Non-LASIK laser eye surgery options: Pros and cons explained

LASIK dominates laser eye surgery recognition, but there are other options too. LASIK involves creating a thin flap in the cornea. Non-LASIK laser eye surgery procedures take a different approach. PRK works on the surface of the cornea, and SMILE reshapes the cornea via a small incision.

Each laser vision correction surgery has its own pros, cons, recovery timeline, and suitability criteria. And if LASIK isn’t a suitable option, that's not to say that PRK or SMILE automatically become one.

In this quick guide, our Re:Vision laser eye specialists cover the main non-LASIK options. You'll learn how they work, their pros and cons, and which factors may influence the right approach for you.

Non-LASIK options at a glance

Please note: Suitability varies from person to person. To find out which laser eye surgery is right for you, you need to have a comprehensive eye assessment.

PRK

PRK works from the surface of the eye down. 

First, your eye surgeon will gently remove a thin outer layer of your cornea. Then, they'll use an excimer laser to reshape the tissue underneath. This involves making tiny and very precise changes to how light focuses in your eye.

When the laser work is complete, your eye surgeon will put a special clear contact lens over your eye. This protects it while the surface layer grows back.

Pros of PRK

• No corneal flap: There’s no flap that could become displaced if you get knocked in the eye.
• Can suit thinner corneas: If your corneas are too thin for LASIK, PRK might still be an option.

• Tried and tested: PRK has been around for over 30 years.
• Treats common vision problems: It can correct short-sightedness, long-sightedness, and astigmatism in suitable patients.
• Good long-term results: Recovery takes longer than LASIK, but the end result can be just as good.

Cons of PRK

• Takes longer to heal: You'll likely be able to drive after about five days and go back to work in five to seven days.
• Uncomfortable at first: Your eyes may sting, water, feel gritty, or become sensitive to light for the first few days.
• Needs more aftercare: You’ll need to wear a protective contact lens, use prescription eye drops, and go to follow-up appointments during your recovery.
• Small risk of corneal haze: Some people develop temporary cloudiness during recovery.
• Small risk of infection: The cornea is vulnerable while its outer surface regenerates.

SMILE

SMILE works from inside the cornea. 

Your eye surgeon will begin by using a femtosecond laser to separate a tiny, lens-shaped piece of tissue inside your cornea. This piece of tissue is called a lenticule. Next, they'll remove it through a 2mm to 4mm incision. By taking this tissue out, your cornea changes shape, allowing light to focus properly in your eye.

Unlike LASIK, your eye surgeon won't have to create or reposition a corneal flap. And the small incision will heal on its own, without stitches.

Pros of SMILE

• No corneal flap: There’s no flap that could become displaced if you get knocked in the eye.
• Small incision: The surgeon removes the lenticule through a small 2mm to 4 mm opening.
• Faster recovery than PRK: You can usually go back to work in a day or two, but your vision may take longer than this to fully settle.
• Less dryness at first: You may experience fewer dry-eye symptoms than you would initially after LASIK.
• Treats short-sightedness and astigmatism: SMILE can correct short-sightedness and mild-to-moderate astigmatism in suitable patients.

Cons of SMILE

• Treats fewer prescriptions: SMILE only works for short-sightedness and some types of astigmatism.
• Less personalised: Surgeons can't tailor the procedure to the intricate details of your eyes in the same way as they can with wavefront-guided LASIK.
• Vision can take time to sharpen: You're likely to get back into your usual routine quickly, but crisp vision can take a few weeks.
• Harder to fine-tune: If you need more correction later, you might need to have PRK or LASIK instead of another SMILE procedure.
• The laser doesn't do everything: The lenticule has to be removed manually, so the result depends more heavily on your eye surgeon’s technique.

PRK or SMILE?

PRK can be a good option if you have thinner corneas or a higher risk of eye injury. But it comes with a longer recovery. SMILE usually gets you back up and running sooner. But it treats fewer vision problems and can be harder to adjust down the line. Neither is automatically better. And LASIK may still offer the most tailored treatment for suitable patients.

What if I'm not suitable for laser eye surgery?

Don't worry! If laser eye surgery isn’t a safe bet for your eyes, you don't need to write off vision correction completely. There might be other options to consider still; for example:

• Implantable contact lenses (ICL): Instead of changing the shape of your cornea, your eye surgeon places a small prescription lens behind your iris. Your natural lens stays where it is. The ICL can come out or be replaced later.
• Refractive lens exchange (RLE): Instead of adding a lens, your eye surgeon removes your natural lens and puts an artificial prescription one in its place. If age-related changes have started impacting how you see, RLE might be an option.

Vision correction surgery Auckland

There's more than one way to correct your vision. 

Each type of laser refractive surgery has its strengths, but each also asks you to compromise somewhere. That may mean a more drawn-out recovery, fewer treatable prescriptions, or tricky adjustments down the track. 

The right procedure for you is the one that safely suits your eyes.

That decision calls for experience. At our laser eye clinic in Auckland, our surgeons have decades of combined practice. They've performed tens of thousands of laser eye surgeries using advanced laser technology. If you have a look on Google, you'll also find glowing five-star reviews from 950+ patients.

Ready to discover the right option for your eyes?