Is Smile Better Than Lasik?

It depends on your specific vision needs and priorities. 

While both SMILE (Small Incision Lenticule Extraction) and LASIK (Laser-Assisted In Situ Keratomileusis) are excellent procedures for correcting refractive errors, they differ in technique, recovery, and suitability. This blog will help you understand how the two compare so you can make an informed decision.

What are SMILE and LASIK?

Before we dig into the comparison, it’s important to understand what each procedure entails.

What is SMILE?

SMILE is a minimally invasive laser eye surgery designed to correct myopia (nearsightedness) and astigmatism. It uses a femtosecond laser (a highly precise laser) to create a small disc-shaped piece of tissue, called a lenticule, within the cornea. This lenticule is removed through a small incision, reshaping the cornea and improving your vision.

Highlights of SMILE:

  • Minimal disruption to the corneal surface (only a small incision needed)
  • Typically requires no flap creation
  • Often recommended for patients with dry eye concerns

What is LASIK?

LASIK is a popular form of laser eye surgery that uses two different lasers to reshape the cornea. First, a flap is created in the outer layer of the cornea, which is lifted like a hinge. A second laser then reshapes the underlying cornea to correct vision. The flap is repositioned at the end of the surgery to heal naturally.

Highlights of LASIK:

  • Widely performed, with a long history of satisfactory results
  • Quick recovery time for most patients
  • More versatile in treating a wide range of refractive errors, including myopia, hyperopia (farsightedness), and astigmatism

Key Differences Between SMILE and LASIK

To help you understand the nuanced differences between the two procedures, here’s a side-by-side comparison:

Aspect SMILE LASIK
Procedure Uses a femtosecond laser to remove a lenticule via a small incision Creates a corneal flap followed by laser reshaping
Corneal Disruption Minimal (small incision of ~2-4mm) Higher (flap creation of ~20mm)
Vision Issues Treated Primarily for myopia and low astigmatism Broad range—myopia, hyperopia, and astigmatism
Recovery Time Quick but may take slightly longer than LASIK Faster recovery for most patients
Dry Eye Risk Lower (smaller surgical disruption) Higher (flap cuts corneal nerves, which affects tear production)
Flap-Related Risks No flap, so no flap-related complications Flap-related risks like displacement or wrinkles
Suitability Ideal for patients with a high risk of dry eye or thinner corneas Suitable for most patients with stable prescriptions
Night Vision Issues Rare but possible Rare but possible in some cases
Cost Higher (equipment and technique are newer) Usually lower compared to SMILE

1. Corneal Impact

  • SMILE is less invasive because it involves only a small incision, preserving the majority of the cornea’s surface and structure.
  • LASIK, while effective, requires creating a larger flap, which can lead to longer-term corneal sensitivity.

2. Range of Vision Correction

  • LASIK is more versatile, handling not only myopia and astigmatism but also hyperopia of varying severity.
  • SMILE is currently limited to correcting myopia and mild astigmatism, but advancements may expand its capabilities in the future.

3. Dry Eye Risks

  • Dry eye is a common side effect of laser eye surgeries. SMILE has a lower risk due to its minimally invasive nature, making it a better choice for individuals prone to dry eye symptoms.
  • LASIK patients are more likely to experience temporary dry eye because of nerve disruption during flap creation.

4. Recovery and Comfort

  • LASIK offers slightly faster visual clarity (often within a day), but the flap may require additional care to prevent displacement during healing.
  • SMILE has no flap-related risks, but complete clarity may take a day or two longer due to the novel procedure.

Advantages and Disadvantages of Each Procedure

Advantages of SMILE:

  • Minimal disruption to the corneal surface, preserving corneal strength.
  • Lower risk of complications like flap displacement.
  • Reduced risk of dry eyes, making it ideal for those prone to tear production issues.
  • A suitable option for those with thin corneas who may not be candidates for LASIK.

Disadvantages of SMILE:

  • Limited to treating myopia and mild astigmatism, so it’s not an option for hyperopia.
  • Fewer surgeons are experienced with SMILE, given its relatively recent introduction.
  • Costs are generally higher due to the more advanced technology required.

Advantages of LASIK:

  • Treats a broader range of vision issues, including farsightedness and higher astigmatism.
  • Established procedure with a long history of successful outcomes.
  • Greater availability, as most eye surgeons are trained to perform LASIK.
  • Typically lower cost than SMILE.

Disadvantages of LASIK:

  • Flap-related complications can occur, such as displacement or wrinkles in the healing flap.
  • Higher risk of dry eye after surgery due to nerve disruptions near the cornea.
  • Patients with thin corneas or certain eye conditions may not qualify for LASIK.

How to Decide Between SMILE and LASIK

Both SMILE and LASIK are effective, safe, and FDA-approved, but the right choice depends on your specific needs. Here are some factors to consider:

  • Are you prone to dry eye? If yes, SMILE may be the better option due to its lower risk of disrupting tear production.
  • Do you have hyperopia or severe astigmatism? LASIK may be your only viable option as it has a broader treatment range.
  • Do you have thin corneas? SMILE is often preferred for individuals with thinner corneas because it preserves more corneal integrity.
  • What’s your budget? LASIK is generally more affordable, while SMILE’s higher cost may be a limitation.
  • Do you prefer quicker results? LASIK provides rapid vision improvement, whereas SMILE may take slightly longer for full clarity.

Consulting with a qualified ophthalmologist is crucial. They can assess your eye health, prescription stability, and personal goals, and guide you toward the procedure that best suits your profile.

Final Thoughts

There isn’t a one-size-fits-all answer to whether SMILE is better than LASIK. Both have unique advantages and are effective at improving vision for millions of people worldwide.

If you prioritize minimal invasive techniques and a lower risk of dry eye, SMILE might be your best bet. On the other hand, if you need a versatile option for a broader range of vision corrections, LASIK could be the way to go.

Ultimately, the choice lies in your unique vision needs, lifestyle, and preferences. Consulting an experienced ophthalmologist who can provide a personalized recommendation will ensure the best outcome for your eyes.

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