- LASIK and SMILE both correct vision by reshaping the cornea, but use different techniques to do so.
- LASIK creates a corneal flap; SMILE is flapless and uses a small incision instead.
- SMILE carries a lower risk of dry eyes and is better suited to active patients and those with contact sports lifestyles.
- LASIK can correct farsightedness; SMILE cannot.
- Both procedures are safe, proven, and deliver permanent vision correction.
If you have problems with your eyesight and are considering surgery, there are several options available. LASIK is a well-established and highly effective technique, while SMILE is a newer procedure that is becoming increasingly popular.
Both procedures are safe, painless, provide permanent vision correction, and have a short recovery period. They do have certain differences, however, so it is worth considering all factors before making your choice.
What is SMILE Eye Surgery and How Does it Work?
Both LASIK and SMILE change the shape of the cornea, the clear layer at the front of the eyeball, and are intended to correct refractive errors caused by a misshapen cornea that prevents light from focusing accurately on the retina. Reshaping the cornea corrects the path that light takes and restores clear vision. The method of achieving this, however, differs between the two procedures.
For LASIK (Laser Assisted In Situ Keratomileusis), the eye is numbed with drops and a flap approximately two centimeters is created and folded back so that underlying tissue can be removed to change the cornea’s shape. On completion, the flap is repositioned to protect the eye during healing.
SMILE (Small Incision Lenticule Extraction) is a newer procedure with the same goals. A laser creates a small, lens-shaped piece of tissue called a lenticule within the cornea. This tissue is then extracted through a very small incision of approximately three millimeters, causing the cornea to change shape and improving the focus of light on the retina.
The Key Differences Between LASIK and SMILE Surgery
Although the two procedures have similar aims, there are significant differences to consider:
- Range of correction: LASIK can correct nearsightedness, farsightedness, and complex astigmatism. SMILE can correct certain levels of nearsightedness and astigmatism but does not treat farsightedness.
- Dry eye risk: Because LASIK creates a larger flap, more corneal nerves are affected, which increases the risk of dry eyes. SMILE is much less invasive and is more suitable for those who have dry eyes or are at risk of developing the condition. It is also better suited to those who are intolerant to contact lenses.
- Recovery speed: Both procedures offer swift recovery. LASIK is marginally quicker, with clear vision typically experienced within 24 hours. SMILE can take up to 48 hours before full clarity of vision is achieved.
- Structural integrity: SMILE removes less tissue than LASIK, which better preserves the structural integrity of the cornea. This is particularly relevant for patients with active lifestyles, contact sports involvement, or physically demanding occupations, as there is no flap that could be dislodged.
For both procedures, age-related changes to the eye’s natural lens may eventually require reading glasses when presbyopia develops. This is a natural part of aging and is not caused by either procedure.
| Feature | LASIK | SMILE |
|---|---|---|
| Treats farsightedness | Yes | No |
| Treats nearsightedness | Yes | Yes |
| Treats astigmatism | Yes (including complex cases) | Yes (certain levels) |
| Corneal flap | Yes | No |
| Dry eye risk | Higher | Lower |
| Vision recovery | Within 24 hours | Up to 48 hours |
| Suited to active lifestyles | Less so | Yes |
Why SMILE is Called the Flapless LASIK Alternative
SMILE is described as a flapless procedure because no corneal flap is created. Where LASIK requires a flap to be opened on the surface of the eye and then repositioned after the cornea is reshaped, SMILE requires only a tiny incision of a few millimeters and the removal of a small piece of tissue through it.
Because the incision is so small, the procedure is considerably gentler on the eye and carries a lower risk of side effects. Fewer corneal nerves are affected, which substantially reduces the risk of dry eyes developing. The absence of a flap also makes SMILE a safer choice for people with active lifestyles, as there is no risk of flap displacement following physical contact.
LASIK vs. SMILE: Which Procedure is Right for You?
LASIK is the longer-established of the two procedures, having received FDA approval in 1999. It is estimated that more than 20 million eyes have received LASIK treatment, and over 7,000 research studies confirm its safety, with over 99% of patients achieving 20/40 vision and over 90% achieving 20/20 vision.
SMILE was commercially launched internationally in 2011 and received FDA approval in 2016. Over 12 million procedures have been performed worldwide.
Although LASIK can address most common refractive errors, around 20% of potential patients are not suitable candidates due to conditions such as dry eyes, thin or irregular corneas, or extreme prescriptions. SMILE may be appropriate for some of these patients, particularly those prone to dry eyes, those with thin corneas, or those with active or sporting lifestyles. SMILE does not, however, treat farsightedness.
Neither procedure is universally superior. Both are suited to different conditions and circumstances, and both provide permanent improvements to vision. The best choice depends on your prescription, corneal thickness, lifestyle, and what you want to achieve. Laser surgery of either type may not be suitable for patients with cataracts, severe glaucoma, or unmanaged diabetes.
Before making your decision, book a free consultation with one of our doctors. You will receive a thorough assessment of your eye health and an evaluation of your requirements, followed by a recommendation with no obligation to proceed.
Frequently Asked Questions
What does flapless mean in SMILE surgery?
Flapless means that no corneal flap is created during the procedure. Unlike LASIK, which cuts and lifts a flap on the corneal surface to access underlying tissue, SMILE uses a tiny incision of just a few millimeters to extract a small disc of tissue called a lenticule from within the cornea. This results in less disruption to the corneal surface and fewer nerves being affected.
Is SMILE better for people with dry eyes?
Yes. Because SMILE does not create a large corneal flap, fewer corneal nerves are disrupted during the procedure. This significantly reduces the risk of dry eyes developing post-surgery, making SMILE a preferred option for patients who already experience dry eyes or are at risk of the condition.
Can SMILE correct farsightedness?
No. SMILE is currently approved to treat nearsightedness and certain levels of astigmatism. It does not correct farsightedness. If you have farsightedness, LASIK or an alternative procedure such as Customized PRK may be more appropriate.
How do I find out which procedure I qualify for?
Suitability for LASIK or SMILE depends on your prescription, corneal thickness, eye health, and lifestyle. The only way to confirm eligibility is through a comprehensive pre-operative assessment. Book a free consultation at ScottHyver Visioncare and our team will evaluate your eyes and guide you to the right option.
