SMILE vs. LASIK: Insights From An Eye Expert

While SMILE (Small Incision Lenticule Extraction) and LASIK have emerged as two types of surgeries, LASIK has been the best corrective eye surgery in Orange County for close to 30 years, with a well-established procedure and a proven track record of excellent outcomes for a wide range of vision conditions.

SMILE and LASIK are two similar procedures, each with the goal to reduce the need for  corrective lenses, yet they differ in their techniques, outcomes, and potential risks. It’s  important to understand the differences between SMILE and LASIK and the potential  benefits and/or drawbacks of each when considering vision correction.

However, the best way to determine your candidacy for vision correction and which  procedure is best for you is to consult with an experienced specialist like Dr. Manger.  Schedule your complimentary* exam today to receive information on a custom  treatment to help you reach your individual needs and goals.


SMILE and  LASIK are two vision correction surgeries that differ in various ways. LASIK  was approved by the FDA in 1999 and has shown consistent success in treating various  types of vision impairments for close to 30 years. SMILE has only been approved by the  FDA since 2016 and is shown to have varying results.

The following are a few other comparisons of the LASIK and SMILE procedures:

A. Procedure

LASIK creates a thin flap on the cornea, which is lifted to allow the excimer treatment  laser to reshape the underlying corneal tissue. The flap is then replaced, and healing  begins immediately.

SMILE, on the other hand, creates a small incision in the cornea through which a small  piece of tissue (lenticle) is removed in order to reshape the cornea. In some cases, this  lenticule is not fully cut by the laser, and fragments of tissue remain, causing irregular  astigmatism resulting in the need for further correction.

B. Recovery time

LASIK offers a faster visual recovery time than SMILE, with most patients seeing 20/20  or better the day after their procedure. In fact, many patients can even drive themselves  home a few hours after having surgery.

In contract, SMILE can take several days or even weeks for the vision to become clear,  which can make driving or work difficult for patients.

SMILE has also been associated with a higher incidence of glare than LASIK, with  some patients reporting experiencing temporary side effects, such as difficulty seeing at  night or double vision that can last weeks after their procedure.

C. Effectiveness

Visual acuity and predictability are two critical measures of effectiveness in laser vision correction.  While both LASIK and SMILE correct refractive errors, the femtosecond laser used to  do SMILE is less precise than the excimer laser in correcting vision due to its lack of  capability to use custom, wavefront technology; therefore, outcomes with SMILE are not  as good as with LASIK.

Furthermore, there is no consensus on the best way to enhance a SMILE eye if results  do not meet the desired results. Typically, a patient has to have a PRK enhancement  after SMILE. Studies show approximately 11% of SMILE patients need an  enhancement, versus less than 1% of Dr. Manger’s LASIK patients need an  enhancement following their initial procedure. Therefore, LASIK is also more  predictable in achieving the desired result.

D. Safety

LASIK and SMILE are generally considered safe, but each has risks and potential complications. LASIK has been performed for close to 30 years and has a well-documented safety profile. As with all relatively new procedures, SMILE has fewer, less conclusive data for long-term safety and effectiveness.

Advantages of LASIK over SMILE

Below are notable advantages of LASIK over SMILE:

A. Better Visual Outcomes

According to the American Academy of Ophthalmology, LASIK has a higher rate of  achieving 20/20 vision than SMILE.

Studies have shown that only 88% of patients who undergo SMILE achieve 20/20 vision  as compared to Dr. Manger’s LASIK results where 99.7% of his patients see 20/20 or  better. (In fact, 72% of his patients are seeing 20/15 or 20/10, which is even better than  20/20!)

B. Wider Range Of Treatable Vision Conditions

LASIK’s more extensive range of treatable vision conditions is due to the precision of  the procedure and the ability to remove more tissue from the cornea. On the other hand,  SMILE is limited to correcting lower levels of nearsightedness and astigmatism. SMILE  cannot treat higher levels of nearsightedness, higher levels of astigmatism, or farsightedness.

While it is a viable option for patients with these conditions, SMILE may not be the best  choice for those with more severe vision problems. In addition, the technology used in  LASIK allows for more customization in the treatment, which can lead to better  outcomes for patients with unique eye shapes and conditions.

C. Long-term Studies

LASIK has been performed in the United States since the mid-1990s and was approved  by the FDA in 1999. We have close to 30 years of data on LASIK results showing it to  be one of the most successful surgeries performed in the world. It has an excellent  reputation for safety and effectiveness.

In contract, SMILE has only been FDA-approved since 2016. Experts estimate that less  than 5% of refractive procedures performed are done with SMILE. There is no long-term data on SMILE at this time to show it is more safe or effective than LASIK.

In fact, current studies show SMILE is much less effective than LASIK in correcting low to moderate amounts of nearsightedness and astigmatism, and it is not able to correct  higher amounts of nearsightedness and astigmatism at this time, nor does it correct  farsightedness.

Considerations Between SMILE vs. LASIK

In summary, LASIK and SMILE are both effective procedures for correcting refractive errors, but they have distinct differences. LASIK has a proven track record of excellent outcomes for a broader range of vision conditions and can produce better visual results.

When considering LASIK vs. SMILE, it is crucial to consult a qualified and experienced eye surgeon to determine which procedure best suits your needs. Factors such as the severity of your refractive error, age, and overall eye health should be considered.

Remember, while the cost and convenience of these procedures are important to consider, the ultimate goal is to achieve optimal visual outcomes and maintain the long-term health of your eyes.

If you’re considering LASIK corrective eye surgery, schedule a complimentary* exam  with the West Coast’s most experienced LASIK surgeon, Dr. Manger. Having performed  over 94,000 vision correction procedures over the past 27 years, you won’t find another  surgeon with more experience and expertise.

Don’t let poor vision hold you back – schedule your FREE 3D LASIK exam today!

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