What is the new eye surgery that is better than LASIK?

The new surgery often referred to is SMILE (Small Incision Lenticule Extraction), which uses a femtosecond laser to correct nearsightedness and astigmatism. Unlike LASIK, it does not require creating a corneal flap, which may reduce the risk of dry eye and other complications.

Is SMILE safer than LASIK?

SMILE is considered to have a lower risk of dry eye and corneal flap complications because it involves a smaller incision and no flap creation. However, both procedures are generally safe, and the choice depends on individual eye anatomy and prescription.

How long does recovery take for SMILE eye surgery?

Most patients see significant improvement within 24 hours and can return to normal activities in a few days. Full visual stabilization typically takes about one to three months.

Can SMILE correct astigmatism as well as LASIK?

Yes, SMILE effectively corrects astigmatism and nearsightedness, and studies show it can achieve comparable or better outcomes for certain types of astigmatism. However, it is not currently approved for farsightedness.

What are the disadvantages of SMILE compared to LASIK?

SMILE may have a slightly slower visual recovery in the first few days and is not suitable for treating farsightedness. Additionally, it may be more expensive and requires a surgeon with specific training and equipment.

New Eye Surgery Better Than LASIK: What You Need to Know

If you are looking into vision correction, you have probably heard about a new eye surgery better than LASIK. The direct answer is that for many patients, SMILE (Small Incision Lenticule Extraction) offers advantages over traditional LASIK, primarily because it is a flapless procedure that preserves more of the cornea’s structural strength. However, “better” depends on your specific eyes, your lifestyle, and what risks you want to avoid. This article explains the key differences so you can have an informed conversation with your surgeon.

How SMILE Differs from LASIK

Both LASIK and SMILE are laser vision correction procedures that reshape the cornea to fix nearsightedness (myopia) and astigmatism. The main difference is how the surgeon accesses the cornea to reshape it.

In LASIK, the surgeon creates a thin flap in the top layer of the cornea using a laser or a blade. They lift that flap, use an excimer laser to reshape the underlying corneal tissue, and then lay the flap back down to heal. The flap never fully reattaches; it heals along the edges.

In SMILE, the surgeon uses a single femtosecond laser to create a small, disc-shaped piece of tissue (a lenticule) inside the cornea. They then make a tiny incision (about 2-4 mm) on the surface and pull the lenticule out through that opening. No flap is created, and the surface of the cornea remains largely intact.

This flapless approach is the core reason why some surgeons and patients consider SMILE a better option for certain cases.

Key Advantages of the Flapless SMILE Procedure

Because SMILE does not involve a flap, it avoids the main risks associated with the flap in LASIK.

Reduced risk of flap complications. With LASIK, there is a small but real risk of flap dislocation if the eye is rubbed or hit during healing. This risk is essentially eliminated with SMILE. This makes SMILE a strong option for people in contact sports, the military, or law enforcement.

Less dry eye after surgery. LASIK requires cutting through many of the corneal nerves during flap creation. These nerves help signal the eye to produce tears. SMILE’s small incision cuts far fewer nerves. Multiple studies, including research cited by the American Academy of Ophthalmology, have shown that patients report less dry eye symptoms in the first few months after SMILE compared to LASIK. If you already have dry eyes, this is a major consideration.

Faster biomechanical stability. The cornea is the structural window of the eye. By preserving the anterior layers of the cornea, SMILE leaves the eye stronger and less prone to ectasia (a dangerous bulging of the cornea) than LASIK. This is a safety advantage, especially for patients with thinner corneas who might not be good candidates for LASIK.

Who Is a Good Candidate for SMILE

The ideal candidate for SMILE is similar to that for LASIK, with a few key differences.

You are likely a good candidate if you:

Are at least 18-22 years old with a stable prescription for at least one year.
Have mild to moderate nearsightedness (usually up to -10 diopters) with or without astigmatism (up to about -3 diopters).
Have corneas that are thick enough for the procedure (SMILE can sometimes treat patients with thinner corneas than LASIK can).
Do not have active eye disease, severe dry eye, or uncontrolled autoimmune conditions.

