Introduction: LASIK and SMILE at a Glance

LASIK (Laser-Assisted in Situ Keratomileusis) and SMILE (Small Incision Lenticule Extraction) are today’s most advanced vision correction procedures. 

Both utilize state-of-the-art laser technology to reshape the cornea, correcting refractive errors such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism.

In LASIK, a thin flap is created on the cornea’s surface, which is lifted to expose the underlying corneal tissue. The surgeon then uses an excimer laser to reshape the shape of the cornea, allowing light to focus properly on the retina. Once the desired corneal reshaping is achieved, the flap is repositioned, and it adheres naturally without the need for stitches.

The SMILE operation, on the other hand, is a newer procedure that requires a smaller incision. A femtosecond laser creates a small lenticule (a thin disc of corneal tissue) within the cornea, which is then removed through the small incision. Removing this lenticule reshapes the shape of the cornea, leading to the correction of refractive errors.

Embracing Laser Eye Surgery: The Increasing Demand for Vision Correction

The growing popularity of laser vision correction can be attributed to its numerous benefits, such as quick recovery times, minimal discomfort, and significantly improved vision. LASIK and SMILE surgery has gained worldwide recognition and has been performed on millions of patients, allowing them to reduce or eliminate their dependence on glasses or contact lenses.

As an expert ophthalmologist, it is essential to educate patients about the differences between LASIK and SMILE surgery and guide them toward making an informed decision to correct their vision first. While both procedures have their merits, LASIK has been around longer, has a proven track record, and offers several advantages over SMILE. In this blog, I will explore the top 10 reasons you should consider LASIK over SMILE surgery (small incision lenticule extraction) for your vision correction journey.

LASIK: A Proven Track Record

The History and Success of LASIK

LASIK has been performed for more than 25 years, with its roots dating back to the early 1990s. Dr. Ioannis Pallikaris, a Greek ophthalmologist, is credited with developing the modern LASIK technique, which combined a microkeratome (a precision surgical instrument) to create a corneal flap with excimer laser ablation to reshape the cornea.

Over the years, LASIK has undergone significant advancements, incorporating new technologies like femtosecond lasers, wavefront-guided treatments, and topography-guided treatments to improve the procedure’s precision, safety, and overall outcomes. These advancements have made LASIK one of the most successful and popular vision correction procedures globally.

The Vast Number of Satisfied Patients

LASIK has been performed on millions of patients worldwide, and its high success rate speaks for itself. According to numerous clinical studies and patient satisfaction surveys, over 96% of LASIK patients are satisfied with their results. This impressive satisfaction rate can be attributed to the procedure’s ability to provide excellent visual outcomes with minimal side effects and complications.

One key reason behind LASIK’s high patient satisfaction rate is its ability to treat a wide range of refractive errors. From mild to moderate myopia, hyperopia, and astigmatism, LASIK can effectively address various visual issues and correct refractive errors, allowing patients to enjoy clear vision without needing glasses or contact lenses.

In summary, LASIK’s proven track record and many satisfied patients make it a reliable and effective option for those considering vision correction surgery. As we explore the top reasons to choose LASIK over SMILE, you will gain a deeper understanding of the unique advantages LASIK offers in various aspects of the vision correction journey.

Visual Outcomes: Clarity Matters

Comparing LASIK and SMILE (Small Incision Lenticule Extraction) Vision Results

LASIK and SMILE have demonstrated excellent visual outcomes, allowing patients to achieve clear vision without needing glasses or contact lenses. However, LASIK has a slight edge regarding overall visual clarity. Studies have shown that LASIK patients tend to achieve better postoperative vision quality, particularly in contrast sensitivity and night vision, compared to SMILE patients.

Higher-order aberrations and LASIK’s Edge

Higher-order aberrations (HOAs) are complex optical imperfections that can degrade the quality of vision, causing issues like glare, halos, and starbursts. LASIK’s edge over SMILE in terms of visual outcomes can be attributed to its ability to manage HOAs better. Wavefront-guided LASIK, in particular, can measure and treat HOAs, improving vision quality and reducing nighttime visual disturbances.

Faster Recovery Time With LASIK

LASIK offers a faster recovery time than SMILE, with patients typically experiencing significant vision improvement within hours and resuming normal activities within a day or two. The quicker recovery is due to LASIK’s technique, where the repositioned corneal flap acts as a natural bandage, promoting rapid healing and minimal discomfort. In contrast, SMILE patients may take up to a week or more for complete visual recovery.

