Refractive surgery · Comparison
LASIK or SMILE: which technique should you choose?
LASIK and SMILE both deliver excellent results for myopia. SMILE better preserves corneal biomechanics and removes the risk of flap displacement; LASIK also treats hyperopia and presbyopia. It is the preoperative assessment that settles the choice.
LASIK vs SMILE comparison table
Both techniques are performed at the Clinique Laser Victor Hugo (Paris 16) with the Zeiss VisuMax 800 femtosecond laser. The table below summarises the clinically relevant differences.
| Criterion | LASIK | SMILE |
|---|---|---|
| Number of lasers | 2 (femtosecond + excimer) | 1 (femtosecond only) |
| Corneal procedure | Circular flap (~120 µm, 360°) | 2-4 mm micro-incision + lenticule extraction |
| Corrected errors | Myopia, hyperopia, astigmatism, presbyopia | Myopia, myopic astigmatism (hyperopia possible on the VisuMax 800) |
| Maximum myopia | up to -10 D | -1 to -10 D |
| Dry eye | Transient dryness common, most often resolving | Similar profile; corneal sensitivity sometimes recovered earlier |
| Contact sports | Waiting period recommended (flap can be displaced) | More suitable (no flap) |
| Functional vision | Often from the next day | Day+1 (8-9/10), sharp by day+2-3 |
| Screen work | 48-72 h | Day+2-3 |
| Possible enhancement | Lifting the flap (simple), except contraindication | Via PKR or the CIRCLE technique (more complex) |
| Price (both eyes) | ~3,000 € all-inclusive package | 3,300 € all-inclusive package |
| Published results | TG-LASIK (topography-guided) 95 % within ±0.50 D; 88.3 % at 20/20 (Susanna 2025, 95 studies) | ~98 % within ±0.50 D (Liu 2021, 462 eyes) |
Ideal LASIK profile vs ideal SMILE profile
Ideal LASIK profile
LASIK is particularly well suited to patients wishing to correct hyperopia (up to +5 D) or presbyopia (PresbyLASIK), two indications that SMILE does not cover in its classic version. It also suits those who value fast recovery: usable vision often present from the next day (≈ 24 h), return to screen work in 48-72 h.
An enhancement is simpler with LASIK: it is most often done by lifting the existing flap, except in case of contraindication. The worldwide clinical track record of LASIK (more than twenty-five years) makes it the best-documented refractive technique.
Ideal SMILE profile
SMILE is particularly well suited to contact-sport athletes (rugby, martial arts, water sports): the absence of a flap removes the risk of traumatic displacement. Preserving a greater amount of anterior stromal tissue supports corneal biomechanics, an asset for patients concerned about long-term stability.
It also preserves the corneal nerves slightly better, which can be of interest in case of a tendency toward dryness — the difference with LASIK remaining moderate. In the largest published series worldwide (Reinstein 2022, 4,138 eyes), 88.1 % of results fall within the refractive target.
The 3 differences that really matter
1. Flap vs lenticule: two distinct surgical approaches
LASIK creates a circular corneal flap with the femtosecond laser (about 120 microns thick, the full perimeter of the cornea), then reshapes the underlying tissue with the excimer laser. This flap is replaced without sutures and adheres spontaneously. SMILE cuts an intrastromal lenticule inside the cornea, then extracts it through a 2 to 4 mm micro-incision.
The cornea is never opened across its entire surface. This structural difference is the source of all the others. Note: in low myopia, the lenticule is thinner and therefore more delicate to dissect and extract; this technical parameter is taken into account during the assessment when choosing between SMILE, LASIK or PKR.
Coupe transversale de cornée
Comparaison du geste chirurgical — LASIK et SMILE
LASIK
SMILE
2. No flap: no displacement, biomechanics preserved
This is the most concrete difference in everyday life. The LASIK flap, even when well healed, remains theoretically vulnerable to a significant ocular trauma: it is therefore not advised for those who practise contact sports or martial arts. SMILE, with no flap, removes this risk of displacement and offers superior corneal integrity after healing. Preserving a greater amount of anterior stromal tissue also improves corneal biomechanics, a parameter measured by Corvis ST during the preoperative assessment.
3. Dry eye: a real but moderate difference
Creating the flap in LASIK severs the anterior corneal nerves over 360°, which can transiently reduce corneal sensitivity and promote postoperative dryness. SMILE, thanks to its limited micro-incision, preserves these nerves slightly better. In practice, transient dryness occurs with both techniques and most often resolves; meta-analyses find a moderate difference that tends to fade over time. The tear profile is assessed during the preoperative assessment (Schirmer test, Break-Up Time) to tailor management, whichever technique is chosen.
The essential common point: the assessment decides
Neither LASIK nor SMILE is universally superior. Both techniques show comparable results for simple myopia — recent comparative meta-analyses find no significant difference in refractive predictability between LASIK and SMILE — and both are performed with the same Zeiss VisuMax 800 femtosecond laser at the Clinique Laser Victor Hugo (Paris 16). The question “LASIK or SMILE?” cannot receive a general answer: it depends on the corneal anatomy, the dryness profile, the lifestyle and the precise refraction.
The preoperative assessment — corneal topography (Pentacam), pachymetry, tear measurement, macular OCT, refraction under cycloplegia — is the only step that makes it possible to determine which of the two techniques is suitable, or whether a third option (PKR for thin corneas, ICL implant for very high myopia) is preferable. This assessment is carried out at the Cachan (94) office.
Important note: Refractive surgery (LASIK, SMILE, PKR, ICL) is performed exclusively at the Clinique Laser Victor Hugo (Paris 16). Consultations and preoperative assessments take place at the Cachan (94) office. No refractive surgery is performed in Paris 13.
To explore the alternatives: LASIK in detail — SMILE in detail — PKR (surface) — ICL implant — Preoperative assessment — Contact and office.
Frequently asked questions — LASIK or SMILE
Preoperative assessment: LASIK or SMILE is decided in consultation
A complete assessment (topography, pachymetry, OCT, refraction) at the Cachan office determines the technique suited to your corneal anatomy and your lifestyle.
Scientific references
- Susanna BN, Mohan N, Santhiago MR, Randleman JB. Laser in Situ Keratomileusis Outcomes and Complications: 2016 to 2023. J Refract Surg. 2025;41(4):e391-e403. PMID 40197080.
- Liu ET, Sella R, Goernert P, et al. Refractive results with SMILE using lower energy settings in the United States. PLoS One. 2021 (462 eyes).
- Liu ZY, Chen YG. Topography-guided FS-LASIK vs SMILE — network meta-analysis. Zhonghua Yan Ke Za Zhi. 2024.
- Sachdev GS, Ramamurthy S. Decade-long journey with small incision lenticule extraction: the learnings. Indian J Ophthalmol. 2020.
This page is for information purposes only and does not replace a medical consultation. Results vary according to individual characteristics. Any surgical decision is made after a complete preoperative assessment by Dr Tourabaly.