Dr. Griffiths is a well credentialed and an excellent physician. Her staff are pleasant and professional. The office runs like a well-oiled machine. Kudos to them for providing such excellent care.
Holly Horn
LASIK vs. SMILE: Which Laser Vision Correction Is Right for You?
Who Is a Good Candidate?
Not everyone is a candidate for laser vision correction, and the right procedure depends on your eye health, prescription, corneal anatomy, and lifestyle. A thorough evaluation helps us determine which option, if either, is the safest and most effective choice for your eyes.
LASIK can correct nearsightedness (difficulty seeing far away), farsightedness (difficulty seeing up close), and astigmatism (blurred vision at all distances) across a wide range of prescriptions. SMILE is currently FDA-approved for nearsightedness and mild to moderate astigmatism, making LASIK the more versatile option for higher or more complex prescriptions.
Your eyes need to be in good overall health before we can proceed with either procedure. Conditions that may affect your eligibility or require treatment beforehand include the following.
- Active eye infections or inflammation
- Significant dry eye disease
- Keratoconus or other corneal irregularities
- Cataracts, glaucoma, or other structural eye conditions
- Corneas that are too thin to safely reshape
If any of these concerns are present, we discuss them openly and may recommend alternative treatments or preparatory care before surgery.
We generally recommend that patients be at least 18 years old, though waiting until your early to mid-twenties can be beneficial because your prescription is more likely to have stabilized. Your glasses or contact lens prescription should not have changed significantly for at least one year before surgery.
Corneal thickness is one of the most critical measurements we take. There must be enough tissue to safely reshape your cornea and still maintain its structural integrity. If your corneas are too thin, we may recommend a surface-based alternative such as PRK or EpiLase instead.
Your daily activities can influence which procedure we recommend. If you participate in contact sports, serve in the military, or work in environments where eye trauma is possible, SMILE may be a better fit because the absence of a flap reduces the risk of flap-related injury years after surgery.
If your prescription requires correction for both nearsightedness and farsightedness, or if it falls outside the current range for SMILE, LASIK offers greater flexibility. We discuss your lifestyle in detail during your consultation to match you with the safest, most appropriate option.
Certain systemic health conditions can affect how your eyes heal. Autoimmune diseases such as lupus or rheumatoid arthritis, poorly controlled diabetes, and conditions that suppress your immune system may increase surgical risk. Pregnancy and breastfeeding can also temporarily alter corneal shape and prescription, so we typically recommend waiting until after this period before scheduling surgery.
Your Evaluation and What Happens on Surgery Day
Before recommending any procedure, we perform a comprehensive pre-operative evaluation. This process ensures we have everything we need to plan a safe, precise treatment tailored to your eyes.
Your evaluation includes a full vision assessment with and without corrective lenses, measurement of eye pressure, and an examination of your retina and optic nerve. We also review your medical history and current medications to identify anything that could affect your surgery or recovery.
Advanced imaging technology gives us a highly detailed picture of your cornea before we make any treatment decisions. The measurements we collect include the following.
- Corneal topography to map the shape and curvature of your cornea
- Pachymetry to measure corneal thickness at multiple points
- Wavefront analysis to detect higher-order aberrations, subtle optical imperfections that affect the quality of your vision
- Pupil size measurement to plan the optimal treatment zone
We combine all of your test results, your prescription, your eye health history, and your personal goals to recommend the procedure that best suits you. If your eyes are well within the treatment range for both LASIK and SMILE, we walk you through the advantages and tradeoffs of each option and let your lifestyle and preferences guide the final decision.
On surgery day, we apply numbing eye drops so you will not feel pain. You recline comfortably, and a gentle device holds your eyelids open. A femtosecond laser creates the corneal flap, which is then carefully lifted. You focus on a target light while the excimer laser reshapes your cornea in a matter of seconds. Your LASIK Surgeon then repositions the flap, smooths it into place, and lets it adhere naturally. The entire process typically takes about 10 to 15 minutes per eye.
After numbing drops are applied, you lie under the SMILE laser and a gentle device keeps your eye still. The femtosecond laser creates the lenticule inside your cornea over approximately 25 seconds. Your LASIK Surgeon then uses specialized instruments to carefully separate and remove the lenticule through the small incision. Because there is no flap to reposition, the procedure is complete once the lenticule is removed. SMILE also takes approximately 10 to 15 minutes per eye.
Both procedures are generally painless because of the numbing drops. You may feel mild pressure when the device holds your eye in position. Your vision may dim or blur briefly while the laser is working, which is completely normal and temporary.
Recovery, Aftercare, and Follow-Up Care
Understanding what to expect after surgery helps you recover safely and comfortably. Recovery timelines are similar for both procedures, though there are some important differences in the first few days.
After LASIK, your eyes may feel gritty, watery, or light-sensitive for several hours, but many patients notice noticeably improved vision within the same day. Rest with your eyes closed and limit screen time during this initial period.
After SMILE, you may experience similar sensations, though many patients report less dryness and irritation early on. Vision improvement after SMILE can be slightly more gradual in the first day or two, but discomfort is generally mild and manageable.
Recovery progresses steadily for both procedures, though the pace can vary from person to person.
- LASIK vision is often clear enough to drive within one to two days
- SMILE vision may take a few additional days to reach the same sharpness
- Both procedures typically result in stable vision within one to three months
- Final results can continue to refine for up to six months
We provide protective eye shields to wear while sleeping in the days following surgery to prevent accidental rubbing or pressure on your eyes. Avoid rubbing your eyes, swimming, hot tubs, and heavy eye makeup for at least one to two weeks. Contact sports and activities with a risk of eye trauma require a longer waiting period, which we discuss based on your specific procedure.
Wearing sunglasses outdoors is important during recovery to shield your healing eyes from UV light and wind.
