LASIK, SMILE or Lens replacement? Which is best?


You’ve done your research on the best laser eye surgery procedure for you – a corneal procedure such as SMILE or LASIK, or a lens replacement procedure; you’ve talked to people who’ve had it; you’ve even seen a surgeon (or two) for an initial consultation. But after all this, you’re still not sure which procedure will give you the best results. This post looks at the pros and cons of each procedure and will hopefully help you understand the main points of difference.

What’s your error?

If you’re shortsighted in the range of -3 and -10 diopters and have a suitable cornea, SMILE offers some advantages over LASIK. It has been shown in clinical studies to be more accurate for higher errors (above -3) and is also less likely to interfere with your tear film during the healing period (which can lead to temporary dry eyes).

As surgeons, we are cautious about offering a clear lens replacement (also called a clear lensectomy or a clear lens exchange or CLE) to short-sighted patients, as the surgical risk of complications is  higher than with a corneal procedure.

If you’re long-sighted, however, depending on your age, either LASIK or clear lens replacement surgery may be a very good option.  Lower errors (up to about +3) can get great results with LASIK, but if you are over 50 years of age, a lens replacement procedure can have several advantages over a corneal procedure. Not only can it correct all of your long-sightedness (no matter how high your prescription) but it will also mean that you will never get a cataract or require future cataract sugery.


What’s your age?

Under 45’s should definitely be looking at a corneal procedure (LASIK / SMILE) rather than a lens replacement. As long as your natural crystalline lens is still functioning well, hang onto it, as you will see better at a range of distances compared to any currently available IOL. Science hasn’t yet found a way to exactly mirror the function of the young, healthy crystalline lens, which seamlessly changes the focus of your eye from distance to near.

Things are different if you are over 50 though; by now, your crystalline lens will have become rigid, and no longer offers any change in focus from distance to near. A good quality intraocular lens will correct your error and provide crisp vision, with the possibility of blended vision to improve spectacle independence for near / intermediate tasks. Another possibility is to get trifocal IOLs. These are not for everyone, but for the carefully chosen candidate, who is prepared for some loss of crispness to their vision, particularly at night, these can offer unprecendented independence from glasses for all distances.

If you are, like our average patient, between the ages of 45 and 55, then you really need to listen to the advice of an experienced laser eye surgeon who has all procedures available tochoose from. This is an important decision and one you make once in your life.  Second and third opinions are better than rushing things.  Some people are better off just waiting a few more years with their glasses before having any surgery. This is advice we commonly offer where we think it will be worth the wait.

What’s your lifestyle?

Professional athlete? Martial arts enthusiast? Surfer?  Contact sports can be resumed within a week of having SMILE laser, making it a very popular option for the physically active. It’s usually a few days before you can see crisply after this procedure, but most people are back at work within a few days. LASIK has an even quicker visual recovery – usually overnight – but as it involves the creation of a flap of tissue it is less well suited to a rapid return to these types of activities.

Lens replacement is a more invasive procedure and takes a few weeks to recover from. If you’re over 50 and your main goal from surgery is to eliminate glasses from your lifestyle, multifocal or trifocal IOLs can get you there, providing you are prepared for some compromise to the crispness of your vision.

All of these options are discussed as part of the comprehensive initial consultation offered by our surgeons.