SMILE is not currently approved by the U.S. Food and Drug Administration for treating farsightedness (hyperopia) or presbyopia (the age-related need for reading glasses). If you are farsighted or need reading glasses, LASIK or PRK may still be your best options.

Recovery and Visual Outcomes

The recovery timeline for SMILE is slightly different from LASIK.

Immediate recovery. With LASIK, vision improves very quickly, often within a few hours. With SMILE, the initial recovery can be a bit slower. Many patients see well enough to drive the next day, but some report a hazy or “cloudy” sensation for the first 24 to 48 hours as the cornea settles.

Long-term results. Studies show that both SMILE and LASIK achieve excellent visual outcomes. Over 98% of patients achieve 20/40 vision or better, and a very high percentage achieve 20/20. The long-term stability of the correction is comparable between the two procedures.

Discomfort. Both procedures involve some temporary discomfort. SMILE patients often report less scratchiness and burning in the first few hours compared to LASIK, likely because the surface nerves are less disturbed.

Limitations of SMILE You Should Know

No procedure is perfect. SMILE has some limitations compared to LASIK.

No wavefront-guided customization. LASIK can use wavefront technology to measure and correct subtle imperfections in the eye’s optics, potentially giving a sharper quality of vision in low light. SMILE currently does not have this level of customization, though newer versions of the technology are improving.

Surgeon experience matters more. SMILE requires a different surgical skill set than LASIK. The surgeon must be very precise in centering the lenticule and removing it smoothly. An inexperienced SMILE surgeon may have a higher rate of complications like a difficult lenticule removal or a “cap” tear.

Not for hyperopia. As noted, SMILE is not FDA-approved for farsightedness. If you are farsighted, LASIK or PRK are your main laser options.

Corneal haze risk. There is a small risk of temporary corneal haze after SMILE, similar to PRK, though it is less common.

SMILE vs. PRK: Another Flapless Option

If you are avoiding a flap, you might also consider PRK (Photorefractive Keratectomy). PRK is also flapless, but it works differently.

In PRK, the surgeon removes the entire top layer of the cornea (the epithelium) and then reshapes the underlying tissue with an excimer laser. The epithelium grows back over the next few days. PRK has a longer and more uncomfortable recovery than SMILE, but it is also extremely safe and avoids flap risks.

SMILE is often described as a middle ground: it has a faster recovery than PRK (though not as fast as LASIK) and avoids the flap risks of LASIK. If you have a very thin cornea or a history of dry eye, your surgeon may recommend PRK over SMILE.

What to Ask Your Surgeon

Before choosing any vision correction surgery, you need a thorough evaluation. Ask your surgeon these specific questions about SMILE:

“Based on my corneal thickness and topography, am I a better candidate for SMILE, LASIK, or PRK?”
“How many SMILE procedures have you performed? What is your complication rate?”
“What is your protocol for managing dry eye after SMILE?”
“What happens if the lenticule is difficult to remove during surgery?”
“Can you show me my pre-op measurements and explain why you recommend one procedure over another?”

The best choice is the one that fits your eye anatomy and your lifestyle. Do not let a clinic push you into one procedure because it is newer or more profitable.

Key Takeaways

SMILE is a flapless laser vision correction procedure that preserves more corneal structure than LASIK.
The main advantages of SMILE are a lower risk of flap complications and less dry eye after surgery.
SMILE is currently approved for nearsightedness and astigmatism, not for farsightedness.
Recovery is slightly slower than LASIK but faster and more comfortable than PRK.
Your specific eye measurements, not general claims, should determine which procedure is best for you.
Always consult with an experienced surgeon who performs all three procedures (LASIK, PRK, and SMILE) for an unbiased recommendation.