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Laser Eye Surgery: LASIK vs LASEK vs PRK vs SMILE, Which Is Right for You?
LASIK, LASEK, PRK and SMILE are all laser eye surgery that reshapes the cornea. They differ in how the surgeon reaches the tissue: LASIK lifts a flap, LASEK and PRK treat the surface, and SMILE removes a small disc through a keyhole. Corneal thickness, dry eyes, prescription and lifestyle decide which suits you. At Laser Istanbul Clinic, Prof. Dr. Ahmet Satıcı and Op. Dr. Aysan Bayram lead laser surgery.
What is the difference between LASIK, LASEK, PRK and SMILE?
All four operations correct short-sightedness and astigmatism by changing the shape of the cornea, the clear window at the front of the eye. The NHS describes laser eye surgery as using a laser "to alter the shape of the outer layer of your eye (cornea)". The real difference is the route the surgeon takes to the tissue that needs reshaping.
| LASIK (Femto-LASIK) | LASEK | PRK (including no-touch) | SMILE (SMILE Pro) | |
|---|---|---|---|---|
| Route to the tissue | A thin flap is made, lifted and folded back | The surface cell layer is loosened with a dilute alcohol solution and moved aside as a sheet | The surface cell layer is removed | A small disc of tissue is removed through a keyhole tunnel of about 2–3 mm |
| Flap | Yes | A flap of surface cells only, put back afterwards | None | None |
| Laser | Excimer laser, plus a femtosecond laser or blade to make the flap | Excimer laser | Excimer laser | Femtosecond laser only |
| Healing | The flap reattaches by itself | Surface cells regrow under a bandage lens (about 3–4 days) | Surface cells regrow; bandage lens out at about day 4–5 | Small incision heals; no surface layer removed |
Sources: American Academy of Ophthalmology (AAO) LASIK overview; EyeWiki (PRK, LASEK, SMILE); AAO Young Ophthalmologists' introduction to SMILE. See Sources.
How does LASIK work, and who is it for?
LASIK is the best-known laser operation. The AAO explains that the surgeon makes "a paper-thin flap in the cornea tissue" with a microkeratome (a blade device) or a laser, lifts it, reshapes the tissue underneath with the laser and lays the flap back, where it reattaches on its own within two to three minutes. "Femto-LASIK", also called blade-free LASIK, means the flap is made by a femtosecond laser instead of a blade.
Why people choose it: visual recovery is the quickest of the four, and it treats short-sightedness, long-sightedness and astigmatism. The AAO says about 9 in 10 people who have LASIK end up with vision between 20/20 and 20/40 without glasses or contact lenses.
What to weigh up:
- The flap. Problems with the flap during surgery are uncommon but have been reported in 0.7% to 6.6% of cases in older series (EyeWiki). Late injuries are rare: published case reports describe a flap knocked out of place by a direct blow years after surgery. One surgeon writes that with femtosecond flaps the risk is "exceedingly low", while others prefer a surface treatment for people who are hit in the face through sport or work.
- Dry eye. Cutting the flap divides corneal nerves, and dry eye is the most common side effect. EyeWiki, the AAO's clinical encyclopedia, reports that 60–70% of people have signs of dry eye early on after LASIK. Most improve over the following months.
- Thickness. LASIK removes tissue from under the flap, and a thin remaining bed raises the risk of the cornea weakening and bulging (ectasia). EyeWiki lists a residual bed below roughly 250–300 µm as a major risk factor, along with abnormal corneal maps, high myopia (short-sightedness) and young age.
Overall safety: in a large contemporary series of 61,833 LASIK eyes, reported by EyeWiki, the total rate of adverse events was 1.3%, and serious adverse events occurred in 0.4%.
Who the AAO says LASIK is not for: people with an unstable prescription, severe dry eye, thin corneas, corneal disease such as keratoconus, advanced glaucoma, cataracts affecting vision or poorly controlled diabetes. You should be at least 18 (ideally over 21), with a stable prescription for at least a year.
LASIK vs LASEK: what is the difference?
LASEK and PRK both work on the surface of the cornea, so neither needs a flap of corneal tissue. In PRK, the surgeon removes the thin surface layer (the epithelium) and the laser reshapes the cornea beneath it. In LASEK, the surgeon soaks the surface layer in a dilute alcohol solution (18–20%, according to EyeWiki), pushes it aside as a single sheet, applies the laser and lays the sheet back over the cornea under a bandage contact lens for about 3 to 4 days.
