SMILE Pro vs LASIK: What Is the Difference?

Author: Dr Val Phua
Estimated reading time: 23 minutes

SMILE Pro and LASIK are two of the most established ways of correcting myopia and astigmatism with laser refractive surgery.

Both aim to achieve the same fundamental goal:

reshape the cornea so that light focuses more accurately on the retina, reducing dependence on spectacles or contact lenses.

However, they achieve this in very different ways.

With LASIK:

A thin corneal flap is created.
The flap is lifted.
An excimer laser removes microscopic amounts of corneal tissue.
The flap is repositioned.

With SMILE Pro:

A femtosecond laser creates a thin lens-shaped piece of tissue, called a lenticule, within the cornea.
A small peripheral incision is created.
The surgeon separates the lenticule.
The lenticule is removed through the small incision.
No LASIK-style flap is created.

This is why SMILE Pro is often described as flapless laser vision correction.

The difference is not simply cosmetic.

It changes:

How much of the anterior cornea is disturbed
How corneal nerves are affected
Early dry-eye recovery
The possibility of flap-related complications
Treatment customisation
Enhancement options
The experience during surgery

However, it is important not to turn these differences into exaggerated claims.

Randomised trials and meta-analyses comparing established SMILE with femtosecond LASIK consistently show that both procedures are highly effective, safe and predictable for appropriately selected patients. A meta-analysis of 11 randomised controlled trials found no significant difference in the proportion achieving 20/20 unaided vision, final refractive spherical equivalent or major safety outcomes. LASIK showed a small advantage in the proportion of eyes within ±0.50 D of target in that analysis.

SMILE Pro is the newer generation of the same lenticule-extraction procedure, performed with the ZEISS VISUMAX 800.

Compared with the original SMILE platform, the newer system offers:

Much faster lenticule creation
Computer-assisted centration
Cyclotorsion compensation for astigmatism
Updated digital surgical workflow

Recent studies show excellent refractive outcomes with SMILE Pro, including a prospective international study in which 93.2% of eyes achieved 20/20 or better unaided vision at six months and 95.1% were within ±0.50 D of the intended spherical-equivalent target.

The practical conclusion is:

SMILE Pro and LASIK can both produce excellent vision. The more meaningful question is not “Which procedure is better?” but “Which procedure better matches this patient’s cornea, prescription, ocular surface and lifestyle?”

The Quick Answer

What Is the Main Difference Between SMILE Pro and LASIK?

LASIK creates a corneal flap.

SMILE Pro does not.

LASIK uses an excimer laser underneath the flap to reshape the cornea.

SMILE Pro uses a femtosecond laser to create a lenticule within the cornea, which is removed through a small incision.

Which Gives Better Vision?

For most appropriately selected patients with myopia and regular astigmatism:

final visual outcomes are very similar.

Meta-analyses of randomised trials comparing conventional SMILE with LASIK show comparable:

Unaided visual acuity
Corrected visual acuity
Refractive accuracy
Overall safety

The visual difference between two well-selected patients undergoing different procedures is usually much smaller than the difference between:

A well-selected and poorly selected patient
A normal and abnormal cornea
A healthy and unhealthy ocular surface
Accurate and inaccurate preoperative measurements

Which Recovers Faster?

Both recover quickly.

LASIK may still provide slightly faster initial crispness, particularly during the first day or two.

SMILE Pro also provides rapid functional recovery, and many patients see well the following day.

The important difference is that neither requires the several-day epithelial-healing period associated with PRK.

Which Causes Less Dry Eye?

SMILE generally produces:

Less early corneal nerve disruption
Faster recovery of corneal sensation
Better early tear-film measurements

than LASIK.

Meta-analyses have repeatedly found better early tear-film stability and corneal sensitivity after SMILE.

However:

SMILE Pro does not eliminate dry eye.

Both procedures can cause temporary postoperative dryness, and the difference in patient-reported symptoms is not always dramatic.

Which Is Better for Contact Sports?

SMILE Pro has an advantage because there is no large flap that can be traumatically displaced.

Late traumatic LASIK flap displacement is rare but has been reported years after surgery.

For someone involved in:

Martial arts
Boxing
Rugby
Contact sports
Military activities
Occupations with facial-trauma risk

this may favour SMILE Pro.

Which Is Better for Astigmatism?

Modern LASIK has historically provided highly accurate astigmatic treatment because of:

Eye tracking
Iris registration
Cyclotorsion compensation
Customised excimer ablation

Earlier-generation SMILE showed a modest tendency towards astigmatic under-correction in some studies.

SMILE Pro addresses some of this limitation through:

OcuLign cyclotorsion compensation
CentraLign-assisted centration

Recent VISUMAX 800 studies report favourable results even in higher astigmatism, although the evidence is still newer and shorter-term than the LASIK literature.

Which Is Better for Very High Myopia?

Neither should automatically be chosen simply because the prescription falls within a laser’s technical treatment range.

As myopia increases:

More corneal tissue must be altered.
Residual stromal tissue decreases.
Optical quality becomes increasingly important.
Regression risk may increase.

For selected patients with high myopia, ICL should also be considered.

The best treatment may therefore be:

SMILE Pro
LASIK
PRK
ICL

depending on the eye.

How LASIK Works

Step 1: The LASIK Flap Is Created

Modern LASIK usually uses a femtosecond laser to create a thin flap across the central cornea.