Treating Astigmatism: LASIK’s Superior Flexibility

Compared to SMILE, LASIK offers a more comprehensive solution for a broader range of refractive errors, including astigmatism. It can effectively treat mild to moderate astigmatism and provides customizable treatment options, such as wavefront-guided and topography-guided techniques, to enhance visual outcomes. In contrast, SMILE laser eye surgery is limited in treating astigmatism, addressing only lower levels of the condition and lacking the customization options available with LASIK. This makes LASIK laser eye surgery a more versatile choice for patients with various refractive errors, particularly astigmatism.

Customizable Treatment: Personalized LASIK

LASIK’s ability to offer personalized treatments tailored to each patient’s unique eye characteristics is a significant advantage. Wavefront-guided LASIK employs advanced technology to measure optical imperfections, including higher-order aberrations, and create a customized treatment plan, resulting in improved visual outcomes such as contrast sensitivity and night vision. Topography-guided LASIK, meanwhile, utilizes corneal surface mapping to identify surface irregularities, allowing the surgeon to develop a custom treatment plan addressing these specific issues. This technique is particularly beneficial for patients with corneal irregularities or those who have undergone previous eye surgeries.

LASIK’s Touch-Up Options

The Possibility of Enhancements After LASIK

Another advantage of LASIK surgery is the possibility of postoperative enhancements, also known as touch-ups. Patients may sometimes require minor adjustments to fine-tune their vision after the initial LASIK procedure. These enhancements can be performed quickly and easily, allowing patients to achieve their desired visual clarity.

SMILE’s Limitations in Providing Postoperative Adjustments

SMILE’s technique of removing a small lenticule through only a small incision a tiny, small incision, makes it more challenging to perform postoperative enhancements. If a patient requires a touch-up after SMILE eye surgery, they may need to undergo a LASIK procedure to achieve the necessary adjustments. This limitation can make the overall vision correction process more complicated and potentially more expensive for SMILE eye surgery patients.

Safety Matters

The clinical review on “LASIK vs. SMILE” by the Bochner Eye Institute revealed the following key points regarding safety:

  • SMILE does not outperform LASIK in visual and refractive outcomes, and concerns about its safety profile, particularly the higher reported loss of best-corrected visual acuity.
  • SMILE does not provide better visual and refractive outcomes than LASIK. There are no clear differences between LASIK.
  • SMILE in terms of predictability and efficacy. However, the safety profile is of concern. The reported loss of 2 lines of best-corrected acuity in 1.5 to 2.5% is very high compared to current LASIK outcomes.
  • No significant difference in dry eye incidence is found between LASIK and SMILE.
  • Contrary to expectations, visual recovery post-SMILE is slower than LASIK, with LASIK patients recovering faster initially.
  • SMILE has limitations, such as the inability to perform customized ablations, treat certain refractive errors, and a higher risk of decentered ablations.
  • Additionally, the depth of treatment for SMILE is greater than LASIK, challenging the belief that SMILE could treat higher myopia with less risk of ectasia. Further research is required to understand the true risks.

Accessibility: More Surgeons Offer LASIK

The Widespread Availability of LASIK Providers

With its proven track record and extensive history, many eye surgeons worldwide offer LASIK eye surgery. This widespread availability ensures that patients can easily access skilled and experienced LASIK eye surgery providers who have honed their techniques over years of practice.

In contrast, SMILE eye surgery is a newer procedure with fewer providers globally. While the number of SMILE eye surgery providers is growing, it still falls short of LASIK’s extensive network of surgeons. This limited availability can make it more challenging for patients to find a skilled SMILE surgeon or may require them to travel to receive the procedure.

Long-Term Patient Satisfaction: Trusting the LASIK Legacy

Survey Data on LASIK Patient Satisfaction

Over the years, numerous studies and surveys have consistently shown high patient satisfaction rates with LASIK. With an overall satisfaction rate of over 96%, LASIK has maintained a strong reputation for delivering excellent visual outcomes and meeting most patients” expectations.

Comparing Long-Term Satisfaction Rates Between LASIK and SMILE

While SMILE eye surgery has also demonstrated high patient satisfaction rates, the long-term data on SMILE is limited due to its relative novelty. LASIK’s long history and extensive clinical data make it a more reliable option for those seeking long-term satisfaction with their laser vision correction or enhancement procedure.

