LASIK vs LASEK vs PRK vs SMILE: Which Laser Eye Surgery Is Right for You?

The reality is that choosing the right surgery for you is all about carefully deciding between different ways of reshaping the cornea.  This is a decision for both you and your surgeon, and the things that shape your choice can vary from person to person. The experience itself can also vary, with differences in how your eyes will heal, how they will feel in the early stages and also the way your vision will settle.

This guide clearly explains all the things to consider in detail, as well as what can make the difference for you. It covers how each procedure is performed, how recovery will usually go, and when one option is likely to suit you better than another. It also explains where SmartSight, a flapless procedure using a more advanced platform to SMILE, fits in, and how age-related changes such as presbyopia could affect your choices.

Which laser eye surgery is best?

There is no one procedure that is best for everyone when it comes to laser eye surgery, and that’s because everyone’s eyes are different. The decision on which suits you will be made by you and your surgeon together and comes down to the structure of your cornea, how swiftly you need to recover and your vision priorities.

For example, if your priority is a faster recovery, you may be recommended a slightly different surgery than someone who doesn’t mind a slower recovery. And a slower recovery isn’t a bad thing; LASEK and PRK take longer to settle because the surface layer of the cornea has to regrow, but the visual outcome is usually just as good.

If you do need a faster result, LASIK suits people who want to return to their usual activities quickly and have a cornea thick enough to safely accommodate a flap. For those who need minimal disruption or to get back to work quickly, it can be a popular choice.

LASEK and PRK are usually recommended when your cornea isn’t thick enough for a flap, or when avoiding one is important for structural reasons. This often comes up when the cornea is on the thinner side or the prescription pushes the limits of what it can support. It also matters if there’s a higher risk of impact to the eye. Recovery is slower and more uncomfortable early on, but the end result is comparable.

SmartSight is another option and works within the cornea through a small incision rather than creating a flap, which means there's no flap to account for in the corneal thickness calculation and no flap-related risk from impact afterwards. Recovery is faster than with LASEK or PRK, so it’s often considered when preserving corneal structure and returning to normal activity quickly are both priorities.

After discussing your priorities, symptoms and preferred outcomes with your surgeon, you should find the right option for you, and in some cases it may be that laser eye surgery is not the right treatment at all.  If your natural lens is what’s causing issues, it may be the case that a different type of procedure would be more suitable. These are all things your surgeon will discuss with you at your consultation.

What is the actual difference between LASIK, LASEK, PRK and SMILE?

All of the different types of laser eye surgery procedures correct your vision by reshaping your cornea, but the difference is the way they treat the surface of your eye. That’s why for each one, the recovery time and the way your eye feels after surgery differ and why different types of laser eye surgery are recommended to different people. 

LASIK 

For LASIK procedures, a thin flap is created in the outer cornea using a femtosecond laser. Following this, another type of laser known as an excimer laser changes the shape of the underlying layer before the flap is returned to its original position. In this method, the cornea’s outer layer is preserved, which is why patients heal more quickly and regain functional vision within a day or two. The speed of recovery for this treatment is why LASIK is a popular choice for people whose priority it is to get back to everyday activities and keep downtime to a minimum. 

LASEK 

LASEK, on the other hand, loosens the outer surface layer of your cornea, moves it aside for the laser treatment, then puts it back. This layer still needs to recover afterwards, which is why the first few days can feel a little more uncomfortable than with LASIK and why it takes a little longer. This procedure is often recommended when there are reasons to avoid working deeper in the cornea.

PRK 

PRK removes the outer layer entirely, rather than repositioning it, allowing it to regrow over several days. The recovery pattern is similar to LASEK, but PRK allows the layer to regrow from scratch, whereas LASEK preserves and replaces it. Despite this difference, long-term results are comparable.

SMILE and SmartSight 

SMILE and SmartSight reshape the cornea through a small keyhole incision with no flap involved. Because no flap is created, there’s no risk of it being affected by impact to the eye. This is why these procedures are often chosen by people who play contact sports regularly.

Avoiding a flap also means that dry eye recovery is faster with this procedure. Recovery with this procedure is faster than with LASEK or PRK and closer to the LASIK timeline. SmartSight uses a different laser platform to SMILE, but it works on the same principle. SmartSight has several technological advantages over SMILE; firstly, it works with lower, more gentle energy. Secondly, it has a very advanced pupil tracking system, and finally, it has an automated and very accurate alignment system for treating astigmatism. 

Whilst all of these procedures work for improving distance eyesight, only some of them can address age-related near vision changes using laser blended vision or presbyMAX. If this is affecting your eyesight, it can influence what will be considered the right option for you and is something your surgeon will discuss with you.

