LASIK vs PRK vs SMILE vs ICL: Which Procedure Is Right for You?

If you're considering vision correction surgery, you've probably heard of LASIK — but it's not your only option. Four main procedures can correct refractive errors, each with distinct advantages and limitations. Understanding the differences helps you have a productive conversation with your surgeon about what's best for your specific eyes and lifestyle.

How These Procedures Work

All four procedures aim to correct how light focuses on your retina. They achieve this in different ways:

LASIK: Create Flap, Reshape, Replace

LASIK (Laser-Assisted In Situ Keratomileusis) is the most well-known vision correction procedure. Here's how it works:

1. A femtosecond laser creates a thin flap in the cornea (about 100-120 microns thick)
2. The surgeon lifts the flap to expose the underlying corneal tissue
3. An excimer laser reshapes the cornea by removing microscopic amounts of tissue
4. The flap is repositioned and naturally adheres — no stitches needed

The entire procedure takes about 15 minutes for both eyes. Vision improvement is noticeable within hours.

PRK: Remove Surface, Reshape, Regrow

PRK (Photorefractive Keratectomy) was the original laser vision correction procedure, predating LASIK by about 10 years:

1. The surgeon removes the epithelium (outermost layer of the cornea) either manually or with a diluted alcohol solution
2. The same excimer laser used in LASIK reshapes the cornea
3. A bandage contact lens is placed to protect the eye
4. The epithelium regenerates naturally over 3-5 days

Because no flap is created, PRK eliminates flap-related complications but requires longer healing time.

SMILE: Small Incision, Lens Removal

SMILE (Small Incision Lenticule Extraction) is the newest laser procedure:

1. A femtosecond laser creates a small lens-shaped piece of tissue (lenticule) within the cornea
2. The same laser creates a tiny 2-4mm incision
3. The surgeon removes the lenticule through the small incision
4. Removing the lenticule changes the cornea's shape, correcting vision

No flap is created, preserving more corneal nerves and potentially reducing dry eye issues.

ICL: Implant a Permanent Lens

ICL (Implantable Collamer Lens) takes a completely different approach — instead of reshaping the cornea, it adds a lens inside the eye:

1. A tiny incision (about 3mm) is made in the cornea
2. A foldable lens made of biocompatible collagen polymer is inserted
3. The lens unfolds and is positioned between the iris and natural lens
4. The incision self-seals — no stitches needed

Think of it as a permanent contact lens that never needs to be removed or cleaned. Importantly, ICL is completely reversible — the lens can be removed or exchanged if needed.

Complete Comparison Table

Deep Dive: LASIK

LASIK remains the most popular refractive surgery, with over 40 million procedures performed worldwide. Its popularity comes from the combination of quick recovery and excellent outcomes.

LASIK Pros

• Fastest recovery: Most patients see clearly within 24 hours
• Minimal discomfort: Less painful than PRK during healing
• Proven track record: Decades of data on long-term outcomes
• Treats all refractive errors: Myopia, hyperopia, and astigmatism
• Lowest cost: Most affordable laser option in Colombia

LASIK Cons

• Flap-related risks: Although rare (<1%), flap complications can occur
• Dry eye: More corneal nerves are cut, potentially causing more dry eye than SMILE
• Not for thin corneas: Requires minimum 500 microns (after flap creation)
• Caution with contact sports: Theoretical risk of flap dislocation from direct trauma

LASIK Is Best For

Patients with mild-to-moderate myopia (-1.00 to -8.00D), adequate corneal thickness, and no severe dry eye issues. Ideal for people who want the fastest possible recovery and can avoid contact sports or activities with high risk of eye trauma.

Deep Dive: PRK

PRK was the original laser vision correction procedure, first performed in 1987. While LASIK overtook it in popularity, PRK remains the preferred choice for certain patients.

PRK Pros

• No flap: Eliminates all flap-related complications
• Safe for thinner corneas: Can treat patients who don't qualify for LASIK
• Better for active lifestyles: No flap to worry about with contact sports
• Military/pilot approved: Often required by armed forces
• Same long-term outcomes: Results are equivalent to LASIK after healing

PRK Cons

• Longer recovery: 1-2 weeks for clear vision; 3-6 months for stability
• More discomfort: First 3-5 days are more painful than LASIK
• Haze risk: Rare corneal haze can occur during healing (reduced with modern techniques)
• More follow-up visits: Requires closer monitoring during recovery

PRK Is Best For

Patients with thin corneas (under 500 microns), those in military or law enforcement, contact sports athletes (boxing, MMA, basketball), and anyone concerned about flap complications. Also often chosen for enhancement procedures after previous LASIK.