So the question behind "LASEK or LASIK surgery" is mostly flap or no flap:
| LASIK | LASEK / PRK | |
|---|---|---|
| Vision in the first days | The quickest recovery of the four | Blurred while the surface heals; for PRK, EyeWiki gives initial vision of about 20/30 to 20/50 |
| Discomfort | Scratchy or burning for a few hours (AAO) | Mild to moderate; for PRK, worst on days 2–3 |
| Time to settle | Dryness and fluctuating vision usually fade within a month (AAO) | PRK: 3–6 months; LASEK: about 60 days |
| Dry eye at 6 months | Higher in one 2023 study (mean score 1.07) | Lower (0.78 for PRK, 0.82 for LASEK, same scale) |
| Flap risks | Yes | None |
| Thin or unusual corneas | May be unsuitable | Often preferred |
| Surface haze | Not applicable | Possible; steroid drops are usually used for up to about 4 months after PRK to reduce it |
On the evidence, neither is simply "better". EyeWiki reports a matched comparison of 122 LASEK and 122 LASIK eyes in which the visual and refractive differences were "not clinically significant", and a meta-analysis that found no difference between PRK and LASIK for myopia from 0 to −9.0 D. For high myopia, one comparison found LASIK ahead: 83% of LASIK eyes reached 20/25, against 76% of LASEK eyes.
Pain after LASEK is also debated. One study found lower pain and haze scores with LASEK than with PRK; another found less discomfort with PRK. At Laser Istanbul Clinic our surface options are PRK and no-touch laser (Trans-PRK), where the laser also removes the surface layer, so nothing touches the eye. Your surgeon explains which suits you.
How does SMILE work?
SMILE (small incision lenticule extraction) uses a single femtosecond laser to shape a thin disc of tissue, called a lenticule, inside the cornea. The surgeon then removes it through a tunnel of about 2–3 mm, with no flap and no excimer laser. The AAO's description is that "microforceps remove the lenticule without the need to debride corneal epithelium or to create a flap". Removing the disc flattens the cornea and corrects the prescription.
Why people choose it:
- Less dry eye. In a meta-analysis of six studies (291 SMILE and 277 Femto-LASIK eyes), symptom scores were lower after SMILE at every time point, and returned to baseline by 6 months only after SMILE. EyeWiki adds that at 6 months, 80% of SMILE patients had stopped all eye drops, against 57% of LASIK patients.
- Corneal strength. In a 2022 study of 227 patients, the cornea lost the most stiffness after Femto-LASIK, less after SMILE and least after no-touch PRK, with similar tissue removed. EyeWiki describes SMILE as better than LASIK and comparable to PRK at preserving corneal strength. The AAO's young ophthalmologists' guide adds that this "presumed biomechanical advantage" allows a thinner remaining corneal bed.
- Easier return to activity. The same guide says patients avoid strenuous activity for about three days after SMILE, against about a month after LASIK or PRK. Your own surgeon's instructions come first.
What to weigh up:
- Range. In the US, SMILE is approved for short-sightedness from −1.00 to −10.00 D with astigmatism up to −3.00 D, and for people aged 22 and over. It is not FDA-approved for long-sightedness. Ask your surgeon which range their laser treats.
- Slower sharpening. Visual recovery takes several days rather than being near-instant, and in one study LASIK had a significantly higher share of eyes reaching 20/20.
- Higher-order aberrations. The AAO notes SMILE cannot treat these subtle optical errors and can potentially worsen ones you already have.
- Enhancements. If a touch-up is ever needed, EyeWiki mentions PRK as the retreatment route.
- Ectasia. Lower than after LASIK but not zero: EyeWiki cites about 0.15%, mostly in people who were already borderline or high-risk for LASIK.
LASIK vs LASEK vs PRK vs SMILE: side-by-side comparison
| Question | LASIK | LASEK | PRK | SMILE |
|---|---|---|---|---|
| Treats short-sightedness | Yes | Yes | Yes | Yes |
| Treats astigmatism | Yes | Yes | Yes | Yes (US label: up to −3.00 D) |
| Treats long-sightedness | Yes | As PRK | Yes | No (not FDA-approved) |
| Flap | Yes | Surface-cell flap | No | No |
| Dry eye | Highest in the studies above | Lower than LASIK | Lower than LASIK | Lower than LASIK |
| Corneal stiffness lost (2022 study) | Most | Not measured separately | Least (no-touch PRK) | In between |
| Thin corneas | Often unsuitable | Often preferred | Often preferred | Needs less remaining bed than LASIK |
| Visual recovery | Quickest | About 60 days to settle | 3–6 months to settle | Several days to sharpen |
| Activity restrictions | About a month | As directed | About a month | About three days |
Compiled from the AAO, EyeWiki (PRK, LASEK, SMILE, LASIK Complications, Refractive Surgery for Hyperopia), the AAO Young Ophthalmologists' guide, Xin et al. 2022 and Yahalomi et al. 2023. Averages are not promises: your recovery depends on your eyes.
