What the two procedures do
LASIK creates a hinged flap with a femtosecond laser, lifts it, and reshapes the exposed cornea with an excimer laser. SMILE uses the femtosecond laser alone to sculpt a lenticule inside the cornea and removes it through an incision of a few millimeters. Both change the corneal curvature to focus light correctly; they differ in how much of the cornea's surface is disturbed to do it.
Dry eye and corneal nerves
The corneal nerves that trigger tear production enter through the front layers of the cornea. A LASIK flap cuts them around most of its circumference; SMILE's small incision cuts far fewer. That is the basis of SMILE's lower rate of dry eye symptoms in the first six months, which is consistent across studies. For patients with borderline dry eye who are nonetheless suitable for a corneal procedure, this is often the deciding factor.
Corneal strength and lifestyle
Because SMILE leaves the front of the cornea intact, the cornea retains more of its biomechanical strength, and there is no flap that could be displaced by a blow. Patients in contact sports, martial arts, law enforcement or the military often choose SMILE or PRK for that reason.
Where LASIK has the edge
LASIK remains the better choice when:
- You are farsighted, which SMILE does not currently treat
- Your prescription is very low, where SMILE's lenticule becomes thin and less predictable
- You want the fastest possible first day; LASIK vision is usually crisp the next morning, SMILE takes a day or two
- Your surgeon wants a wavefront guided treatment for a specific higher order aberration profile, which is an excimer capability
Safety and results
Both have excellent safety records. LASIK's specific risks relate to the flap; SMILE's relate to the lenticule extraction, which is technique dependent and rare in experienced hands. Visual outcomes are comparable. Enhancement is simpler after LASIK, by lifting the flap, and is done with a surface treatment after SMILE; both are uncommon.
Cost
Both are quoted in writing at your free consultation. LASIK can be financed at 0% interest for up to 18 months, and 0% interest financing is also available for SMILE; the team explains the terms.
Is this right for your eyes?
Nothing on this page is a diagnosis. Whether this is the right choice for you is decided by a full examination at one of our 4 offices: Pasadena, Huntington Beach, Woodland Hills and Beverly Hills.
About this content: This page was written with the assistance of AI tools and reviewed for medical accuracy by Dr. Bavand Youssefzadeh, DO. It is general information, not medical advice, and does not replace an eye examination. Individual results vary. Read our medical disclaimer.
