LASIK vs. LALEX (SMILE) Eye Surgery


At Porter Ophthalmology, we’re dedicated to providing our patients with the most advanced and appropriate vision correction options available. As technology evolves, so do the choices for correcting refractive errors. In this article, we’ll compare LASIK, a well-known laser eye surgery, with LALEX (SMILE), a newer minimally invasive vision correction. Our goal is to help you understand the differences, benefits, and considerations of each, ensuring you’re well-informed about your options for achieving clear vision.

What is LASIK?

LASIK, short for Laser-Assisted In Situ Keratomileusis, is a widely known vision correction surgery that aims to reshape the cornea to correct visual impairments such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. This laser-based procedure is known for its precision and widespread applicability. The process begins with the creation of a flap in the outer layer of the cornea, a step that is performed using a femtosecond laser for enhanced accuracy and safety. Once the flap is carefully lifted, the underlying corneal tissue is exposed for the excimer laser to precisely reshape based on the patient’s specific needs. The flap is then repositioned, enabling the eye’s natural healing process to begin. LASIK uses laser technology for both flap creation and corneal reshaping, and it is a significant advancement in reducing complications and improving outcomes. LASIK remains the most popular choice for laser vision correction due to its ability to correct a broad spectrum of refractive errors efficiently.

What is LALEX (SMILE) Eye Surgery?

LALEX (SMILE), or Laser-Assisted Lenticule EXtraction (SMall Incision Lenticule Extraction), is a newer type of laser eye surgery developed to correct vision by reshaping the cornea. First performed in 2007, and approved by the United States Food and Drug Administration in 2016, the LALEX (SMILE) procedure uses a femtosecond laser to precisely cut and remove a small piece of corneal tissue, called a lenticule, based on the specific vision correction needed. This lenticule removal adjusts the cornea’s shape, correcting nearsightedness and astigmatism. The procedure involves a small keyhole incision, typically less than 4 millimeters, through which the lenticule is removed. Since its introduction, LALEX (SMILE) has been used to correct vision in over eight million eyes, offering a less invasive option for correcting significant refractive errors.

How are LASIK and LALEX (SMILE) Eye Surgery Similar?

LASIK and LALEX (SMILE) eye surgeries are both advanced laser vision correction methods, each costing between $2,000 and $3,000 per eye on average. The process to determine if you are a suitable candidate for either procedure involves a thorough evaluation by an ophthalmologist. This includes creating a detailed map of your cornea, measuring its thickness, confirming the stability of your refraction, and meeting age and health requirements. It’s crucial that your eyes are healthy, with no conditions that could affect healing, such as autoimmune diseases. Additionally, these procedures are not recommended for those who are pregnant or breastfeeding due to possible vision changes caused by hormonal fluctuations.

The preparation for both LALEX (SMILE) and LASIK surgeries is quite similar. Before either procedure, numbing drops are applied to the eyes, and your cornea’s shape, determined through corneal mapping, and your refraction are used to program the laser. A safety device is then used to relax the eyelids, and the eye is stabilized the eye for the laser application, which differs significantly between the two surgeries.

Both LASIK and LALEX (SMILE) are quick, typically lasting less than 10-15 minutes per eye, with patients expected to rest for a day afterwards and use antibiotic eye drops for about a week. The aim of both surgeries is to enhance visual acuity, potentially achieving 20/20 vision without glasses or contacts. Despite the differences in procedure, LASIK and LALEX (SMILE) share the common goal of correcting refractive errors by reshaping the cornea, offering safe and effective options for those looking to improve their vision.

What are the differences between LASIK & LALEX (SMILE) Eye Surgery?

LASIK and LALEX (SMILE) are both laser eye surgeries designed to correct vision, but they differ significantly in their procedures. In LASIK, a thin flap is created on the cornea’s surface with a femtosecond laser. The flap is lifted and a laser reshapes the corneal tissue beneath. The flap is placed back after the cornea has been reshaped and this heals on its own. LASIK offers various ablation patterns, including wavefront-guided, wavefront-optimized, and topography-guided, each with its own advantages and potential drawbacks.

LALEX (SMILE), on the other hand, does not involve creating a flap. Instead, it uses a femtosecond laser to make precise cuts within the cornea to create a disc-shaped piece of tissue, known as a lenticule, which is then removed through a small keyhole incision. This procedure corrects vision by altering the cornea’s shape from within and is primarily used for treating myopia and astigmatism. Currently, in the U.S., LALEX (SMILE) is approved for myopia and astigmatism, whereas LASIK can also correct hyperopia. The FDA recommends LASIK for individuals 18 and older and LALEX (SMILE) for those 22 and above, reflecting differences in criteria for refractive stability.