Which is best if you have dry eyes?
If dry eye is your main worry, the evidence favours the methods that spare corneal nerves: SMILE or a surface treatment. A 2023 study of 251 eyes found that at 6 months LASIK eyes had a higher mean dry-eye score (1.07) than PRK (0.78) or LASEK (0.82) eyes, and the authors suggested LASIK may not be the best choice for people already prone to dry eye. The SMILE meta-analysis above points the same way. The more important step is to find and treat existing dryness before surgery, which is why your surgeon tests your tear film first.
Which is best for thin corneas, sport or long-sightedness?
Thin or unusual corneas: PRK or no-touch laser. EyeWiki says PRK preserves more corneal tissue, which helps people with thin corneas and unusual corneal shapes.
Contact sport, or a job where your face may be hit: a surface treatment. There is no flap to dislodge. Surgeons differ on how much this matters with modern femtosecond flaps, so talk it through with your surgeon.
Dry-eye-prone and active people: SMILE or a surface laser. Both avoid a flap, and SMILE has the shortest activity restrictions.
Long-sightedness: LASIK or PRK. These are the options that treat it. EyeWiki notes that long-sightedness needs larger treatment zones, can induce more optical aberrations and carries more risk of regression over time, so results are less predictable than for short-sightedness.
A high prescription or thin corneas together: sometimes a lens operation such as an ICL (an implantable lens) suits better than any laser, and your surgeon should say so.
From the mid-40s: lens options become part of the conversation, because your surgeon looks at your near vision as well as your distance vision.
Which gives the best vision, and what are the risks?
For short-sightedness, the result depends more on matching the method to your eye than on the method itself. A meta-analysis cited by EyeWiki found no difference between PRK and LASIK between 0 and −9.0 D, and the AAO reports that about 9 in 10 LASIK patients reach 20/20 to 20/40 without glasses or contacts.
The risks are shared by all four, with different weighting:
- Dry eye, glare, halos and starbursts. These are the usual side effects and are mostly temporary. EyeWiki reports that up to 45% of people with no symptoms before LASIK noted at least one new visual symptom, and the NHS says these problems "will normally improve within a few months". A small number of people keep night-vision symptoms.
- Under- or over-correction. Not everyone gets 20/20. A small leftover prescription may need glasses or a touch-up. The FDA says results are generally poorer for people with large refractive errors.
- Loss of best-corrected vision. Rare: EyeWiki reports a loss of two or more lines of corrected distance vision in 0.37% of LASIK eyes.
- Infection and inflammation. Rare. EyeWiki gives infectious keratitis as about 0.02–0.2% after LASIK.
- Haze after surface laser. Managed with steroid drops (see the table above).
- Limited long-term data. The FDA notes LASIK was first approved in 1998, so there are no multi-decade results, and that dry eye after LASIK "may be permanent" in some people.
No method is risk-free, and no honest surgeon guarantees 20/20.
How long is recovery for each method?
| LASIK | LASEK | PRK | SMILE | |
|---|---|---|---|---|
| Bandage contact lens | No | Yes, about 3–4 days | Yes, out at about day 4–5 | No |
| Hardest days | The first few hours (scratchy or burning) | Not reported in our sources | Days 2–3 (mild to moderate discomfort) | Not reported in our sources |
| Functional vision | Quickest | After the lens comes out | After the lens comes out; 20/30–20/50 at first | After several days |
| Settled | Dryness and fluctuations fade within about a month | About 60 days | 3–6 months | Over several weeks to months (glare and halos keep improving up to 12 months) |
| Strenuous activity | About a month | As directed | About a month | About three days |
From the AAO, EyeWiki and the AAO Young Ophthalmologists' guide. Your surgeon's written instructions override any general figure.
Most patients fly home 1–3 days after laser eye surgery, once their surgeon has checked their eyes. Your surgeon plans the dates with you in advance, because surface treatments need the bandage lens out first.