We prescribe antibiotic drops to prevent infection and anti-inflammatory drops to reduce swelling. You will use these several times a day for approximately one week. We also recommend preservative-free artificial tears to keep your eyes moist and support comfortable healing, especially in the first few weeks.
Your first follow-up appointment is usually the day after surgery. We check your vision, examine your cornea, and confirm that healing is on track. Additional visits are typically scheduled at one week, one month, three months, and six months after surgery.
At each visit, we measure your vision, look for any signs of infection or inflammation, and track how your cornea is stabilizing. These appointments are an essential part of achieving the best possible outcome.
Most patients heal without any complications, but it is important to recognize when to contact us right away. Reach out immediately if you experience any of the following.
- Severe pain that does not improve with over-the-counter pain relievers
- Sudden or significant loss of vision
- Heavy discharge or pus from your eye
- Intense redness that is worsening instead of improving
- New floaters, flashes of light, or a shadow in your vision
Side Effects, Risks, and Long-Term Outcomes
Both LASIK and SMILE are safe and well-studied procedures with high patient satisfaction rates. That said, understanding the potential side effects and long-term considerations helps you set realistic expectations and make a fully informed decision.
Temporary dry eye is one of the most common side effects of laser vision correction. LASIK can reduce tear production for a period of time because creating the flap cuts some of the corneal nerves that help regulate moisture. Most patients manage this well with lubricating drops, and symptoms typically improve within weeks to months.
SMILE tends to cause less post-operative dry eye because the smaller incision preserves more corneal nerves. Patients who already experience dry eye symptoms before surgery may benefit from discussing this difference with their LASIK Surgeon during the consultation.
Some patients notice halos, starbursts, or glare around lights at night following surgery. This can occur with both LASIK and SMILE and is related to how the reshaped cornea interacts with light in low-light conditions. For most patients, these symptoms improve as the eyes heal and the brain adapts to the new visual input.
If you have larger pupils, we plan your treatment zone carefully to help minimize the likelihood of night vision disturbances.
Because LASIK creates a corneal flap, there is a small risk of flap-related complications such as minor wrinkles, inflammation under the flap, or, in rare cases, dislodgement from significant eye trauma. These issues are uncommon, particularly when post-operative instructions are followed carefully.
SMILE eliminates flap-related risks entirely, which can be an important consideration for patients with very active lifestyles or occupations involving potential eye contact.
Both procedures carry a low risk of infection, undercorrection, overcorrection, or irregular healing. LASIK has a very small risk of flap-specific complications, while SMILE carries a rare risk of difficulty with lenticule extraction. Our team uses advanced technology and careful surgical planning to minimize all risks for every patient.
Both LASIK and SMILE provide excellent long-term vision outcomes, with high rates of 20/20 vision or better and strong patient satisfaction. Your vision can still change over time due to natural aging. Many patients in their forties develop presbyopia, a gradual loss of near focusing ability that is separate from the original refractive error and is not prevented by laser vision correction.
A small number of patients may benefit from an enhancement procedure to fine-tune their vision. This can occur if your prescription was particularly high, if healing was not as expected, or if your vision changes naturally over time. After LASIK, we can often lift the original flap to perform a secondary treatment. After SMILE, an enhancement may be performed using LASIK or another technique, depending on your remaining corneal thickness. We only recommend enhancements once your vision has fully stabilized.
Frequently Asked Questions
Here are answers to questions patients often ask when deciding between LASIK and SMILE.
Numbing drops are used for both procedures, so neither should be painful. Some patients describe SMILE as feeling slightly more comfortable during surgery because there is no step involving flap creation. Post-operative discomfort is mild for both and typically fades within a day or two. If you feel sore after either procedure, over-the-counter pain relievers and cold compresses can help, and we provide detailed guidance on managing any sensations during recovery.
Absolutely, and we encourage you to come in for an updated evaluation. SMILE technology has continued to advance, and your prescription or corneal measurements may have changed since your last assessment. Updated imaging and measurements ensure we are recommending the options that are most appropriate for your eyes right now, not several years ago.
SMILE generally causes less post-operative dryness because it preserves more corneal nerves, making it a consideration worth discussing if you already experience dry eye symptoms. However, the severity of your existing dry eye matters greatly. If your dry eye is moderate to significant, we may recommend treating it first before any laser procedure. Optimizing your eye surface health before surgery improves both comfort and visual outcomes afterward.
If you are over 40, presbyopia is a natural age-related change that affects the eye's ability to focus up close, and neither LASIK nor SMILE prevents it. However, there are options worth discussing, such as monovision, where one eye is corrected for distance and the other for near vision. During your consultation, we can simulate this approach so you can decide whether it feels natural and comfortable before committing to it.
Enhancements after SMILE are less common today, thanks to more precise pre-operative planning, but they can be performed when needed. Depending on your corneal thickness and other factors, we may use LASIK or another technique to fine-tune your vision. The important thing is that we wait until your vision has fully stabilized before considering any additional treatment, and we choose the safest method for your specific anatomy.
The only way to know for certain is through a comprehensive pre-operative evaluation. Your prescription range, corneal thickness, pupil size, tear film health, and lifestyle all play a role in the decision. Some patients are clear candidates for one procedure over the other, and some may be well-suited for either. Our goal is to give you a complete and honest picture of your options so you can make a confident, informed choice.
Schedule Your Consultation at NewView Eye Center
Choosing between LASIK and SMILE is an important decision, and our team is here to guide you with the expertise and personalized attention you deserve. NewView Eye Center serves patients across Northern Virginia with advanced technology and a commitment to excellence in laser vision correction. We invite you to schedule a comprehensive evaluation so we can assess your eyes, answer all of your questions, and help you find the path to clearer, more comfortable vision.
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