Selecting the right LASIK procedure can be overwhelming given the sheer number of options available. At some point, you may compare LASIK vs LASEK vs PRK vs SMILE, and just end up more confused as to how they differ from each other.

It may be simpler to begin with the similarities. All four are laser eye surgeries designed to improve your vision by correcting refractive errors.

This means all four can have similar outcomes. Where they actually differ is in the techniques involved in executing them, the recovery time, and the specific benefits.

Today, we’ll explore each of these options to help you make an informed decision.

The Types of LASIK Procedures and the Differences Between Them

What is LASIK?

LASIK or Laser-Assisted In Situ Keratomileusis is a procedure that corrects refractive errors by reshaping the cornea.

To do this, surgeons have to slice the outermost layer of the cornea to create a flap, after which they work on the corneal tissue beneath that flap using an excimer laser.

Following that, the flap is moved back into position. The flap seals back on its own over the next few days.

LASIK is one of the most popular laser eye surgeries and is generally viewed as a very safe and effective procedure. Most patients report good vision by the next day.

What is LASEK?

LASEK or Laser Assisted Sub-Epithelial Keratectomy is another common eye surgery. A cornea flap is not created in this method of surgery.

Instead, the epithelium (skin of the cornea) is softened with the help of application of an alcohol solution. A surgical instrument is then used to move away the softened epithelium.

The excimer laser is then applied to the cornea. “Sub-epithelial keratectomy” refers to the layer where the laser is applied: directly underneath the cornea epithelium.

Two lasers are used for LASIK: one to create the flap and the excimer laser to ablate the cornea to change the refractive error (specs power). But only one laser is needed for LASEK: just the excimer laser.

A variation of LASEK is Epi-LASIK. Epi-LASIK makes use of a special mechanical equipment to remove the cornea epithelium.

Basically, the idea is the same, to remove the epithelium and then apply the laser. This method is very seldom used throughout the world now.

LASEK involves a longer recovery period than LASIK. The best vision comes a few weeks after the procedure. It may also involve more discomfort for the first 3 days while the surface of the cornea heals.

If you’re wondering about who wins when considering LASIK vs LASEK prices, the answer is that they’re very similarly priced. However, LASIK will typically be slightly more expensive.

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What is PRK?

PRK is short for Photorefractive Keratectomy. When comparing LASIK vs LASEK vs PRK, it’s worth noting that PRK was the first laser eye surgery technique developed.

This may lead some to suppose that it’s a dated technique. But despite PRK being older, it still has its merits. In PRK, a surgeon doesn’t create a flap. Instead, PRK requires complete removal of the outermost layer of the cornea.

When this layer is removed, the surgeon follows by using an excimer laser to reshape the tissue beneath. After that, a “bandage” that looks like a contact lens is placed atop the cornea. This allows it to heal and regenerate the removed outer layer.

Like LASEK, this surgery is often preferred for those with thin corneas or whose lifestyles may threaten regular blows or direct contact with the area around the eyes.

It’s also often suggested for those who suffer from some degree of dry eye syndrome because it seems to have a lower risk of producing dry eye as a side effect (compared to LASIK).

A variation of this method is called Trans PRK. This method does not require the surgeon to mechanically remove the cornea epithelium. It also does not require the use of alcohol.

Instead, the excimer laser is used to remove the epithelium. In doing so, a smaller area of epithelium is removed compared to PRK or LASEK.

This allows a faster recovery compared to PRK or LASEK, but the recovery period is still longer than LASIK. And added to its pros and cons, while it may be safer for some lifestyles than LASIK, not all excimer laser systems have the software to be able to do it.

Therefore, it means that not all laser centres offer this procedure as it depends on which laser system they use. This advanced laser software is available at our clinic.

What is SMILE?

SMILE is perhaps the newest of the surgeries we compare today. Also known as Small Incision Lenticule Extraction, this technique is designed to correct refractive errors like nearsightedness and astigmatism.

A laser is used to create a very small incision in the cornea – an incision about 2 or 3 millimeters wide. The femtosecond laser also cuts a tiny, lens-shaped disc in the cornea.

This disc is removed by pulling it through the incision we mentioned earlier, which is why a flap is no longer needed.

The benefit of this procedure is that the recovery can be quite fast. Many patients can see well by the next day. But on average, the best vision comes about 1 to 1.5 weeks later. This means the recovery is a bit slower than LASIK but faster than surface laser procedures such as LASEK or Trans PRK.

However, it is not suitable for everyone. For example, it is not accurate for farsightedness and high astigmatism.

In the event of inaccuracy, a second SMILE procedure cannot be done on the eye. Instead, PRK has to be done for an enhancement procedure.