Dry Eye Syndrome: LASIK’s Technological Advancements

The Role of Femtosecond Laser Technology in Reducing Dry Eye Risks

One common concern with laser vision correction procedures is the potential for dry eye syndrome. Advancements in LASIK technology, such as using femtosecond lasers, have helped reduce the risk of postoperative dry eye. By creating a more precise corneal flap, femtosecond lasers minimize the disruption of corneal nerves, leading to a reduced incidence of post-op dry eye.

A Comparison of Dry Eye Prevalence Between LASIK and SMILE

While SMILE is often touted as being minimally invasive and causing much less risk of dry eye due to the smaller incision, studies have shown that the prevalence of dry eye after LASIK and SMILE is comparable. Both procedures have similar dry eye risks, but LASIK’s technological advancements provide additional reassurance for patients concerned about less risk of this side effect.

The Cost Factor: Comparing Affordability

The Average Cost of LASIK Versus SMILE

In general, the cost of LASIK is more affordable than SMILE eye surgery. While prices can vary depending on the surgeon, technology, and location, LASIK’s widespread availability and competition among providers often result in more competitive patient pricing.

How LASIK’s Affordability Can Benefit Patients

By choosing LASIK, patients can save on the overall cost of their vision correction journey without compromising the quality of their results. This affordability makes LASIK an attractive option for those seeking an effective, budget-friendly vision correction solution.

LASIK’s Global Reputation

The Worldwide Acceptance of LASIK

LASIK is a globally recognized and accepted vision correction procedure. It has been performed on millions of patients worldwide, with numerous regulatory bodies and eye care associations endorsing its safety and efficacy.

The Geographical Limitations of SMILE

While SMILE is gaining traction globally, its availability still needs to be improved compared to LASIK. This geographical limitation can make it more challenging for patients to find experienced SMILE providers, particularly in certain regions.

Consulting with an Experienced Eye Surgeon

Before making a decision, it is essential to consult with an experienced eye surgeon who can assess and correct your vision for specific needs and recommend the most appropriate procedure for you with healthy eyes.

Summary: Why LASIK Emerges as the Clear Winner

In conclusion, LASIK is the clear winner when comparing the two vision correction procedures. The 10 compelling reasons to choose LASIK over SMILE include its proven track record, superior visual outcomes, faster recovery time, greater flexibility in treating astigmatism, customizable treatment options, touch-up capabilities, widespread accessibility, long-term patient satisfaction, and technological advancements in reducing dry eye.

Frequently Asked Questions

Q1: What are LASIK and SMILE?

A1: LASIK (Laser-Assisted in Situ Keratomileusis) and SMILE (Small Incision Lenticule Extraction) are advanced laser vision correction procedures that reshape the cornea to correct various refractive errors such as myopia, hyperopia, and astigmatism.

Q2: What is the difference between LASIK and SMILE?

A2: LASIK involves creating a thin flap on the cornea’s surface, which is then lifted to expose the underlying corneal tissue, while SMILE uses a femtosecond laser to create a small lenticule (a thin disc of corneal tissue) within the cornea, which is then removed through a small incision.

Q3: Why is LASIK a better option than SMILE?

A3: LASIK has a proven track record, superior visual outcomes, faster recovery time, greater flexibility in treating astigmatism, customizable treatment options, touch-up capabilities, widespread accessibility, long-term patient satisfaction, and technological advancements in reducing dry eye.

Q4: Can LASIK treat astigmatism?

A4: Yes, LASIK can effectively treat mild to moderate astigmatism and provides customizable treatment options, such as wavefront-guided and topography-guided techniques, to enhance visual outcomes.

Q5: Is LASIK more affordable than SMILE?

A5: In general, the cost of LASIK is more affordable than SMILE eye surgery due to its widespread availability and competition among providers.

Author

Dr. M. Ronan Conlon started his career in the field of ophthalmology at the same time as the development of refractive eye surgery in Canada. In 1996, he brought laser technology to Canada from Germany, which allowed him to perform laser eye surgery before it was available in the United States. With the establishment of the Conlon Eye Institute, Dr. Conlon has performed more than 40,000 refractive procedures and has advanced his expertise in LASIK and refractive cataract surgery.

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