The flap consists of:

Epithelium
Bowman layer
Anterior stroma

and remains attached by a hinge.

Step 2: The Flap Is Lifted

The surgeon gently lifts the flap.

This exposes the underlying corneal stroma.

Step 3: The Excimer Laser Reshapes the Cornea

An excimer laser removes microscopic amounts of stromal tissue.

The ablation pattern depends on:

Myopia
Astigmatism
Hyperopia where applicable
Optical zone
Wavefront data
Corneal topography
Treatment platform

Step 4: The Flap Is Repositioned

The flap is placed back into position.

It adheres without stitches.

The surface epithelium remains largely intact, which explains why LASIK recovery is usually rapid and relatively comfortable.

How SMILE Pro Works

Step 1: The Lenticule Is Created

The VISUMAX 800 femtosecond laser creates two internal stromal planes.

Together, these define a small lens-shaped piece of corneal tissue.

This is the lenticule.

Step 2: A Small Incision Is Created

The laser creates a small peripheral access incision.

There is no circumferential flap.

Step 3: The Lenticule Is Separated

The surgeon manually separates the front and back surfaces of the lenticule.

Step 4: The Lenticule Is Removed

The lenticule is extracted through the small incision.

Removing this tissue changes corneal curvature.

For myopia, this generally flattens the central cornea.

Step 5: The Incision Heals

No sutures are usually required.

The small incision heals naturally.

SMILE Pro Uses One Laser; LASIK Usually Uses Two Laser Functions

A common simplification is:

SMILE Pro

Uses:

Femtosecond laser

The femtosecond laser creates the lenticule and incision.

LASIK

Usually uses:

Femtosecond laser for flap creation
Excimer laser for refractive reshaping

Some LASIK platforms integrate these into a coordinated workflow, but they remain different laser processes.

What Does “Flapless” Actually Mean?

SMILE Pro is frequently marketed as flapless.

That description is accurate, but it does not mean:

No corneal incision
No tissue removal
No corneal weakening
No healing response
No complications

The procedure still creates:

Internal stromal tissue planes
A small incision
A permanent change in corneal structure

The meaningful advantage is that it avoids the large hinged flap characteristic of LASIK.

SMILE Pro vs LASIK: At a Glance

Feature	SMILE Pro	LASIK
Main technique	Lenticule extraction	Excimer ablation
Large corneal flap	No	Yes
Small access incision	Yes	Not in the same way
Excimer laser needed for primary procedure	No	Yes
Femtosecond laser	Yes	Usually yes
Early recovery	Rapid	Very rapid
Early discomfort	Usually mild	Usually mild
Dry-eye impact	Generally less early nerve disruption	Generally greater early nerve disruption
Astigmatism treatment	Good; improved with VISUMAX 800 alignment	Highly established
Custom wavefront/topography treatment	More limited	Strong advantage
Flap trauma risk	No LASIK flap	Rare but lifelong flap interface remains
Primary hyperopic flexibility	More limited / jurisdiction-dependent	More established
Enhancement	Usually PRK, CIRCLE or other strategy	Often flap relift + excimer
Contact sports	Attractive	Flap considerations
Final vision	Excellent	Excellent

Which Procedure Has Better Refractive Accuracy?

Both are highly accurate.

A systematic review restricted to randomised trials found:

No significant difference in final spherical equivalent
No significant difference in achieving 20/20 or better
No significant difference in achieving within ±1.00 D of target

LASIK had a modest advantage for achieving within ±0.50 D in that particular pooled analysis.

This evidence primarily reflects first-generation SMILE rather than SMILE Pro.

Newer VISUMAX 800 data are encouraging.

In a prospective multicentre SMILE Pro study of 473 eyes:

93.2% achieved 20/20 or better
98.3% achieved 20/25 or better
95.1% were within ±0.50 D of intended spherical equivalent
99.6% were within ±1.00 D

at six months.

The current evidence therefore does not justify telling patients that one procedure universally gives sharper final eyesight.

Does SMILE Pro Improve on Earlier SMILE?

Yes in important technical ways.

A 2025 comparison between VISUMAX 800 and VISUMAX 500 found that lenticule creation took approximately:

10.3 seconds with VISUMAX 800
28.3 seconds with VISUMAX 500

There was no significant difference in final visual acuity or refractive outcome at three months, but the newer platform produced:

Less optical-zone decentration
Less induced vertical coma

A separate 2026 study similarly found:

Lenticule creation approximately 9.5 versus 27.4 seconds
Better centration
Less vertical coma
Slightly better astigmatic vector outcomes

with VISUMAX 800.

This supports an important distinction:

SMILE Pro appears to improve how SMILE is delivered more clearly than it changes the fundamental long-term result of lenticule extraction.

Dry Eye: One of the Most Important Differences

Why LASIK Can Cause Dry Eye

Corneal nerves help regulate:

Blinking
Tear secretion
Corneal sensation
Ocular-surface feedback

Creating a LASIK flap transects many anterior corneal nerves.

This temporarily reduces corneal sensitivity and can disturb the lacrimal functional unit.

Symptoms may include:

Dryness
Burning
Grittiness
Fluctuating vision
Tired eyes
Contact-lens-like awareness

Why SMILE May Preserve More Nerves

SMILE uses a much smaller peripheral incision.

The anterior corneal surface remains more structurally continuous.

This means fewer superficial nerve fibres may be transected.

What Does the Evidence Show?

