PRK vs LASIK vs SMILE – Which One Is Right for You?

Refractive surgeries like PRK, LASIK, and SMILE have transformed vision correction, offering an alternative to glasses and contact lenses. Each procedure has unique advantages and considerations, making it essential for patients to understand their differences before deciding on the most suitable option. In this comprehensive guide, we will explore how each surgery works, their benefits, risks, recovery times, and costs to help you make an informed decision.

Understanding PRK, LASIK, and SMILE

Refractive surgeries work by reshaping the cornea to correct vision problems such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. While all three surgeries achieve the same goal, their methods differ significantly.

What is PRK Eye Surgery?

Photorefractive Keratectomy (PRK) is the earliest form of laser vision correction, developed before LASIK and SMILE. Unlike LASIK, PRK does not involve creating a corneal flap. Instead, the outermost layer of the cornea, known as the epithelium, is completely removed, allowing an excimer laser to reshape the underlying corneal tissue.

Key Features of PRK:

• No corneal flap, reducing flap-related complications.
• Suitable for patients with thin corneas.
• Longer healing period compared to LASIK and SMILE.
• Increased postoperative discomfort but lower risk of corneal weakening.

PRK Procedure

1. The eye is numbed using anaesthetic eye drops.
2. The epithelium is removed using an alcohol solution, laser, or a blunt surgical instrument.
3. An excimer laser reshapes the corneal tissue to correct vision errors.
4. A protective contact lens is placed on the eye to aid healing.
5. The epithelium regenerates over the next few days, leading to gradual vision improvement.

What is LASIK Eye Surgery?

Laser-Assisted In Situ Keratomileusis (LASIK) is one of the most commonly performed laser vision correction surgeries.

Key Features of LASIK:

• Faster recovery time, with most patients achieving clear vision within 24 hours.
• Minimal discomfort during and after the procedure.
• Increased risk of flap complications if the eye is injured post-surgery.
• Higher risk of dry eyes compared to PRK and SMILE.

LASIK Procedure

1. The eye is numbed with anaesthetic drops.
2. A femtosecond laser or microkeratome creates a thin flap on the cornea.
3. The flap is lifted, and an excimer laser reshapes the corneal tissue.
4. The flap is repositioned, and it naturally adheres without stitches.
5. Most patients experience improved vision within a day.

What is SMILE Eye Surgery?

Small Incision Lenticule Extraction (SMILE) is a newer, minimally invasive laser eye surgery designed primarily for myopia correction. Instead of creating a corneal flap, a femtosecond laser creates a small disc of tissue (lenticule) within the cornea, which is then extracted through a tiny incision.

Key Features of SMILE:

• No corneal flap, reducing the risk of flap-related complications.
• Minimal postoperative discomfort.
• Lower risk of dry eye syndrome compared to LASIK.
• Limited ability to correct high astigmatism compared to LASIK.

SMILE Procedure

1. The eye is numbed with anaesthetic drops.
2. A femtosecond laser creates a small lenticule within the cornea.
3. A tiny incision is made, and the lenticule is extracted.
4. The cornea reshapes itself as the lenticule is removed.
5. Vision improves within a few days, with minimal discomfort.

Learn more about LASIK, PRK, SMILE and How They Work.

Differences Between PRK, LASIK, and SMILE

Feature	PRK	LASIK	SMILE
Flap Creation	No flap	Thin corneal flap	No flap
Invasiveness	More invasive	Moderate	Least invasive
Healing Time	Longer (weeks)	Faster (days)	Fast (few days)
Discomfort Level	Higher	Moderate	Minimal
Suitability	Thin corneas, active lifestyles	Most common eligibility	Mild to moderate myopia
Dry Eye Risk	Moderate	Higher	Lower
Corneal Strength	Stronger post-surgery	Weaker due to flap	Stronger post-surgery

Pros and Cons of Each Procedure

PRK

Pros:

• No risk of flap complications: Since PRK does not involve creating a corneal flap, it eliminates the possibility of flap-related issues such as displacement or incomplete healing.
• Suitable for thin corneas: Patients with thinner corneas who are not eligible for LASIK can often undergo PRK safely.
• Stronger corneal integrity post-surgery: Because PRK does not weaken the cornea with a flap, it maintains better long-term structural stability.

Cons:

• Longer healing process: Vision may take several weeks to stabilize, requiring patients to be patient with their recovery.
• More discomfort during recovery: Removing the epithelium results in moderate to severe discomfort, requiring pain management and extended rest.

LASIK

Pros:

• Quick recovery: Most patients experience significant vision improvement within a day or two, making LASIK a convenient option for those with busy lifestyles.
• Minimal discomfort: The corneal flap reduces healing time and postoperative pain compared to PRK.
• Widely available and performed: LASIK is the most commonly performed refractive surgery, meaning more surgeons are experienced in the procedure.

Cons:

• Risk of flap displacement: Trauma to the eye post-surgery can lead to complications due to the corneal flap.
• Higher chance of dry eyes: Because the flap may disrupt corneal nerves, some patients experience prolonged dry eye symptoms.

SMILE

Pros:

• Less invasive, no flap creation: The absence of a corneal flap minimizes the risk of flap-related complications.
• Minimal postoperative discomfort: Patients typically report less irritation and faster initial healing.
• Lower dry eye risk: Since SMILE preserves more corneal nerves, the likelihood of dry eyes is reduced.

Cons:

• Limited suitability: SMILE is primarily effective for myopia and mild astigmatism, but it does not address hyperopia.
• Fewer surgeons perform SMILE: Since it is a relatively new procedure, fewer clinics offer it compared to LASIK.

Conclusion

PRK, LASIK, and SMILE each offer unique benefits and limitations. Those with thin corneas or active lifestyles may benefit from PRK, while LASIK remains the most popular choice for its quick recovery. SMILE, as a minimally invasive option, is gaining popularity for those seeking a lower risk of dry eyes. A consultation with an ophthalmologist is necessary to determine the best procedure based on individual eye health and lifestyle factors.

Take the first step toward a hassle-free life without glasses or contacts. Schedule Your Consultation!

FAQs