Laser vs glasses, contact lenses and orthokeratology
Glasses and contact lenses change nothing in the eye, so they carry no surgical risk, but you rely on them every day. Orthokeratology (ortho-k) sits in between: gas-permeable lenses worn overnight gently reshape the front surface of the cornea, so you may see well in the daytime without lenses. It can correct up to about −6.00 D of short-sightedness, and the effect is reversible: the cornea returns to its original shape if you stop wearing the lenses.
Laser is the only one of these that changes the cornea permanently, which is why it is a decision for adults with a stable prescription, and why a careful assessment matters more than the method. People often consider laser because contact lenses have become uncomfortable. If lenses make your eyes dry, tell your surgeon: dryness from contact lens wear is not the same as dry eye disease, and the pre-operative tests help to tell them apart.
"Laser vs LASIK" is a common search, but LASIK is itself a laser operation. The useful comparison is between the four methods in this guide.
How does your surgeon choose the right laser treatment?
The method is chosen from your measurements, not from a fixed preference. At Laser Istanbul Clinic the examination before surgery includes scans of your corneal shape and thickness, a check of your tear film and eyelids, your pupil size and your exact prescription. Laser surgery is led by Prof. Dr. Ahmet Satıcı and Op. Dr. Aysan Bayram, and your surgeon explains why a method is, or is not, recommended for you.
Typical reasoning:
Is your cornea healthy and thick enough?
If there are signs of keratoconus or a very thin cornea, laser may not be advised at all, and a lens operation may suit you better.
Do you have dry eyes?
They are treated first; then SMILE or a surface laser may be preferred.
Are you short-sighted, long-sighted or astigmatic?
Long-sightedness points to LASIK or PRK.
Do you play contact sport, or does your work risk your eyes?
A surface treatment may be preferred.
How do you want to recover?
Quick comfort and sight (LASIK, SMILE) or a few harder days (PRK).
How old are you?
From the mid-40s, lens options deserve a conversation.
Your surgeon recommends a method after the examination, never before it. Our laser options are Femto-LASIK, SMILE Pro, PRK and no-touch laser.
How much do LASIK, LASEK, PRK and SMILE cost?
At Laser Istanbul Clinic, laser treatment starts from {{price}} for both eyes. Where methods differ in price, your written quote lists each: {{price: Femto-LASIK}} · {{price: PRK / no-touch}} · {{price: SMILE Pro}}. The method you are offered is the one that suits your eyes, not the cheapest.
Included in your price: examination and scans before surgery, surgery by your named surgeon, medication, follow-up checks in Istanbul, a personal interpreter, and a coordinator with remote follow-up after you go home. Not included: flights, and hotel and airport transfers, which are a separate charge arranged on request.
Whichever clinic you compare, whether for "LASEK vs LASIK price" or SMILE, ask for a written quote that shows what is included and what is not, and which surgeon will operate.
Frequently asked questions
Neither is better for everyone. LASIK gives the quickest recovery; LASEK and PRK use no tissue flap, are often chosen for thin corneas, but take longer to settle. For short-sightedness, a matched comparison of 122 LASEK and 122 LASIK eyes found the differences not clinically significant.
LASIK lifts a flap of corneal tissue and reshapes the tissue underneath. LASEK loosens only the thin surface cell layer with a dilute alcohol solution, moves it aside, applies the laser and lays the cells back under a bandage lens. LASEK leaves no tissue flap, but vision takes longer to recover.
They are close relatives. Both treat the surface of the cornea with a laser and both use a bandage lens while the surface heals. In PRK the surface layer is removed; in LASEK it is moved aside and put back. Studies disagree on which is more comfortable.
SMILE has the best evidence for less dry eye than LASIK, and in one 2023 study PRK and LASEK also did better than LASIK at 6 months. Whichever method you choose, existing dry eye should be treated before surgery.
PRK or no-touch laser is usually preferred, because it preserves more corneal tissue than a flap does. Your surgeon measures your corneal thickness and shape before recommending any method, and may advise against laser altogether.
LASIK gives the quickest visual recovery. SMILE takes a few days to sharpen but has the shortest activity restrictions (about three days, against about a month for LASIK or PRK). PRK takes longest: discomfort is worst on days 2–3 and vision settles over 3–6 months.
Not in the US, where SMILE is approved only for short-sightedness and astigmatism. LASIK and PRK treat long-sightedness, though results are less predictable than for short-sightedness.