A meta-analysis comparing SMILE with femtosecond LASIK found:

Better tear break-up time after SMILE
Better corneal sensitivity
Greater sub-basal nerve density early after surgery

A newer meta-analysis of 18 studies also found significantly better tear-film stability after lenticule extraction at three and six months, although differences in symptom scores were smaller.

Therefore:

SMILE Pro has a reasonable advantage when early ocular-surface preservation is a priority.

But it is not accurate to say:

“SMILE Pro does not cause dry eye.”

Both procedures can.

Who Should Be Particularly Concerned About Dry Eye?

Patients with:

Existing dry-eye disease
Meibomian-gland dysfunction
Long screen hours
Contact-lens intolerance
Ocular allergy
Incomplete blinking
Autoimmune disease

require careful assessment before either surgery.

In some patients, neither SMILE Pro nor LASIK should proceed until the ocular surface has been treated.

Early Visual Recovery

LASIK Recovery

LASIK is famous for rapid visual recovery.

Many patients notice a dramatic improvement within hours.

By the following day, vision is commonly sufficient for ordinary daily activities.

Possible early symptoms include:

Mild haze
Grittiness
Tearing
Dryness
Glare
Halos

SMILE Pro Recovery

SMILE Pro also recovers rapidly.

Many patients have good functional vision the next day.

However, some describe early vision as:

Slightly misty
Less crisp
Fluctuating
Mildly hazy

The quality generally improves over the first days and weeks.

Which Is Faster?

Historically, LASIK has had the edge for very early visual clarity.

The difference becomes much less important after the early postoperative period.

Because SMILE Pro has:

Faster laser delivery
Better centration tools
Refined energy settings

its early recovery may be better than older-generation SMILE.

However, direct randomised evidence comparing SMILE Pro specifically with modern LASIK remains more limited than the established conventional-SMILE versus LASIK literature.

Pain and Comfort

Both procedures are generally much more comfortable than PRK.

Anaesthetic drops are used during surgery.

After LASIK

Patients may experience:

Burning
Tearing
Grittiness
Light sensitivity

during the first several hours.

After SMILE Pro

Patients may experience:

Mild stinging
Grittiness
Watering
Light sensitivity

Significant pain is unusual with either procedure.

Increasing pain after initial improvement requires assessment.

Astigmatism: Is LASIK More Accurate?

This question has become more nuanced with SMILE Pro.

Earlier SMILE

Meta-analysis of 1,985 eyes found both SMILE and LASIK effective for astigmatism but identified a tendency towards astigmatic under-correction with SMILE, particularly in low-to-moderate cylinder.

When SMILE was compared specifically with wavefront-guided LASIK, LASIK showed:

Lower astigmatic angle error
A slightly more favourable correction index

while overall refractive and visual outcomes remained similar.

Why Was This a Challenge?

Astigmatism is sensitive to rotational error.

When a patient goes from sitting upright to lying down, the eye may rotate slightly.

This is called cyclotorsion.

A small axis error matters increasingly as cylinder increases.

What Changes with SMILE Pro?

The VISUMAX 800 incorporates:

OcuLign for cyclotorsion compensation
CentraLign for centration assistance

Recent 2026 data in eyes with mean preoperative cylinder around -2.5 D found:

Mean residual cylinder approximately -0.52 D
98% of eyes within 1.00 D residual cylinder
No eye losing two or more lines of corrected acuity

at three months.

Another six-month study using automated cyclotorsion compensation found favourable vector outcomes even in eyes just above 2.00 D of astigmatism.

Therefore:

The historical astigmatism gap between SMILE and LASIK may be narrowing with SMILE Pro, but modern wavefront-guided or topography-guided LASIK retains a very mature evidence base for customised astigmatic correction.

Higher-Order Aberrations and Visual Quality

Vision is not only about reading 6/6.

Visual quality is also influenced by higher-order aberrations such as:

Spherical aberration
Coma
Trefoil

These may influence:

Night vision
Halos
Glare
Contrast
Ghosting

Conventional SMILE vs LASIK

Results depend on the LASIK profile used.

A meta-analysis comparing SMILE with wavefront-guided LASIK found:

Similar total higher-order aberrations
Less spherical aberration after SMILE
More vertical coma and trefoil after SMILE

Another 2024 meta-analysis similarly found:

Similar overall efficacy
Similar total HOA
Less coma with wavefront-guided LASIK

Therefore it is not accurate to claim that SMILE universally produces better optical quality.

How Might SMILE Pro Help?

Decentration can increase coma.

The VISUMAX 800 appears to improve centration.

Recent studies comparing VISUMAX 800 with VISUMAX 500 have shown:

Less treatment-zone decentration
Less induced vertical coma

This may improve some of the optical limitations reported with older-generation SMILE.

Longer-term comparative data remain desirable.

Customised Treatment: A Major LASIK Strength

LASIK has an important advantage when the surgeon wants to use an excimer-laser treatment specifically customised to the eye.

Depending on the platform, LASIK can be:

Wavefront-optimised
Wavefront-guided
Topography-guided

Wavefront-Guided LASIK

Wavefront-guided treatment incorporates measurements of the eye’s optical aberrations.

This may be useful in selected eyes where higher-order optical quality is a priority.

Topography-Guided LASIK

Topography-guided treatment uses detailed corneal-surface information.

It may be particularly useful in selected:

Irregular corneas
Decentered previous treatments
Refractive-surgery enhancements
Eyes where corneal optical regularisation is required

SMILE Pro currently does not provide the same type of point-by-point excimer customisation.

