs. LASIK

Comparing SMILE Eye Surgery and LASIK

Both LASIK and SMILE could help to permanently correct your vision and reduce your reliance on contact lenses or glasses. Your doctor can compare the procedures for you, but this chart can help you understand their similarities and differences as well.

Top Factors to Consider

SMILELASIK 
FDA approval date20161995
Procedure time10 to 15 minutes5 minutes
Conditions treatedMyopia and astigmatismMyopia, hyperopia, and astigmatism
Cost$2,000–$3,500 per eye$1,500–$3,000 per eye
Recovery time24–48 hours, with longer times for full healing24–48 hours, with longer times for full healing
Ideal candidate22 and older with nearsightedness or astigmatism and healthy eyes18 and older with myopia, hyperopia, and astigmatism and healthy eyes 
Access to procedureLess surgeons have experience with SMILE surgeryMany surgeons use this technique and have track records to prove it
How it worksDoctors remove a disc-shaped piece of cornea with a femtosecond laser thru pocket and that reshape the corneaDoctors create a flap on the cornea with a femtosecond laser. Then the flap is folded back. Then with an excimer laser, tissue is removed to reshape the cornea.
Pain during procedureMinimalMinimal
Pain after procedureMinimalMinimal 
Side effectsBlurry vision as the eyes healBlurry vision and discomfort as the eyes heal 
ResultsPermanent vision correctionPermanent vision correction
Outcomes20/40 for most patients, 20/20 for many20/40 for most patients, 20/20 for many

Similarities Between LASIK & SMILE

There are many similarities between LASIK and SMILE. The SMILE procedure was developed from LASIK since that type of laser eye surgery was so popular.

Similarities between the two include the following:

  • Time: They both take about 15 minutes or less to perform.
  • Recovery: They both require only a day of rest and healing.
  • Comfort: Neither are associated with significant discomfort during or after the surgery.
  • Qualifications: You must have otherwise healthy eyes. You must not have underlying conditions that impact your ability to heal, like autoimmune conditions or diabetes. You must not be pregnant or breastfeeding.
  • Outcomes: Both procedures lead to at least 20/40 vision for most patients and 20/20 for many. The long-term results are consistent and predictable.
  • Side effects: There is the potential for similar side effects for up to six months, like glares or halos around lights, dry eye, and trouble with vision in low-light situations. Some patients may still need glasses or an enhancement to improve vision.

Comparing Cost

LASIK and SMILE are similarly priced at around $2,000 per eye. Insurance companies rarely cover the entire cost of these procedures, but patients can use health savings accounts (HSAs) and flexible spending accounts (FSAs) to help them. Some clinicians also offer financing and special deals on surgeries.

The average price of both LASIK and SMILE is about $2,000 per eye.

Procedure

LASIK and SMILE both involve reshaping the cornea with lasers. Computers guide the action, ensuring that doctors don’t take too much or too little tissue. 

The steps of the procedures are similar:

  • You’ll work with an ophthalmologist or optometrist to determine which laser procedure is the best to correct your refractive error.
  • They will make a map of your cornea to program into the laser.
  • The doctor will reshape the cornea using a guided laser.
  • You will rest your eyes at home for about one day following either procedure.
  • Avoid putting anything in or near your eyes, like contact lenses or makeup, for a week or two after the surgery.
  • You’ll use antibiotic eye drops to prevent infection.

Differences Between LASIK & SMILE

While both SMILE and LASIK are procedures that use lasers to reshape the cornea and improve visual acuity, there are several differences between the two that can help you determine if one might work better for your eyes.

