LASIK vs. SMILE By William Goldstein on July 21, 2016

 

The femtosecond laser has revolutionized eye surgery since it's introduction. The lasers ability to 

perfectly split the corneal tissue and create matching perforations makes it very versatile. LASIK or 

laser in situ keratomileusis has been the most popular femtosecond laser surgery for years. It is a two-

step procedure that has been the most utilized when trying to achieve the desired refractive outcome. 

SMILE is a relatively new procedure and is yet to be FDA approved. This article will compare LASIK vs. SMILE procedures.

 

 

The SMILE procedure is a single-step procedure where a lenticule (disc) of tissue is created using the 

femtosecond laser and afterwards removed. The laser photo-ablates a refractive lenticule and a single 

side-cut. Once this is done, the lenticule is dissected by the surgeon, using forceps and removed. The 

post surgery treatment is almost the same as LASIK and involves antibiotics and steroids.

 

 

Theoretically speaking, SMILE is a simpler procedure and has a lot of benefits. Since no flap is 

created, there are no chances of flap related problems after the procedure. Since less corneal nerves are 

severed, there is also a less chance of getting a dry eye. 

 

SMILE however does have it's disadvantages. Unlike with LASIK, it cannot treat very small amount of 

ametropia. It is not useful for wavefront customized procedures. It works for a limited range of 

problems such as myopia/shortsightedness and astigmatism only. LASIK, on the other hand can be 

used to correct hyperopia up to +4D with good results. Some patients who undergo SMILE also report 

longer recovery and adjustment periods when compared to LASIK. A number of patients who have 

undergone the SMILE procedure also reported corneal ectasia.

 

Since LASIK has been around for a longer time, it is more versatile and can be customized to treat a 

wider range of problems. The latest machines offer both static and dynamic cyclotorsion control. When 

treating astigmatism and other wavefront guided treatments, this aspect can be very useful. In cases of 

high astigmatism treatment, LASIK can maximize optical zone as it has bitoric or other various 

ablation patterns.

 

LASIK has the upper hand when it comes to refractive correction as SMILE is relatively new. Through, 

treatments can be customized to treat problems more accurately and make sure the procedure goes as 

planned.

 

Ultimately, the decision to choose either SMILE or LASIK depends on you and your doctor. Your 

doctor will recommend the best treatment based on your needs, so do take their word seriously.