Deep Dive: SMILE

SMILE (Small Incision Lenticule Extraction) was FDA-approved in 2016 and represents the newest advancement in laser vision correction. It's growing in popularity due to its minimally invasive nature.

SMILE Pros

• Minimally invasive: 80% smaller incision than LASIK (2-4mm vs 20mm)
• Less dry eye: Preserves more corneal nerves
• No flap: Greater corneal stability post-surgery
• Quick recovery: Similar to LASIK (24-48 hours)
• Single laser: Only femtosecond laser needed (no excimer)

SMILE Cons

• Myopia/astigmatism only: Cannot treat farsightedness (hyperopia)
• Higher cost: Newer technology means higher prices
• Less enhancement flexibility: Enhancements more complex than LASIK
• Less widespread: Fewer surgeons experienced with technique
• Newer technology: Less long-term data (though outcomes look excellent)

SMILE Is Best For

Patients with myopia and/or astigmatism who are prone to dry eyes, want a minimally invasive procedure, or prefer a flapless option. Particularly good for athletes and those with active lifestyles. Not suitable for farsighted patients.

In Colombia: Instituto de Córnea in Bogotá has the ZEISS VisuMax 800 — the most advanced platform for SMILE procedures.

Deep Dive: ICL

ICL (Implantable Collamer Lens) takes a fundamentally different approach. Rather than reshaping the cornea, it adds a lens inside the eye — essentially a permanent contact lens that never needs to be removed.

ICL Pros

• Highest prescriptions: Treats myopia up to -20D (beyond laser range)
• No corneal tissue removed: Preserves natural corneal anatomy
• Reversible: Lens can be removed or exchanged if needed
• Excellent optics: Often provides sharper vision than laser procedures
• Safe for thin corneas: No minimum corneal thickness required
• Lowest dry eye risk: Corneal nerves are not affected
• Fastest visual recovery: Many patients see clearly same day

ICL Cons

• Highest cost: Most expensive vision correction option
• Intraocular surgery: Lens is placed inside the eye (slightly higher risk profile)
• Age limitations: Best for ages 21-45 (lens must fit properly)
• Potential for cataract: Small risk of early cataract development
• Requires specific anatomy: Adequate anterior chamber depth needed
• Follow-up monitoring: Annual eye exams recommended for life

ICL Is Best For

Patients with high myopia (-6.00 to -20.00D) beyond LASIK's correction range, thin corneas that can't safely undergo laser procedures, severe dry eye that would worsen with laser surgery, or anyone who wants a reversible option. Also excellent for patients who want the sharpest possible vision quality.

Candidacy Requirements Summary

Not everyone qualifies for every procedure. Here's a quick reference:

What If You're Not a Candidate?

Approximately 15-20% of people who seek LASIK aren't ideal candidates. Common reasons include:

• Thin corneas: Consider PRK or ICL instead
• High prescription: ICL can treat up to -20D
• Severe dry eye: May improve with treatment; ICL is gentlest option
• Unstable prescription: Wait until stable for 1-2 years
• Keratoconus: May need corneal cross-linking first; ICL possible after

A thorough pre-operative evaluation will identify which procedures you qualify for. Reputable clinics will be honest about your options — even if that means recommending a procedure they don't offer or advising against surgery altogether.

The Bottom Line

There's no single "best" vision correction procedure — the right choice depends on your prescription, eye anatomy, lifestyle, and personal preferences.

LASIK offers the fastest recovery and lowest cost, making it the go-to choice for most candidates.

PRK sacrifices quick recovery for greater corneal stability, ideal for thin corneas and active lifestyles.

SMILE provides LASIK-like recovery with less dry eye risk, but only treats myopia and astigmatism.

ICL is the premium option for high prescriptions and thin corneas, offering reversibility and excellent visual quality at higher cost.

The best way to determine your options is a comprehensive eye evaluation. A qualified surgeon will assess your corneal thickness, prescription, tear film, pupil size, and other factors to recommend the procedure most likely to give you excellent results.