Three main laser vision correction procedures are available to reduce dependence on glasses or contact lenses: Photorefractive Keratectomy (PRK), Laser-Assisted in Situ Keratomileusis (LASIK), and Small Incision Lenticule Extraction (SMILE). While all aim to improve vision, individuals considering surgery often inquire about potential long-term outcomes 5, 10 or 15 years later.
This article explores the differences between PRK vs LASIK vs SMILE to assist in making an informed decision suitable to one’s lifestyle needs and eye health. Key factors such as visual acuity, dry eye symptoms and corneal stability over time are examined for each method.
What is PRK (Photorefractive Keratectomy)?
PRK is a laser eye surgery operation whereby tissue on the outermost layer of the cornea is removed with the help of a laser. During a PRK procedure, your epithelium, or the outer layer of the cornea, is removed, after which the cornea is reshaped with a special type of cold laser called an excimer laser. The main difference between PRK and LASIK surgery is that the former does not require a flap to be made.
PRK surgery can treat astigmatism, hyperopia and myopia (nearsightedness). It is a short surgery performed as an outpatient on a daily basis and takes about five minutes per eye, excluding a bit of preparation time. Most of the patients say that it is painless.
Key Features of PRK
| Key Feature | Description |
| Procedure | Involves removal of the corneal epithelium, followed by reshaping with an excimer laser. |
| Recovery Duration | Typically slower than LASIK; vision may take several weeks to stabilise fully. |
| Ideal Candidates | Suitable for those with thin corneas or individuals at higher risk of eye trauma. |
| Potential Risks | Includes temporary irritation, extended healing period, and chances of corneal haze. |
Who can go for PRK Surgery?
People who have thin corneas and/or higher prescriptions may benefit significantly from PRK surgery. For people who play contact sports or work in occupations where eye injuries are a possibility (such as boxers or MMA fighters), it may also be the best course of action. PRK is frequently employed as a tactic to improve the distance vision of LASIK patients.
Understanding LASIK (Laser-Assisted In Situ Keratomileusis)
Laser-assisted in Situ Keratomileusis, usually shortened to LASIK, is one of the most popular surgeries used in vision correction today. It involves the creation of a small flap on the surface of the cornea. This flap is raised, and a laser is used to remove the corneal tissue underneath, improving how light focuses around the retina.
Once the reshaping is done, the flap is put back in the right position. Most patients see better one to two weeks after LASIK, and recovery is often quick.
Comparing PRK, SMILE and LASIK, individuals with an urgent need to see results and with small healing periods will give preference to LASIK.
Key Features of LASIK
| Key Feature | Description |
| Procedure | A thin flap is created on the cornea, lifted, and the underlying tissue is reshaped with a laser. |
| Recovery Duration | Quick recovery; noticeable vision improvement usually occurs within a day. |
| Ideal Candidates | Best suited for individuals with stable vision and sufficient corneal thickness. |
| Potential Risks | May include flap-related issues, dry eye symptoms, and light sensitivity, such as glare or halos. |
Who can opt for LASIK?
LASIK is suitable for adults over 18 with a stable eyeglass prescription for at least a year. Ideal candidates have healthy eyes, sufficient corneal thickness, and no conditions like keratoconus or severe dry eye. It’s not recommended during pregnancy or for those with uncontrolled health issues. A thorough eye exam is essential to confirm eligibility and ensure safe, effective results.
What is SMILE (Small Incision Lenticule Extraction)?
SMILE is an advanced flapless surgery that is minimally invasive. Unlike other procedures, SMILE does not use an excimer laser. Instead, a femtosecond laser creates a tiny opening in the cornea. Through this opening, a small piece of corneal tissue called a lenticule is removed. Removing the lenticule reshapes the cornea to improve vision.
SMILE eye surgery combines the advantages of both LASIK and PRK. Most patients say the SMILE procedure is quick and painless.
Key Features of SMILE Eye Surgery
| Key Feature | Description |
| Procedure | A femtosecond laser is used to create a small disc-shaped tissue (lenticule) within the cornea, which is then removed to alter its shape. |
| Recovery Duration | The recovery period for SMILE is generally faster than PRK, but similar to LASIK. |
| Ideal Candidates | Suitable for individuals with myopia and astigmatism looking for a flap-free solution. |
| Potential Risks | SMILE is not ideal for very high refractive errors and may cause temporary dry eyes during early recovery. |
Who can go for SMILE Eye Surgery?
SMILE is suitable for adults over 18 with stable myopia and mild to moderate astigmatism. It’s ideal for those seeking a flap-free, minimally invasive procedure with quicker recovery and fewer dry eye issues. Candidates should have healthy eyes, adequate corneal thickness, and no major eye conditions.
PRK vs LASIK vs SMILE: Key Differences
Here are the main differences between the three:
| Feature | PRK | LASIK | SMILE |
| Surgical Method | The outer corneal layer is removed; the surface is reshaped. | A flap is created and lifted to reshape tissue beneath. | A small lenticule is created and removed through a tiny incision, with no flap. |
| Healing Time | Longer recovery; complete vision stabilisation takes time. | Fast recovery; vision improves in a few days. | Relatively quick recovery; similar to LASIK. |
| Best Suited For | Those with thin corneas or physically active lifestyles. | Individuals seeking rapid visual recovery. | People prefer a flapless procedure with minimal dryness. |
| Dry Eye Risk | Moderate chance of temporary dryness. | Higher likelihood of dry eyes post-surgery. | Lower risk of dry eye symptoms. |
| Activity Restrictions | Requires extended downtime and a healing period. | Short recovery time with minimal restrictions. | Minimal rest required; quick return to daily activities. |
Conclusion
Choosing between PRK, LASIK, and SMILE is not a race to find the newest or quickest fix. It is about matching your eye shape, work style, and long-range expectations with the strengths of each technique. Opt for visiting trusted and reputable eye hospitals and talk openly with a qualified surgeon. With the right guidance, you’re not just choosing a clearer vision, you’re choosing the confidence to see life, fully and freely.