SMILE vs. LASIK: Which Laser Eye Surgery Should You Get?

SMILE and LASIK are two different choices for long-term vision improvement that differ somewhat in their approach. While LASIK is the more popular surgery, both procedures incorporate state-of-the-art laser technology to improve vision.

LASIK (laser-assisted in situ keratomileusis) incorporates a special type of laser used for precision cutting, changing the shape of the cornea for vision correction. SMILE (small incision lenticule extraction) is also a surgical procedure that uses laser technology to reshape the cornea, but it does so differently.  

Whether SMILE or LASIK is a better choice for you will depend on your vision goals and overall eye health. Talk to your eye doctor about the pros and cons of each procedure for your particular case. 

SMILE vs. LASIK 

SMILE and LASIK are extremely similar, but they do have some key differences.

What Is SMILE Eye Surgery?

SMILE is a procedure that can effectively treat astigmatism (blurred vision) and myopia (commonly referred to as nearsightedness). SMILE incorporates second-generation laser technology that was developed by Carl Zeiss Meditec.

SMILE eye surgery can effectively change the curvature of your cornea, which helps with refractive error, rendering vision sharp once again, and reducing dependency on glasses and/or contact lenses. 

What Is LASIK Eye Surgery?

LASIK also enables many patients to go without corrective lenses following the surgery. LASIK is commonly utilized to correct myopia, hyperopia (commonly referred to as farsightedness), and astigmatism.

The technology of LASIK eye surgery was developed in the 1970s. The surgery has an incredibly high success rate as well as a high patient satisfaction rate.

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What Are the Similarities Between SMILE & LASIK?

SMILE and LASIK both have excellent safety profiles due to the laser-precision aspect of each procedure. Ultimately, patients are generally very satisfied with the results of both surgeries, as both correct refractive errors through reshaping the cornea.

Both LASIK and SMILE are painless procedures, and each incorporates numbing eye drops in the initial stages of the procedure to reduce any discomfort. 

Both procedures are fast and can be done in a single session. Patients will need to plan for about an hour for either procedure.

What Are the Differences Between SMILE & LASIK?

The primary difference between SMILE and LASIK is in regard to the size of the incision. While LASIK creates a circular incision (also called a corneal flap), SMILE utilizes a smaller incision that is made into a pocket that sits underneath the cap of the tissue. Both entail tissue removal, just by slightly different means.

SMILE is also a relatively new procedure that has been approved for the correction of myopia as of 2016 and for astigmatism correction as of 2018. LASIK has been around far longer. The early forms of this technology were used in the 1970s, while the first LASIK eye surgery as we now know it was performed in 1991. 

SMILE vs. LASIK: Pros & Cons

Again, the pros of both SMILE and LASIK are as follows:

• Long-term vision correction
• High success rates
• High levels of patient satisfaction following surgery
• Short recovery period
• Painless surgeries
• Low margin of error

However, there are certain risks associated with both SMILE and LASIK. Possible side effects that can occur after the procedure are very similar in both procedures. 

Possible side effects of SMILE and LASIK eye surgery include the following:

• Dryness of the eyes, although this is generally temporary
• Seeing glare and/or halos around lights, particularly at night
• Diplopia (commonly referred to as double vision)
• Difficulty with night vision (generally temporary)
• Sensitivity to light
• Undercorrection of the refractive error
• Overcorrection of the refractive error

In addition to the possible problems that can arise from LASIK and SMILE, astigmatism can also be caused due to the uneven removal of tissue, which can result in an uneven cornea curvature. Uneven tissue removal may require an additional procedure to correct the issue, or the patient may need to continue wearing glasses or contact lenses.

SMILE has a lower risk of scarring, as it does not entail the creation of the corneal flap. Still, this risk is very low with LASIK.

Cost Comparison Between SMILE & LASIK

SMILE and LASIK eye surgery generally fall within the same budget range. Currently, LASIK and SMILE can cost anywhere from $1,800 to $3,600 per eye. 

Price can vary greatly, depending on the eye surgeon in question and their level of experience, geographical area, and follow-up care. Generally, all follow-up visits are included in the total price, so confirm this before you commit to any doctor or clinic.  

Both procedures are usually considered cosmetic (not medically necessary), which means that these procedures are most often not covered by insurance providers. Some insurance providers offer discount programs where policyholders can get a certain dollar amount off the total bill if they work with preferred providers.

Which Procedure Is Better? 

SMILE and LASIK are both extremely effective procedures and can improve vision significantly. According to an assessment of LASIK over 20 years, 92.1 percent of people achieved 20/20 vision. Some individuals may benefit more from SMILE, especially those with thin corneas. 

One procedure isn’t necessarily better than the other. The best choice for you comes down to your personal refractive error and eye health. 

How Will I Know if SMILE or LASIK Is Best for Me? 

The best way to know which procedure is best for you and your individual needs is to consult with an eye care professional. Most eye surgeons will conduct a LASIK or SMILE assessment where they measure your eyes and perform a variety of tests. The results of these tests, as well as your medical history, will inform their decision on which surgery is better for you.

An experienced eye doctor will be able to make recommendations that ensure you experience the best possible results. In both cases, the vast majority of patients are satisfied with the results of LASIK and SMILE. 

References

1. Small Incision Lenticule Extraction. (June 2022). StatPearls Publishing.

2. The Early History of Laser Vision Correction. (April 2011). Ophthalmology Management.

3. The Current State of SMILE vs. LASIK. (April 2021). Review of Ophthalmology.

4. Long Term Safety Results of LASIK Refractive Surgery: A Twenty-Year Retrospective Study. (September 2022). Research Square.

5. Small Incision Lenticule Extraction SMILE – The Future of Refractive Surgery Is Here. (January–February 2018). Missouri Medicine: The Journal of the Missouri State Medical Association.

6. Complications of Small Incision Lenticule Extraction. (December 2020). Indian Journal of Ophthalmology.

7. Does Insurance Cover LASIK? Humana.

8. Analysis of the Effectiveness of SMILE, FS-LASIK, and SBK in Myopic Patients and the Impact in UCVA and Tear Film Stability. (July 2022). Contract Media & Molecular Imaging.