Refractive eye surgery: Understanding your options to be free of glasses or contacts

If you’re tired of relying on glasses or contact lenses, you might be considering refractive laser eye surgery. But with several options available – LASIK, PRK and SMILE – it can be confusing to figure out which procedure is right for you.

Each technique reshapes the cornea to improve how light focuses on the retina, correcting common vision issues like myopia (nearsightedness), hyperopia (farsightedness) and astigmatism. Here’s a breakdown of each method:

LASIK (Laser-Assisted In Situ Keratomileusis)

LASIK involves creating a thin flap in the cornea, folding it back, and using an excimer laser to reshape the underlying tissue. The flap is then repositioned like a natural bandage.

Pros:

• Fast recovery (often clear vision within 24 hours).
• Minimal discomfort.
• Excellent outcomes for most patients.

Considerations:

• Not ideal for thin corneas.
• Risk of flap-related complications (though rare).
• May not be best for active lifestyles/professions.

PRK (Photorefractive Keratectomy)

PRK removes the thin surface layer of the cornea (epithelium), then uses a laser to reshape the underlying corneal tissue. The epithelium regenerates over a few days.

Pros:

• No corneal flap – better for patients with thin or irregular corneas.
• Lower risk of long-term dry eye or flap issues.
• Great option for athletes, active lifestyles/professions.

Considerations:

• Longer recovery time (several days to weeks).
• More initial discomfort than LASIK.

SMILE (Small Incision Lenticule Extraction)

SMILE uses a femtosecond laser to create a small, lens-shaped piece of tissue (called a lenticule) inside the cornea, which is removed through a tiny incision – no flap needed.

Pros:

• Minimally invasive.
• May cause less dry eye.
• Great option for athletes/active lifestyles/professions.

Considerations:

• Currently approved mainly for myopia and low astigmatism.
• Not as widely available as LASIK or PRK.

ICL (Implantable Collamer Lens)

Instead of reshaping the cornea, ICL surgery involves implanting a thin, flexible lens between your iris (colored part of eye) and natural lens. It works much like a permanent contact lens inside the eye. This is an option for higher prescriptions that are not candidates for laser eye surgery.

Pros:

• Ideal for high myopia, or nearsightedness.
• Reversible and doesn’t alter the cornea.
• Great for thin corneas or dry eye sufferers.
• UV protection built into the lens.

Considerations:

• Intraocular surgery (more invasive than laser procedures).
• Slight risk of cataract or glaucoma (though rare with modern lenses).
• Typically more expensive than LASIK or PRK.
• Not ideal for presbyopia, or farsightedness.

Choosing between these options depends on your eye health, corneal thickness, lifestyle and vision goals. A comprehensive eye exam with a refractive surgeon is the best way to determine which option is safest and most effective for you.

Learn more about Baylor Eye Care. 

By Masih Ahmed, assistant professor in the Department of Ophthalmology