It depends on what matters to you. Laser permanently reshapes the cornea and removes the daily routine of lenses, but it carries rare risks that glasses and contact lenses do not. Ortho-k lenses, worn overnight, are reversible. Your surgeon can help you weigh these up after an examination.
Yes. Most patients fly 1–3 days after laser eye surgery, once their surgeon has checked their eyes. Your coordinator and surgeon then follow your recovery remotely, by video, at agreed intervals.
Not sure which laser treatment suits your eyes?
Send your prescription and scans, and a surgeon at Laser Istanbul Clinic tells you honestly whether LASIK, SMILE Pro, PRK or no laser at all suits your eyes. Laser surgery is led by Prof. Dr. Ahmet Satıcı and Op. Dr. Aysan Bayram.
Sources for the facts on this page
- Each page below was opened and checked on 7 Oct 2026.
- American Academy of Ophthalmology (AAO). LASIK — Laser Eye Surgery (how LASIK works, candidacy, 9 in 10 at 20/20–20/40). https://www.aao.org/eye-health/treatments/lasik
- AAO. Facts About LASIK Complications (side effects mostly temporary). https://www.aao.org/eye-health/treatments/facts-about-lasik-complications
- EyeWiki (AAO). Photorefractive Keratectomy (PRK recovery timeline, thin corneas, haze, nerve recovery). https://eyewiki.org/Photorefractive_Keratectomy
- EyeWiki (AAO). LASEK (alcohol solution, epithelial flap, comparisons with PRK and LASIK, 83% vs 76%). https://eyewiki.org/LASEK
- EyeWiki (AAO). Small Incision Lenticule Extraction (SMILE) (tunnel, dry eye, biomechanics, ectasia 0.15%, retreatment). https://eyewiki.org/Small_Incision_Lenticule_Extraction_(SMILE)
- EyeWiki (AAO). LASIK Complications (61,833 eyes; ectasia risk factors; dry eye 60–70%; visual symptoms). https://eyewiki.org/LASIK_Complications
- EyeWiki (AAO). Refractive Surgery for Hyperopia (LASIK and PRK treat hyperopia; SMILE not FDA-approved for it; regression). https://eyewiki.org/Refractive_Surgery_for_Hyperopia
- AAO Young Ophthalmologists. Introduction to SMILE (range −1.00 to −10.00 D, astigmatism up to −3.00 D, activity restriction, higher-order aberrations, US approval 2016). https://aao.org/young-ophthalmologists/yo-info/article/introduction-to-smile
- NHS. Laser eye surgery and lens surgery (laser reshapes the cornea; side effects normally improve within a few months). https://www.nhs.uk/tests-and-treatments/laser-eye-surgery-and-lens-surgery/
- US Food and Drug Administration. LASIK: What are the risks and how can I find the right doctor for me? (poorer results with large errors; dry eye may be permanent; approved 1998). https://www.fda.gov/medical-devices/lasik/what-are-risks-and-how-can-i-find-right-doctor-me
- Shen Z, et al. Dry Eye after Small Incision Lenticule Extraction (SMILE) versus Femtosecond Laser-Assisted in Situ Keratomileusis (FS-LASIK) for Myopia: A Meta-Analysis. PLoS One 2016. https://pmc.ncbi.nlm.nih.gov/articles/PMC5161410/
- Yahalomi T, et al. Dry Eye Disease following LASIK, PRK, and LASEK: An Observational Cross-Sectional Study. Journal of Clinical Medicine 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10253504/
- Xin Y, et al. Biomechanical Effects of tPRK, FS-LASIK, and SMILE on the Cornea. Frontiers in Bioengineering and Biotechnology 2022. https://www.frontiersin.org/journals/bioengineering-and-biotechnology/articles/10.3389/fbioe.2022.834270/full
- Stonecipher KG, Soni M, Likins B. Traumatic Flap Dislocation After Laser Vision Correction. CRSToday 2022. https://crstoday.com/topics/refractive-surgery/traumatic-flap-dislocation-after-laser-vision-correction/44624/
- Heiting G (OD). Ortho-K and Corneal Reshaping Therapy: Overnight Contacts to Correct Myopia. AllAboutVision, 2019 (optometrist-authored consumer source, used for the one ortho-k paragraph; swap for an AAO or NHS page if you prefer). https://www.allaboutvision.com/eyewear/contact-lenses/conditions/orthok-contacts/