For an ordinary symmetrical myopic cornea, this may not be clinically important.

For a highly customised optical problem, LASIK or surface ablation may be preferable.

Corneal Biomechanics

One theoretical attraction of SMILE is preservation of the strong anterior corneal lamellae because no large flap is created.

The reality is more complicated.

What Does the Evidence Show?

A 2019 meta-analysis found biomechanical parameters measured with the Ocular Response Analyzer favoured SMILE over LASIK, but heterogeneity between studies was substantial.

A newer 2023 systematic review and meta-analysis of 16 studies found no statistically significant overall biomechanical superiority of SMILE over femtosecond LASIK at three months across a broader range of measured parameters.

Therefore the cautious conclusion is:

SMILE has theoretical biomechanical advantages because it avoids a flap, but current clinical measurement techniques have not demonstrated a consistent major biomechanical superiority over modern femtosecond LASIK.

Does SMILE Pro Prevent Corneal Ectasia?

No.

Ectasia is progressive:

Corneal thinning
Steepening
Irregular astigmatism
Visual distortion

after refractive surgery.

It is rare but serious.

Which Has a Higher Ectasia Risk?

A systematic review attempting to estimate reported ectasia rates in eyes without identifiable preoperative risk factors found approximately:

90 cases per 100,000 LASIK eyes
11 cases per 100,000 SMILE eyes

However, these were based on reported cases and estimated procedure volumes rather than prospective population registries. SMILE was also newer, with shorter observation time.

These figures should therefore not be used to promise an individual patient that SMILE is eight times safer.

The strongest protection against ectasia is:

Proper patient selection
Normal corneal tomography
Adequate corneal thickness
Appropriate treatment magnitude
Recognition of keratoconus or forme-fruste ectasia

A flapless procedure does not make an abnormal cornea safe.

LASIK Flap Complications

Because LASIK creates a flap, unique complications may include:

Flap striae
Flap displacement
Interface inflammation
Epithelial ingrowth
Flap-edge problems
Traumatic displacement

Modern femtosecond LASIK has reduced many flap-related complications substantially.

Can the Flap Move Years Later?

Rarely, yes.

The LASIK interface does not heal with the same tensile strength as untouched cornea.

Published cases describe traumatic displacement many years after surgery.

Most patients will never experience this.

It becomes more relevant in someone exposed to repeated:

Finger or fist contact
Eye gouging
Combat
Facial trauma

SMILE-Specific Complications

SMILE Pro avoids a flap but introduces a different set of possible complications.

These include:

Suction loss
Difficult lenticule separation
Incomplete lenticule extraction
Lenticule remnant
Cap tear
Interface inflammation
Epithelial ingrowth
Infection
Residual refractive error

A 2026 series of 916 SMILE Pro eyes found successful completion as planned in 99.45% of eyes. Suction loss occurred in 0.66%.

These are uncommon events, but they illustrate why SMILE Pro remains surgeon-dependent surgery, not simply a laser treatment.

Infection

Infection is rare after both procedures.

Possible symptoms include:

Increasing pain
Increasing redness
Falling vision
Light sensitivity
Discharge
A visible white corneal spot

These require urgent review.

Which Is Better for Contact Sports?

For patients involved in high-impact activities, SMILE Pro may be particularly attractive because there is no LASIK flap.

Examples include:

Boxing
Muay Thai
MMA
Rugby
Martial arts
Military combat training

The advantage is specifically the absence of flap-displacement risk.

However, SMILE Pro does not protect against:

Corneal abrasion
Traumatic iritis
Cataract
Retinal tear
Retinal detachment
Globe rupture

Protective eyewear remains important where practical.

Which Is Better for Military Personnel?

Historically, flap-free procedures have attracted interest in military populations because of concerns regarding:

Trauma
Dust
Harsh environments
Deployment
Contact activity

PRK has traditionally been widely used in military refractive programmes.

SMILE provides a flap-free option with faster recovery than PRK.

Suitability depends on:

The specific military authority
Current medical standards
Occupation
Deployment requirements

Patients should check occupational regulations before surgery.

Which Is Better for Thin Corneas?

There is no simple answer.

SMILE removes a stromal lenticule.

LASIK removes stromal tissue after creating a flap.

The surgeon must consider:

Central corneal thickness
Corneal tomography
Cap or flap thickness
Treatment magnitude
Residual tissue
Overall ectasia risk

In selected cases:

PRK may preserve more structural tissue.
ICL may avoid corneal tissue removal altogether.

A thin cornea should not automatically trigger selection of SMILE Pro.

Which Is Better for High Myopia?

Both SMILE and LASIK can correct substantial myopia in suitable corneas.

Meta-analysis of high-myopia studies found both procedures:

Safe
Effective
Predictable

with some optical outcomes favouring SMILE in the included studies.

However, high myopia requires more tissue alteration regardless of technique.

At higher prescriptions, the discussion should include ICL.

ICL may offer advantages because:

No corneal tissue is removed.
Optical quality can be excellent in high corrections.
The treatment does not induce large corneal curvature changes.

The disadvantage is that ICL is intraocular surgery.

Which Is Better for Low Myopia?

Both may perform extremely well.

In very low myopia, practical considerations may become more important than tissue conservation, including:

Treatment range
Visual demands
Surgeon preference
Corneal anatomy
Enhancement strategy

PRK may also be reasonable.

