SMILE (Small Incision Lenticule Extraction) has emerged as a popular alternative to LASIK, offering a minimally invasive approach to vision correction. Approved by the FDA in 2016 and gaining traction in recent years, SMILE is often touted as a safer, flapless option for treating nearsightedness and astigmatism. But is it truly the better choice in 2025? This blog dives deep into the pros and cons of SMILE, compares it to LASIK, and helps you decide if it’s the right option for your vision needs.
What is SMILE?
SMILE is a refractive eye surgery that corrects vision by removing a small, lens-shaped piece of corneal tissue (called a lenticule) through a tiny incision. Unlike LASIK, which creates a corneal flap, SMILE is flapless, reducing certain risks associated with flap complications. It’s primarily used to treat nearsightedness (myopia) and astigmatism, with FDA approval expanding in recent years to include a wider range of prescriptions.
The Pros of SMILE
Minimally Invasive:
SMILE requires only a 2–4 mm incision, compared to the 20 mm flap created in LASIK. This reduces the risk of flap-related complications.
The flapless design also means less disruption to the corneal nerves, potentially lowering the risk of dry eyes.
Lower Risk of Dry Eyes:
Studies show that SMILE causes less post-operative dry eye syndrome compared to LASIK, making it a better option for patients prone to dry eyes.
New research confirms that SMILE preserves more corneal nerves, leading to faster recovery of tear film stability.
Quick Recovery:
Most patients experience improved vision within 24 hours, with minimal discomfort.
The smaller incision also reduces the risk of infection and speeds up healing.
Stable Results:
SMILE has shown long-term stability, with most patients maintaining their corrected vision for years.
A 2024 study published in Ophthalmology found that 95% of SMILE patients maintained 20/20 vision or better five years post-surgery.
Suitable for Thin Corneas:
SMILE is an excellent option for patients with thin corneas who may not be candidates for LASIK.
The Cons of SMILE
While SMILE has many advantages, it’s not without its drawbacks. Here’s what you need to know:
Limited Treatment Range:
SMILE is currently only FDA-approved for nearsightedness (myopia) and astigmatism. It cannot treat farsightedness (hyperopia).
Research is ongoing to expand SMILE’s applications, but as of now, it remains limited compared to LASIK.
Less Customization:
SMILE does not yet offer the same level of wavefront-guided customization as LASIK, which can address higher-order aberrations (subtle vision imperfections).
While advancements are being made, SMILE still lags behind LASIK in this area.
Surgeon Experience Matters:
SMILE is a technically demanding procedure, and outcomes depend heavily on the surgeon’s skill. Inexperienced surgeons may have higher complication rates.
As SMILE gains popularity, more surgeons are being trained, but it’s still less widely available than LASIK.
Higher Cost:
SMILE is often more expensive than LASIK, with costs ranging from $5,000-$9,000.
Prices remain high due to the advanced technology and limited number of trained surgeons.
Potential for Undercorrection or Overcorrection:
Like LASIK, SMILE carries a small risk of undercorrection or overcorrection, which may require enhancements.
Enhancements are more challenging with SMILE because it’s a flapless procedure, often requiring a follow-up LASIK or PRK surgery.
Long-Term Data Still Emerging:
While SMILE has shown excellent results in the short to medium term, long-term data (beyond 10 years) is still limited.
Ongoing studies are tracking SMILE patients, but it’s too early to draw definitive conclusions about its long-term safety and efficacy.
SMILE vs. LASIK: Which is Better?
Here’s a quick comparison to help you decide:
Why You Should See an Optometrist for a Second Opinion
Before deciding on SMILE, it’s crucial to consult with an optometrist for an unbiased assessment. Here’s why:
Comprehensive Evaluation: Optometrists can assess your overall eye health and determine if you’re a good candidate for SMILE.
Alternative Options: If SMILE isn’t right for you, an optometrist can recommend alternatives like LASIK, PRK, EVO ICL, or even glasses and contact lenses.
No Financial Bias: Unlike surgeons who perform SMILE, optometrists have no financial incentive to recommend one procedure over another.
Conclusion: Is SMILE Worth It in 2025?
SMILE is a promising alternative to LASIK, offering a flapless, minimally invasive option with a lower risk of dry eyes and excellent visual outcomes. However, it’s not without limitations, including its higher cost, limited treatment range, and dependence on surgeon skill.
Key Recommendations:
Consult an Optometrist: Get a second opinion to ensure SMILE is the right choice for your vision needs.
Research Surgeons: Choose a highly experienced SMILE surgeon to minimize risks.
Consider Alternatives: If SMILE isn’t suitable, explore other options like LASIK, PRK, or EVO ICL.
Your vision is priceless—take the time to make an informed decision.
Next Steps:
If you’re considering SMILE, schedule a consultation with an optometrist first. They can help you weigh the pros and cons and explore all your options. Your eyes deserve the best care possible!