LASIK vs PRK vs SMILE vs ICL

PRK is typically the least expensive option nationally at $3,500–$5,500 for both eyes. Standard LASIK is close behind at $4,000–$6,000. SMILE runs $4,500–$7,000 and ICL is significantly more at $8,000–$14,000. PRK achieves equivalent long-term outcomes to LASIK — the main tradeoff is 5–7 days of slower recovery versus LASIK's 24-hour turnaround.

Both use the same excimer laser to reshape corneal tissue. LASIK first cuts a thin flap (heals in 24 hours), while PRK removes the surface epithelium and lets it grow back over 4–5 days. Long-term outcomes are equivalent. PRK is preferred for thin corneas, dry eye tendencies, and active military — no flap means no flap dislocation risk from physical impact.

SMILE uses a femtosecond laser to create a small tissue disc (lenticule) inside the cornea and removes it through a 2–4mm incision — no exposed surface, no flap. This smaller incision cuts fewer corneal nerves, resulting in the lowest dry eye risk of all laser procedures. Recovery is similar to LASIK (1–3 days). The key limitations are cost ($500–$1,000 premium), inability to correct farsightedness, and more limited enhancement options if retreatment is needed.

ICL is best for patients not eligible for laser surgery — very high prescriptions (−3.00 to −20.00), thin corneas, or dry eye disease that rules out laser options. It's also the only reversible procedure. ICL requires a pre-surgical iridotomy (small laser opening in the iris) and a more involved surgical process. At $8,000–$14,000, the cost is significantly higher than laser alternatives, so most patients who qualify for LASIK or PRK choose those first.

SMILE has the lowest dry eye risk of all laser procedures — its 2–4mm incision severs fewer corneal nerves than LASIK's full flap cut. ICL has essentially no dry eye impact because it adds a lens without removing corneal tissue. Standard LASIK has the highest incidence at 20–30% of patients experiencing temporary dryness. PRK is intermediate. For patients with pre-existing significant dry eye disease, ICL is usually the safest option.

Most patients spending $900–$1,400 per year on contacts, glasses, exams, and solution reach break-even with a $5,000 LASIK procedure in approximately 4–6 years. Over 10 years, contacts typically cost $9,000–$14,000. LASIK's 10-year all-in cost (including 5–10% enhancement rate) is $5,500–$8,500 for most patients. Use our break-even calculator for a personalized estimate.

The Department of Defense prefers PRK for active-duty personnel. The absence of a flap eliminates flap dislocation risk from impact — a critical safety consideration in combat or high-impact training environments. LASIK is approved in some branches for non-combat roles. SMILE is accepted in some branches but has less military-specific clinical data. Always verify current standards with your specific branch's medical standards office.

LASIK enhancement (retreatment) is possible in 5–10% of cases, typically for undercorrections or prescription regression over years. Most surgeons offer a written enhancement policy — ask about it and what it covers before you book. LASIK enhancement lifts the existing flap for a second laser pass. PRK enhancement involves surface re-ablation. SMILE enhancement options are more limited and often require converting to PRK. ICL enhancement means replacing the lens — more costly but fully correctable.

Yes — ICL is the only major refractive procedure that is fully reversible. The STAAR EVO+ Visian ICL can be removed or exchanged by a surgeon. This reversibility is a key advantage for patients who may want to change their correction method in the future, or who are hesitant about a permanent procedure. All laser procedures (LASIK, PRK, SMILE) permanently reshape corneal tissue and cannot be undone.

Both achieve comparable outcomes for myopia correction. Choose SMILE if dry eye is a concern — its smaller incision spares more corneal nerve tissue. Choose LASIK if you have farsightedness (SMILE cannot correct hyperopia), if enhancement options are important (LASIK retreatment is more straightforward), or if surgeon experience is the priority (LASIK has a 30-year clinical track record vs SMILE's 10 years). The cost premium for SMILE typically runs $500–$1,000 higher in the same market.

LASIK typically corrects up to −8.00 diopters of myopia; PRK extends this to approximately −10.00 with adequate corneal thickness. SMILE corrects −1.00 to −10.00 for myopia with up to −3.00 CYL astigmatism. For prescriptions above −10.00, ICL is often the only viable option, correcting up to −20.00 diopters. Your surgeon will measure your corneal thickness during pre-op mapping to determine the maximum correction available for your anatomy.

Standard health insurance classifies LASIK, PRK, SMILE, and ICL as elective procedures and does not cover them. Some employer vision plans offer negotiated discounts of 15–25%. HSA (Health Savings Account) and FSA (Flexible Spending Account) dollars are IRS-eligible for all four procedures under Publication 502. Using pre-tax funds effectively reduces your net cost by your marginal tax rate. Read the full breakdown in our insurance and HSA/FSA guide.