Which Is Better for Hyperopia?

LASIK currently has a more established role in hyperopic laser correction.

Hyperopic SMILE Pro is becoming available on the newer platform in selected jurisdictions, but availability and regulatory approval vary.

LASIK therefore remains more flexible for many hyperopic patients at present.

Presbyopia

Neither procedure stops presbyopia.

A patient with perfect distance vision after either surgery may later require reading glasses.

Monovision

Both procedures can potentially be used for monovision.

One eye is targeted for distance.

The other is left mildly myopic for near.

A contact-lens simulation before surgery is useful because monovision can reduce:

Stereopsis
Distance crispness
Binocular quality

in some patients.

Enhancement: What Happens if Some Degree Remains?

This is one of the clearest practical differences.

Enhancement After LASIK

If the cornea remains suitable, the existing flap can sometimes be lifted and additional excimer ablation performed.

Advantages include:

Familiar technique
Rapid visual recovery
No need for another new flap

In older flaps or selected eyes, surgeons may choose surface ablation instead because flap relifting can increase the risk of epithelial ingrowth.

Enhancement After SMILE Pro

There is no conventional flap to relift.

Options may include:

PRK / surface ablation
CIRCLE conversion
Thin-flap LASIK in selected eyes
Other specialised strategies

A review of enhancement techniques concluded that these options can all be effective when appropriately selected.

PRK Enhancement After SMILE

Surface ablation preserves the flapless nature of the original surgery.

The disadvantage is:

Greater early discomfort
Slower recovery
Surface-healing requirements

Singapore data from 524 conventional SMILE eyes found a two-year enhancement incidence of 2.9%, with good visual outcomes after PRK enhancement.

CIRCLE Enhancement

CIRCLE uses the femtosecond laser to convert the existing SMILE cap into a LASIK-style flap.

The flap can then be lifted and excimer laser treatment performed.

A comparative study found similar three-month refractive results between surface ablation and CIRCLE, but faster early visual recovery after CIRCLE.

The trade-off is obvious:

the eye becomes a flap-based eye after CIRCLE.

Does Easier Enhancement Make LASIK Better?

Not necessarily.

Enhancements are needed only in a minority of appropriately selected patients.

However, when the preoperative risk of residual prescription is relatively high, the ease of future retreatment may influence procedure choice.

What About Long-Term Results?

LASIK has several decades of clinical experience.

Traditional SMILE now has more than a decade of follow-up.

Both demonstrate good long-term effectiveness in appropriately selected patients.

SMILE Pro itself is newer.

Therefore, direct 10-year SMILE Pro data do not yet exist.

Long-term evidence for the lenticule-extraction concept comes from first-generation SMILE, while current VISUMAX 800 studies demonstrate strong short- to medium-term outcomes.

This distinction is important.

Newer technology should not be credited with follow-up time it has not yet accumulated.

Does Either Procedure “Wear Off”?

The tissue removed during:

LASIK
SMILE Pro

does not grow back.

The corneal reshaping is permanent.

However, the eye remains biologically active.

Future changes may occur because of:

Continued myopic progression
Refractive regression
Presbyopia
Cataract
Other ageing changes

Does Either Procedure Prevent Cataracts?

No.

Both reshape the cornea.

Neither removes or replaces the natural lens.

A cataract may still develop later.

Does Either Procedure Affect Cataract Surgery?

Yes.

Both alter corneal optics and therefore affect future intraocular-lens calculations.

Modern formulas are designed to manage post-refractive eyes.

Still:

Tell your cataract surgeon about the previous procedure.
Keep old refractive-surgery records where possible.

Does Either Procedure Remove the Retinal Risks of High Myopia?

No.

This is extremely important.

Suppose a patient was:

-8.00 D before SMILE Pro or LASIK

and becomes:

plano with 6/6 unaided vision afterwards.

The eye may still remain anatomically elongated.

The lifetime risk of:

Retinal tears
Retinal detachment
Myopic macular degeneration
Myopic choroidal neovascularisation

does not disappear.

Laser surgery corrects the cornea.

It does not shorten the eyeball.

What About Eye-Pressure Measurements?

Both LASIK and SMILE alter:

Corneal thickness
Curvature
Biomechanics

This can cause standard tonometry to underestimate intraocular pressure.

Studies demonstrate changes in measured IOP after both procedures.

Future eye-care professionals should know that refractive surgery has been performed.

A seemingly low pressure should not be interpreted without considering:

Corneal history
Optic nerve
OCT
Visual field
Other glaucoma risk factors

Who Might Prefer SMILE Pro?

SMILE Pro may be particularly attractive for someone who:

Has myopia with or without regular astigmatism
Has suitable corneal anatomy
Wants a flapless procedure
Participates in contact sport
Is concerned about early dry eye
Wants rapid recovery without PRK surface healing
Has no need for highly customised excimer treatment

Who Might Prefer LASIK?

LASIK may be particularly attractive when:

Very rapid initial visual clarity is important
A highly customised wavefront-guided treatment is desirable
A topography-guided treatment is indicated
The refractive error is better suited to excimer ablation
Hyperopia needs treatment
Straightforward future flap-relift enhancement is considered advantageous

Who Might Prefer PRK Instead?

PRK may be selected when:

Avoiding a flap is desirable
Surface treatment better preserves available stromal architecture
Topography-guided treatment is required
Previous refractive surgery requires a surface enhancement
The corneal anatomy suits PRK better

Its major disadvantage is slower recovery.