What recovery feels like, and how long it takes

Most people don't experience any pain during a laser procedure because numbing drops are used throughout. What varies after treatment is how your eyes feel once those drops wear off, and that comes down to how the surface of the eye heals after each type of treatment.

With LASIK, the outer layer is preserved, so discomfort is usually mild. A sense of pressure is common during treatment, followed by some dryness or grittiness in the first few hours. The irritation can be noticeable, but it settles quickly, and most people are back to normal activities within a day or two.

SmartSight follows a similar pattern, though most people notice slightly less sensitivity in the early hours, with complete comfort normally achieved later on the day of treatment. Perfect clarity of sight can take a little longer to fully sharpen than with LASIK, with some people reporting slightly milky vision for the first day or two. 

LASEK and PRK feel more uncomfortable in the early stages because the surface of the eye is healing directly. Your eyes might feel gritty or sore, with light sensitivity and watering also common in the first few days. Discomfort tends to build before it eases within 2-3 days, and it usually takes two to four weeks before vision feels consistently reliable.

For more details on what recovery looks like week by week, including when you can drive and return to work, read our guide to laser eye surgery recovery.

Do they all give the same results long term?

LASIK, LASEK, PRK, and flapless procedures like SMILE or SmartSight are all designed to achieve the same outcome by reshaping the cornea so light focuses more accurately on the retina. Although the early recovery can feel different, the long-term visual result is usually comparable.

The change made to the cornea is permanent, so it does not return to its previous shape. Even so, your eyes can still change over time. The natural lens inside your eye continues to age. This can affect how you see later in life, especially for near vision.

Real-life scenarios: which type of treatment do people usually choose?

The differences between procedures become clearer when you apply them to real situations. 

If minimising downtime is your priority

Getting back to work and screens quickly points towards LASIK or SmartSight. Vision is usually functional within a day or two with both, though SmartSight tends to sharpen a little more gradually. LASEK and PRK involve more discomfort and a longer period of limited vision in the first few days, which makes an early return to work more difficult.

Usually best suited to: LASIK or SmartSight.

If you do contact sports or high-impact activity

A direct impact to the eye soon after treatment can very rarely displace the corneal flap created during LASIK.  LASEK and PRK avoid this entirely because no flap is involved. SmartSight is also flapless and recovers faster than surface treatments, which makes it worth discussing if a quicker recovery also matters.

Usually best suited to: LASEK, PRK, or SmartSight.

If you've been told your cornea is thin

Creating a flap uses up corneal depth before any reshaping begins, which is why LASIK can be difficult to perform safely on thinner corneas. LASEK and PRK work on the surface without working as deep into the corneal tissue, which means more of it remains available for reshaping. Whether SmartSight is appropriate depends on your specific measurements.

Usually best suited to: LASEK or PRK.

If you're prone to dry eyes

Creating a flap during LASIK involves temporarily affecting more corneal nerves than flapless procedures, and those nerves play a role in signalling tear production. This is why SmartSight tends to result in less dry eye symptoms in the months after surgery and is worth considering when dryness is already an issue beforehand.

Usually best suited to: SmartSight.

If near vision is already becoming harder

Near vision changes from the late 40s onwards are usually caused by the natural lens becoming less flexible, rather than by any change in the cornea. Laser eye surgery for distance vision only does not address this so reading glasses are likely to still be needed even after successful treatment for distance vision. However, if you are approaching reading vision age or already in the age where reading vision has become affected, then your surgeon will discuss with you and plan to incorporate a reading vision correction known as laser blended vision or presbyMAX to treat both distance vision and reading vision at the same time .

Usually best suited to: Discussing your options with your consultant to make sure you’re making the best choice for your long-term sight.

What if your near vision is changing?

As previously discussed, from your mid-40s onwards, the natural lens inside the eye gradually loses its flexibility and ability to focus up close. Tasks that were quite effortless before, like reading a menu or your phone, can start to take more effort, and glasses for close work become necessary. This is called presbyopia, a normal part of aging that affects everyone and develops regardless of whether you've had laser eye surgery.

Why standard laser eye surgery doesn't address this

LASIK and similar procedures for distance vision correction reshape the cornea to bring light to a single point of focus in the distance. The problem in presbyopia is that near focus is also required which is why reading glasses are often still eventually needed even after successful laser treatment for distance vision correction. 

How this is sometimes managed

PresbyMAX takes a different approach. Rather than correcting for one focal distance, it adjusts the cornea to create a graduated range of focus, with different zones handling near, intermediate, and distance vision. The brain draws on whichever zone is most relevant at any given moment, which can permanently eliminate the need for glasses for both distance vision and close tasks.

Adjusting to this can take time, particularly after dark. It also isn't appropriate for everyone. The question worth asking is whether flexibility across a range of distances matters to you.