Major differences between SMILE and LASIK include the following:

  • Eligibility: LASIK treats all refractive errors. SMILE treats myopia with or without astigmatism but not farsightedness or astigmatism by itself.
  • Preparation: LASIK requires a flap to be cut in the cornea, so the excimer laser reaches the inside of this part of your eye. SMILE reshapes the top of the cornea to flatten it with creation of a flap.
  • Corneas: LASIK is not a good choice for people who have thin corneas. SMILE can still benefit nearsighted people who have thin corneas.
  • Recovery times: LASIK has better recovery from side effects at a seven-day follow-up point compared to SMILE, although there was no difference in recovery rates at one month after the operation.
  • Prescriptions: LASIK, and other types of refractive surgery like photorefractive keratectomy (PRK), can treat higher-order aberrations (HOAs) that impact night vision, while SMILE cannot treat these issues.
  • Access: LASIK is a less demanding procedure for eye surgeons, while SMILE is newer and requires more intensive training. Fewer surgeons specialize in SMILE. 
  • Timeframes: LASIK has been around for about 30 years. SMILE is new to the U.S.

Pros & Cons to Consider 

There are several pros and cons to both SMILE and LASIK eye surgeries, and many of the benefits and detriments overlap. Understanding what they are can help you make a smart decision.

Pros & Cons of LASIK Eye Surgery 

Is LASIK right for you? Looking through the benefits and drawbacks can help you decide. 

ProsCons
Permanent correction for vision problemsNot reversible, even if you change your mind
Well-tested, well-used surgery techniqueDoctors create a flap to change shape of eye and flap could potentially move
Available for wide range of refractive issues, including nearsightedness Still may need glasses or contacts for best corrected vision

Pros & Cons of SMILE

Is SMILE right for you? Keep reading to find out about the pros and cons of this relatively new procedure. 

ProsCons
Permanent correction for vision problemsNot reversible, even if you change your mind
No flap so safer with contact sports and eye rubbingLess access to surgeons
Available for people with myopia and astigmatismNot available for hyperopia 

SMILE or LASIK: Which Option Is Better?


Ultimately, both SMILE and LASIK are safe, reliable, and affordable procedures to improve refractive errors, with certain limitations on who is a good candidate for each option.

Talk with your eye doctor to determine the best procedure for you. For most people, LASIK will be the recommended choice. If you’re older than 18 with healthy eyes and vision challenges, you might be right for LASIK. 

For people who aren’t good candidates for LASIK, SMILE may be a viable option. Thin corneas aren’t a problem for SMILE, and no flap creation means a smaller risk of dry eye issues. 

SMILE and LASIK at NVISION Eye Centers

NVISION doctors provide both LASIK and SMILE for patients looking for permanent vision correction. Our doctors perform detailed examinations, and they talk to patients to help them make the right choice about what is best for their specific situation. Get started today and make an appointment.

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SMILE vs. LASIK FAQs

We’ve compiled the most frequently asked questions about SMILE vs. LASIK, along with answers from our experts.

Is SMILE better than LASIK?

SMILE isn’t better or worse than LASIK. It’s a different procedure made for different types of patients. Your doctor will likely recommend one procedure over the other.

Does SMILE last as long as LASIK?

Both are surgeries that alter your vision permanently. Neither will wear off with time.

Is SMILE cheaper than LASIK?

Both procedures come with a similar price, so one isn’t less expensive than another.

Is SMILE eye surgery safer than LASIK?

Both surgeries are very safe for patients with healthy eyes. SMILE doesn’t require a flap, so it might be better for people with thin corneas. But neither surgery could be considered unsafe, and both boast high patient satisfaction rates.

References

  1. Refractive Errors. (June 2022). National Eye Institute.
  2. FDA Approves VisuMax Femtosecond Laser to Surgically Treat Nearsightedness. (September 2016). U.S. Food and Drug Administration.
  3. What Is Small Incision Lenticule Extraction? (May 2023). American Academy of Ophthalmology.
  4. The 25th Anniversary of Laser Vision Correction in the United States. (March 2021). Clinical Ophthalmology.
  5. The Current State of SMILE vs. LASIK. (April 2021). Review of Ophthalmology.
  6. SMILE: Latest and Limits. (February 2021). Cataract and Refractive Surgery Today.
  7. SMILE vs. LASIK: Which Offers Better Early Visual Recovery? (October 2018). American Academy of Ophthalmology.
  8. SMILE Compared to LASIK and Other Procedures. (June 2016). EyeWorld.

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