Who Might Prefer ICL?

ICL should be considered when:

Myopia is high
Corneal tissue is limited
Corneal laser treatment would require substantial tissue removal
Optical quality is a major priority
Ocular surface concerns make corneal laser less attractive

ICL is intraocular surgery and has its own distinct risks.

How Do I Know Which Procedure I Am Suitable For?

The choice should follow a detailed refractive assessment.

Refraction

The surgeon needs to know:

Sphere
Cylinder
Axis
Stability over time

Corneal Topography and Tomography

These assess:

Corneal curvature
Posterior corneal elevation
Thickness distribution
Asymmetry
Keratoconus risk

Corneal Thickness

The surgeon calculates the structural consequences of each procedure.

Ocular Surface

Dry eye and meibomian-gland disease should be identified and treated.

Pupil Size

This may influence:

Glare
Halos
Optical-zone planning

Retinal Examination

Particularly important in:

Moderate myopia
High myopia
Flashes and floaters
Lattice degeneration
Previous retinal tears

Lifestyle

Tell your surgeon about:

Contact sports
Military work
Night driving
Screen demands
Travel
Work deadlines
Pregnancy plans

A technically successful procedure can still be the wrong procedure if it does not match the patient’s life.

Common Myths

“SMILE Pro Is Better Because It Is Newer”

False.

Newer does not automatically mean better for every patient.

“LASIK Is Old Technology”

False.

Modern femtosecond LASIK uses sophisticated:

Eye tracking
Iris registration
Wavefront guidance
Topography guidance
Excimer-laser profiles

It remains one of the most advanced refractive platforms available.

“SMILE Pro Gives Better Final Vision Than LASIK”

Not generally established.

Final safety and efficacy are broadly comparable.

“LASIK Always Gives Better Vision”

Also false.

Both procedures can produce excellent outcomes.

“SMILE Pro Has No Flap, So It Has No Risks”

False.

“LASIK Flaps Usually Fall Off”

False.

Flap displacement is rare.

“A LASIK Flap Heals Exactly Like Untouched Cornea”

False.

A persistent interface remains, explaining why late traumatic displacement is possible, although uncommon.

“SMILE Pro Cannot Cause Dry Eye”

False.

“LASIK Causes Permanent Severe Dry Eye in Everyone”

False.

Most postoperative dryness improves with time.

“SMILE Pro Is Always Better for Dry Eyes”

Not necessarily.

Severe pre-existing dry eye may make both procedures inappropriate until the surface is treated.

“SMILE Pro Is Stronger Than LASIK”

Too simplistic.

There are theoretical biomechanical advantages, but clinical meta-analysis has not consistently demonstrated a major superiority across available biomechanical measurements.

“SMILE Pro Cannot Cause Ectasia”

False.

“LASIK Always Causes Ectasia”

False.

It is rare after properly selected surgery.

“SMILE Cannot Correct Astigmatism Well”

Outdated.

Modern SMILE Pro includes improved cyclotorsion and centration tools.

“LASIK Is Always Better for Astigmatism”

Also too broad.

Wavefront-guided LASIK has a very strong astigmatism record, while recent SMILE Pro results are increasingly competitive.

“SMILE Pro Is a Ten-Second Operation”

Misleading.

The laser portion is very short.

The surgeon must still separate and remove the lenticule.

“LASIK Is Fully Automated”

False.

LASIK also requires surgical judgement and flap management.

“SMILE Pro Is Better for Everyone Who Plays Sport”

Not necessarily.

The absence of a flap is advantageous, but PRK may also be appropriate and other anatomical factors remain more important.

“Once I Have Laser Surgery, I Will Never Need Glasses”

Not guaranteed.

“Laser Surgery Stops Presbyopia”

False.

“Laser Surgery Removes the Retinal Risk of Myopia”

False.

Frequently Asked Questions

Which Is Safer: SMILE Pro or LASIK?

Both have excellent safety profiles in appropriately selected patients.

The risk profile differs rather than one procedure being universally safer.

SMILE Pro avoids:

LASIK flap complications

LASIK avoids:

Lenticule-dissection complications

The most important safety determinant is appropriate patient selection.

Which Has Better 20/20 Rates?

Both have high 20/20 rates.

Randomised-trial meta-analysis does not show a clinically meaningful overall superiority in final unaided acuity.

Which Is More Accurate?

LASIK showed a modest advantage for ±0.50 D predictability in one RCT meta-analysis of older-generation SMILE.

Current SMILE Pro outcomes are highly predictable, but long-term direct randomised comparison against current-generation customised LASIK remains limited.

Which Has Better Night Vision?

Neither universally.

Night vision depends on:

Pupil size
Prescription
Treatment centration
Tear film
Residual astigmatism
Higher-order aberrations

Which Causes Fewer Halos?

There is no reliable guarantee.

Most early halos improve after either procedure.

Which Causes Less Dry Eye?

On average, SMILE produces less early corneal nerve disruption and better early tear-film stability.

Which Is More Comfortable?

Both are usually comfortable.

Neither has the typical first-three-day pain profile of PRK.

Which Procedure Is Faster?

The VISUMAX 800 creates the SMILE Pro lenticule extremely quickly.

However, total procedure time also includes lenticule dissection.

LASIK laser treatment is also brief.

The difference usually matters less than patients expect.

Which Has Faster Visual Recovery?