Post-surgery recovery for both LASIK and LALEX (SMILE) is quick, typically allowing patients to drive within 24 hours, although full visual recovery might take 3-6 months. While both surgeries have similar risks of complications like halos, glare, and dry eyes, LALEX (SMILE) is associated with less significant corneal nerve disruption, potentially reducing dry eye symptoms in the first 3-6 months. LALEX’s flapless nature eliminates the risks of flap complications, making it a safer option for individuals engaged in combat sports.

LALEX (SMILE) is considered less invasive since it preserves more of the cornea’s structural integrity by avoiding a large flap and minimizing nerve disruption. This results in a lower risk of dry eye symptoms in the short term and maintains more of the cornea’s biomechanical strength. Additionally, LALEX (SMILE) uses only a femtosecond laser, streamlining the procedure and reducing tissue exposure. Its lack of risk for flap-related issues makes LALEX (SMILE) an attractive option for many seeking laser vision correction, especially those involved in physical activities where eye injury is a concern.

Which is better, LASIK or LALEX (SMILE)?

Determining whether LASIK or LALEX (SMILE) surgery is the better option for refractive surgery heavily depends on the individual’s specific needs and circumstances and isn’t a one-size-fits-all answer. Both procedures boast high satisfaction rates and offer significant improvements in correcting refractive errors. LASIK, being the older of the two, is more widely recognized and available, whereas LALEX (SMILE), despite its benefits, might not be offered at all clinics.

When it comes to eligibility, LASIK provides a broader range of correction, including for hyperopia (farsightedness), making it the go-to option for individuals who do not fall within the myopia and astigmatism limits set for LALEX (SMILE). One of the standout advantages of LALEX (SMILE) is its flapless technique, reducing the risks associated with flap creation, such as dry eye syndrome and flap complications. However, this may lead to a marginally longer period for achieving full visual recovery compared to LASIK.

Both LASIK and LALEX (SMILE) reshape the cornea to correct vision, achieving similar long-term outcomes and visual recovery timelines. The choice between LASIK and LALEX (SMILE) should be made in consultation with a refractive surgeon or ophthalmologist, who can offer advice customized to your unique eye structure, refractive error, and personal health.

The decision between LASIK and LALEX (SMILE) boils down to individual suitability. LASIK is generally preferred for correcting farsightedness, while LALEX (SMILE) might be more suitable for those with concerns about dry eyes. It’s important to discuss with a healthcare provider to assess which procedure aligns better with your vision correction needs, considering factors like prescription stability and overall eye health. Consulting with an ophthalmologist is an important step in understanding your candidacy for these procedures and making an informed decision on which path towards less dependence on glasses and contacts is right for you. At Porter Ophthalmology, we take pride in offering both LALEX (SMILE) and LASIK to our patients, ensuring personalized, expert guidance to help you choose the path that’s best suited to your vision needs and lifestyle.

More FAQ’s About LASIK vs. LALEX (SMILE) Eye Surgery

What is the success rate of LASIK vs. LALEX (SMILE)?

At Porter Ophthalmology, both LASIK and SMILE surgeries boast high success rates, closely aligning with national averages. Success is measured not just in 20/20 vision outcomes but in patient satisfaction, which is consistently high for both procedures. The specific success rate can vary based on individual factors, including the extent of refractive error and corneal anatomy.

Can LASIK or LALEX (SMILE) correct presbyopia?

Currently, LALEX (SMILE) is not used to correct presbyopia directly, a condition most commonly affecting those over 40 and characterized by difficulty focusing on close objects. Porter Ophthalmology explores all available options with patients experiencing presbyopia, including blended vision LASIK, where one eye favors distance and the other favors near vision, and Lens Replacement.

Is recovery faster with LASIK or LALEX (SMILE)?

Patients at Porter Ophthalmology often find that recovery from LALEX (SMILE) can be slightly faster, with less discomfort immediately post-surgery. However, both LASIK and LALEX (SMILE) patients typically resume normal activities within a few days. The exact recovery timeline can vary based on individual healing processes and adherence to post-operative care instructions.

Are there fewer restrictions after LALEX (SMILE) compared to LASIK?

Given LALEX’s flapless procedure, patients may experience fewer immediate post-operative restrictions, particularly concerning activities that risk flap displacement. Porter Ophthalmology advises all patients on specific post-surgery care to ensure optimal healing, regardless of the chosen procedure.

How does the cost of LASIK compare to LALEX (SMILE) at Porter Ophthalmology?

The cost of LASIK and LALEX (SMILE) varies based on specific treatment plans and patient needs. At Porter Ophthalmology, we strive to provide transparent pricing and offer financing options. Both procedures are equally and competitively priced, reflecting the advanced technology and expertise involved.

Which surgery is better for someone with dry eyes, LASIK or LALEX (SMILE)?

For patients with dry eyes, LALEX (SMILE) may be the preferable option due to its less invasive nature and reduced risk of exacerbating dry eye symptoms in the short term. In the longer term, both procedures have a low risk of discomfort or STODS (Surgical Temporary Ocular Discomfort Syndrome). Porter Ophthalmology conducts thorough pre-operative assessments to advise patients with dry eyes on the best course of action tailored to their condition.

