17 Oct Top 3 Refractive Procedures Compared: LASIK, SMILE, PRK
More than 150 million Americans wear corrective spectacles and lenses. This eyewear helps Americans compensate for refractive errors. The most common of them are nearsightedness, farsightedness, and astigmatism.
When do errors arise? They happen when an eye does not refract the light to concentrate on the retina. This occurs because of the cornea’s form. If you wear lenses or glasses, understanding LASIK vs SMILE surgery is for you.
LASIK Eye Surgery
About
Laser Assisted In-Situ Keratomileusis is what stands behind LASIK. In the USA alone, this is the top sought-after surgical intervention. The procedure is 100% bladeless and involves a laser beam for cornea reshaping.
The procedure has been FDA-approved for 20 years. Since then, it has revolutionized the domain. There is more than one type of LASIK surgery.
Procedure
LASIK is an outpatient operative treatment. It typically takes up to 30 minutes for both eyes. The anesthetic for LASIK is specialized eye drops that numb the eye’s surface. While getting LASIK eye surgery, a patient is fully awake. However, it’s common practice to use some medications to help patients relax.
First LASIK procedures utilized a microkeratome for flap cutting. Today, they use a femtosecond for the same effect.
Femtosecond lasers are lasers that produce pulses in the femtosecond range. Femtosecond lasers can cut thinner flaps for corneas that are thin or have high refractive errors.
The flap is lifted off, allowing a laser to restructure the corneal tissue. The flap’s hinge allows warding off complete flap separation.
The surgeon determines the amount of removed tissue in advance. The factors that predetermine this amount are:
- Contact lens/glasses prescription
- Wavefront test
- Cornea shape
LASIK does not require stitches, since the cornea holds the flap in position.
Recovery
Recovery is fast, with minimal inconvenience. Dry eyes and eye discomfort are easy to avoid with pain medicine and eye drops. The list of rare but serious post-surgery complications may include:
- Infection
- Under-/overcorrected eyesight
- Corneal glare
- Blurry vision
- Irregular astigmatisms
SMILE Eye Surgery
About
SMILE stands for Small Incision Lenticule Extraction. It is a comparatively new refractive surgical procedure for treating myopia and improving how light rays focus on the eye retina. SMILE is designed to be less invasive than LASIK.
The procedure was first performed in 2008 and was performed by Sekundo and Blum. In the USA, it was approved in 2016. SMILE has been accessible in other countries for over a decade.
Procedure
Certain eye conditions either affect the intervention or escalate eyesight after the procedure. Surgeons thoroughly test the patient’s vision to be sure it remains the same over the past 365 days. Also, the eyesight is to be within the limits that SMILE can fix.
SMILE is also an outpatient operative treatment. The process is 100% computer-guided and requires up to 20 minutes for both eyes. The anesthetic used for SMILE is local: specialized eye drops make one’s eyes numb.
With a femtosecond laser, a surgeon cuts a small lens-shaped disc in one’s cornea to reshape the cornea. This is how they reverse the eye’s refractive error.
Recovery
Recovery is fast and usually takes up to several hours. The eyesight may remain blurry throughout the day. In most patients, it takes 24 hours before they witness any results. The vision completely stabilizes in between 2 and 4 weeks.
The list of post-surgery complications may include:
- Blurry vision
- Hazy vision
- Grittiness
- Dry Eyes
- Light Sensitivity
Less common post-surgery conditions are infections, debris remains, or corneal abrasion.
PRK Eye Surgery
About
Photorefractive keratectomy is what stands behind PRK. This is an alternative operative intrusion for patients who don’t qualify for LASIK or SMILE. PRK hopes to deal with astigmatism, myopia, and hyperopia.
PRK is the eldest of three. It was first successfully performed back in 1987 by Dr. Theo Seiler in Berlin. It gained FDA approval only in 1995. This precursor gained popularity and gave a push to LASIK and SMILE.
Procedure
When it started in 1987, patients got Valium instead of anesthesia. Today, specialized eye drops make one’s eyes numb. A surgeon places an eyelid holder on each eye to prevent blinking.
The surgeon then removes and removes the eye’s corneal surface cells with a brush, laser, alcohol solution, or blade.
During reshaping the cornea with a laser, the patient hears beeps. They place contact lenses on each eye instead of a bandage. Eyes remain clean and infection-free. This specific bandage remains on the eyes for up to 7 days.
Recovery
In most cases, vision gets worse at first. Some patients see clearly in weeks after the surgery. Yet, they can return to work 5–7 days after the procedure.
High sensitivity stays for up to 3 weeks. There are frequent cases when people experience all the benefits 3 to 6 months after the surgery. The most common side effects of PRK are eye redness, swelling, and dryness. On rare occasions, patients experience:
- Corneal ectasia
- Corneal haze
- Irregular astigmatism
- Decentered ablation
- Reduced visual acuity
- Under-/overcorrection
Brief Comparison: LASIK vs. SMILE vs. PRK
| LASIK | SMILE | PRK | |
| Method | Flap surgery | Minimally invasive | Surface ablation |
| Description | A flap in the outer corneal layer. It is folded back to sculpt the underlying tissue with a femtosecond. | A femtosecond creates a layer in the form of a contact lens beneath the eye’s surface. It forms a small opening to remove the layer and correct one’s eyesight. | Alcohol solution removes the epithelium to reshape the tissue with a laser. The surgeon places a bandage until the epithelium grows back. |
| Best for | Patients with healthy corneas | Patients with healthy corneas or dry eyes | Patients with thin corneas |
| Recovery | 4 to 12-hour recovery | 4 to 12-hour recovery | Extended recovery period |
Reviewing LASIK, SMILE and PRK
Patients may tend to choose a surgery that promises faster results and easy recovery. It is the doctor and patient together who make the final choice. The decision depends on many factors, among them are current eyesight prescription, current overall health, and other factors. All three types have helped millions of patients achieve clear vision.
More information:
- https://www.healthline.com/health/eye-health/faqs-about-myopia-procedures
- https://www.mayoclinic.org/tests-procedures/lasik-eye-surgery/in-depth/lasik-surgery/art-20045751
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Last Updated on November 25, 2024 by Marie Benz MD FAAD