LASIK may provide the fastest initial crispness.

SMILE Pro also has rapid recovery.

Can I Drive the Next Day?

Possibly after either procedure.

Do so only when:

Vision meets legal standards
Glare is manageable
You feel safe
The postoperative examination is satisfactory

Which Is Better for Office Workers?

Either may be suitable.

Patients with significant dry-eye tendency may lean towards SMILE Pro, but ocular-surface treatment is more important than procedure choice alone.

Which Is Better for Pilots?

This depends on:

Regulatory authority
Prescription
Optical requirements
Occupational medical rules

Check requirements before surgery.

Which Is Better for Soldiers?

Flap-free procedures may be attractive, but military policy and individual anatomy should determine the choice.

Which Is Better for Boxing?

SMILE Pro or PRK may be more attractive than LASIK because they do not leave a LASIK flap.

Can I Rub My Eyes After SMILE Pro?

Avoid rubbing during recovery.

Long-term vigorous eye rubbing should also be avoided because of its association with corneal ectatic disorders.

Can I Rub My Eyes After LASIK?

Avoid rubbing, particularly early after surgery.

Traumatic flap movement later is rare but possible.

Can SMILE Pro Treat -10.00 D?

Some regulatory indications extend to high myopia.

That does not mean it is automatically the best procedure.

ICL should be discussed for high corrections.

Can LASIK Treat -10.00 D?

Technically possible on some platforms and in selected corneas, but again:

technical possibility is not the same as optimal treatment selection.

Which Is Better if My Cornea Is Thin?

Neither can be chosen from thickness alone.

Tomography and expected tissue alteration matter.

PRK or ICL may be better.

Which Is Better if I Have Dry Eye?

Treat the dry eye first.

If both are otherwise suitable, SMILE Pro may have an early ocular-surface advantage.

Which Is Better if I Have Keratoconus?

Ordinary elective SMILE Pro and LASIK are generally inappropriate.

Can I Have SMILE Pro After LASIK?

Not routinely.

An enhancement strategy requires specialised assessment.

Can I Have LASIK After SMILE?

Selected eyes can undergo a flap-based enhancement strategy such as CIRCLE or thin-flap LASIK, but this is not equivalent to simple primary LASIK.

Can I Have Cataract Surgery Later?

Yes after either procedure.

Will My Cataract Surgeon Know Which I Had?

Tell them.

Ideally retain your refractive-surgery records.

Can My Myopia Return?

Yes after either procedure.

Possible reasons include:

Natural myopic progression
Regression
Lens changes

Can Either Surgery Be Reversed?

No.

Corneal tissue removed during LASIK or SMILE Pro does not regrow.

Can SMILE Pro Be Enhanced More Than Once?

Potentially in selected circumstances, but each further procedure must be assessed according to:

Remaining tissue
Corneal shape
Previous treatment
Refractive need

Can LASIK Be Enhanced More Than Once?

Sometimes, but repeated surgery is not automatically safe or advisable.

Warning Signs After Either Procedure

Contact the treating clinic promptly for:

Increasing pain
Increasing redness
Sudden loss of vision
Significant light sensitivity
Significant discharge
A visible white corneal spot
Eye trauma

Additional Warning Signs After LASIK

Seek review after trauma if there is:

Sudden blur
Significant discomfort
A visible flap wrinkle
Foreign-body sensation

even many years after LASIK.

Retinal Warning Signs After Either Procedure

Patients who were myopic before surgery should seek urgent assessment for:

New flashes
A sudden shower of floaters
A curtain or shadow
Sudden peripheral-field loss

Laser correction does not remove retinal-detachment risk.

SMILE Pro vs LASIK: Which Should I Choose?

A useful way to think about the decision is:

SMILE Pro May Have the Edge When You Prioritise

No LASIK flap
Contact-sport compatibility
Less early corneal nerve disruption
Rapid recovery without surface ablation
A small-incision procedure
Myopia with suitable regular astigmatism

LASIK May Have the Edge When You Prioritise

Maximum excimer-laser customisation
Wavefront-guided treatment
Topography-guided treatment
Very rapid initial crispness
Established hyperopic treatment
Straightforward flap-relift enhancement in selected cases

Neither May Be Best When

Corneal tomography is abnormal
Myopia is very high
Corneal tissue is limited
There is significant uncontrolled dry eye
Cataract is developing
The prescription is unstable

In those situations, alternatives such as:

PRK
ICL
Lens-based surgery
Spectacles
Contact lenses

may be safer.

A Pre-Surgery Checklist

Ask About Your Cornea

Is my tomography completely normal?
Is there any keratoconus suspicion?
How thick is my cornea?
How much tissue will be affected?
What is my calculated ectasia risk?

Ask About Your Prescription

Is my prescription stable?
How much astigmatism do I have?
Is my correction particularly high?
Should I also consider ICL?

Ask About Visual Quality

Do I have large pupils?
Do I have significant higher-order aberrations?
Would wavefront-guided or topography-guided LASIK offer an advantage?
How accurately can SMILE Pro treat my astigmatism?

Ask About Dry Eye

Is my ocular surface healthy?
Do I have meibomian-gland dysfunction?
Should this be treated before surgery?
Does my dry-eye profile favour SMILE Pro?

Ask About Lifestyle

Do I play contact sports?
Do I work in a high-trauma environment?
How quickly do I need to return to driving or work?
Do I have important night-vision requirements?