Can I have LASIK after LALEX (SMILE) if I’m not satisfied with the results?

It is technically possible to undergo LASIK after LALEX (SMILE) for retreatment, although such cases are rare due to the high satisfaction rates with LALEX (SMILE). At Porter Ophthalmology, we prioritize thorough pre-surgical evaluations and precise surgical techniques to minimize the need for further interventions.

How long do the results of LASIK and LALEX (SMILE) last?

The results from both LASIK and LALEX (SMILE) surgeries are intended to be permanent. However, it’s important to note that natural changes in the eye related to aging can affect vision over time. Porter Ophthalmology provides comprehensive follow-up care to monitor and address any long-term vision changes.

Are LASIK or LALEX (SMILE) procedures painful?

Patients at Porter Ophthalmology report minimal discomfort during both LASIK and LALEX (SMILE) procedures, thanks to numbing drops applied to the eyes. Some may experience slight pressure or a sensation of light touch, but the procedures are generally painless.

Which is more suitable for high myopia, LASIK or LALEX (SMILE)?

LALEX (SMILE) is often recommended for patients with high myopia due to its ability to correct significant nearsightedness while maintaining corneal structural integrity. However, Porter Ophthalmology evaluates each patient’s specific condition and vision goals to determine the most suitable procedure, whether LASIK, LALEX (SMILE), or EVO.

Can LALEX (SMILE) or LASIK correct far-sightedness and near-sightedness?

Both LASIK and LALEX (SMILE) are primarily known for correcting near-sightedness (myopia) with great success. LASIK can also correct far-sightedness (hyperopia), offering a broader range of correction. Our team at Porter Ophthalmology utilizes advanced technology, including the excimer laser for LASIK, to precisely reshape the curvature of the cornea, addressing the refractive errors that lead to blurred vision and cause dependence on a corrective lens.

How do LASIK and LALES (SMILE) surgeries affect visual perception?

LASIK and LALEX (SMILE) surgeries enhance visual perception by correcting aberrations of the eye. LASIK employs an excimer laser to reshape the cornea’s surface, while LALES (SMILE) involves creating a small surgical incision in the stroma of the cornea to remove tissue and adjust its curvature. Both procedures aim to sharpen visual acuity, with results typically leading to significantly improved vision.

What should contact lens wearers consider before undergoing LASIK or LALEX (SMILE)?

Contact lens wearers need to switch to wearing glasses for a period before undergoing LASIK or LALEX (SMILE) to ensure the cornea returns to its natural shape. This is critical for obtaining accurate measurements of the cornea’s curvature and thickness, which are essential for a successful outcome. The team at Porter Ophthalmology will provide personalized advice based on your optometry history and specific needs.

Are LASIK and LALEX (SMILE) considered minimally invasive procedures?

Yes, both LASIK and LALEX (SMILE) are considered minimally invasive procedures. LASIK involves creating a thin flap on the cornea’s surface, while LALEX (SMILE) requires only a small keyhole incision. These techniques significantly reduce the risk of complications such as infection and inflammation, making them alternatives to other corrective surgeries like photorefractive keratectomy (PRK).

How does diabetes affect eligibility for LASIK or LALEX (SMILE) surgery?

Patients with diabetes must manage their condition and maintain stable blood sugar levels to be considered for LASIK or LALEX (SMILE) surgeries. Uncontrolled diabetes can lead to fluctuations in vision, increased risk of infection, and slower healing. Porter Ophthalmology conducts thorough assessments to determine if laser vision correction is safe and beneficial for patients with diabetes.

What is the role of clinical trials in the development of LASIK and LALEX (SMILE)?

Clinical trials have been instrumental in the development and refinement of LASIK and LALEX (SMILE) surgeries. These trials have provided valuable information on the safety, efficacy, and potential risks of each procedure, leading to advancements like the introduction of mode locking in lasers for more precise corneal reshaping. Porter Ophthalmology stays abreast of the latest clinical trial outcomes to offer the most effective treatment options.

Will insurance cover LASIK or SMILE surgery?

Most insurance plans consider LASIK and LALEX (SMILE) optional procedures and do not cover them. However, some insurance policies may offer discounts or have partnerships with specific providers. We recommend patients check with their insurance provider for any available benefits and discuss financing options with the staff at Porter Ophthalmology.

Can LASIK or LALEX (SMILE) correct diopter ranges associated with severe myopia or hyperopia?

LASIK can address a wide range of diopters, making it suitable for patients with mild to severe myopia or hyperopia, as well as astigmatism. SMILE is primarily used for myopia, including cases of high near-sightedness. During your consultation at Porter Ophthalmology, we will assess your specific diopter range and recommend the most appropriate procedure for your refractive error.