Ask About Future Retreatment

What happens if I have residual myopia?
How do you enhance LASIK?
How do you enhance SMILE Pro?
Would the enhancement create a flap?
Would I require PRK?

The Bottom Line

SMILE Pro and LASIK are both highly effective forms of laser vision correction.

Their fundamental difference is how the cornea is reshaped.

With LASIK:

A large corneal flap is created.
An excimer laser reshapes the underlying stroma.
The flap is repositioned.

With SMILE Pro:

The VISUMAX 800 creates an internal stromal lenticule.
The surgeon removes it through a small incision.
No LASIK flap is created.

For most appropriately selected myopic patients, established evidence shows that SMILE and LASIK provide broadly comparable:

Safety
Efficacy
Unaided vision
Refractive outcomes

SMILE Pro’s main potential advantages include:

No large flap
Less early corneal nerve disruption
Better early tear-film stability
No late flap-displacement risk
Attractive profile for contact sports
Faster laser delivery and improved centration compared with earlier-generation SMILE

LASIK’s main advantages include:

Very rapid visual recovery
Extensive long-term experience
Excellent astigmatism predictability
Wavefront-guided treatment
Topography-guided treatment
Greater flexibility for certain prescriptions
Relatively straightforward enhancement in selected patients

Earlier studies suggested that LASIK had a modest advantage in fine refractive predictability and astigmatic accuracy compared with first-generation SMILE.

SMILE Pro may narrow some of these differences because the VISUMAX 800 improves:

Centration
Cyclotorsion compensation
Lenticule-creation speed

Early evidence is encouraging, particularly for astigmatism, but the SMILE Pro evidence base is necessarily shorter than the decades of data available for LASIK.

Neither procedure is universally better.

A patient with:

Significant dry-eye tendency
A high-impact lifestyle
Completely normal corneal anatomy

may lean towards SMILE Pro.

A patient who would benefit from:

Topography-guided treatment
Wavefront-guided treatment
Hyperopic correction
Maximum excimer customisation

may be better suited to LASIK.

A patient with:

Very high myopia
Limited corneal tissue

may be better suited to ICL.

A patient with:

Abnormal tomography
Keratoconus

may be unsuitable for both.

The most important message is:

Do not choose SMILE Pro simply because it is newer, and do not dismiss LASIK simply because it uses a flap. Both are excellent procedures when used for the right eye. The best refractive operation is the one that achieves the desired vision while respecting the patient’s corneal anatomy and long-term safety.

References

Yao L, et al. Small incision lenticule extraction and LASIK for myopia and myopic astigmatism: systematic review and meta-analysis of randomised clinical trials. Semin Ophthalmol. 2023. PMID: 35912896.
Zhang Y, et al. Clinical outcomes of SMILE and femtosecond LASIK used to treat myopia: meta-analysis. PMID: 27070233.
Kobashi H, Kamiya K, Shimizu K. Dry eye after small incision lenticule extraction and femtosecond LASIK: meta-analysis. PMID: 27560032.
KLEx versus LASIK for dry-eye outcomes: systematic review and meta-analysis. 2025. PMID: 40778870.
Tian H, et al. Wavefront-guided LASIK versus SMILE: clinical outcomes and higher-order aberrations. Acta Ophthalmol. 2023. PMID: 36726315.
Clinical outcomes of SMILE and wavefront-guided LASIK for myopia and astigmatism: systematic review and meta-analysis. 2024. PMID: 38377878.
SMILE versus LASIK for astigmatic correction: systematic review and meta-analysis. 2022. PMID: 36410469.
Sekundo W, Chang JSM, Ganesh S, Hjortdal J, Wiltfang R. Keratorefractive lenticule extraction with the VISUMAX 800: six-month prospective multicentre outcomes. J Refract Surg. 2025. PMID: 40067668.
Chung YT, et al. Comparison of SMILE using VISUMAX 800 versus VISUMAX 500. 2025. PMID: 40664759.
Yang et al. Early visual and optical-quality outcomes after SMILE using VISUMAX 800 versus VISUMAX 500. 2026. PMID: 42145766.
Tran LHT, et al. Refractive and vector outcomes of SMILE Pro with VISUMAX 800 for high astigmatism. 2026. PMID: 42496490.
Mei Y, et al. Vector outcomes after SMILE Pro using automated cyclotorsion compensation. 2026. PMID: 42318400.
Guo H, et al. Corneal biomechanical properties after SMILE versus LASIK, PRK and related procedures: systematic review and meta-analysis. 2019. PMID: 31370817.
Corneal biomechanics after SMILE and femtosecond LASIK: systematic review and meta-analysis. 2023. PMID: 37565903.
Moshirfar M, et al. Ectasia after corneal refractive surgery: systematic review. Ophthalmol Ther. 2021. PMID: 34417707.
Xiao J, et al. Traumatic corneal flap displacement after LASIK and literature review. 2017. PMID: 28458585.
Late traumatic flap dislocations after LASIK. PMID: 16722490.
Liu YC, Rosman M, Mehta JS. Enhancement after small-incision lenticule extraction: incidence, risk factors and outcomes. Ophthalmology. 2017. PMID: 28318639.
Siedlecki J, et al. Surface ablation versus CIRCLE for myopic enhancement after SMILE. J Refract Surg. 2019. PMID: 31059578.
Beckers D, et al. Intraoperative safety and postoperative complications after SMILE Pro: 916-eye case series. 2026. PMID: 42355753.