LASIK vs PRK vs SMILE vs ICL: Which Vision Correction Surgery Fits Your Eyes?

The short version: two families of procedures

It helps to stop thinking of these as four competing brands and start thinking of them as two families. The first family, LASIK, PRK and SMILE, changes the shape of the cornea, the clear front surface of the eye. The second family adds something instead of removing tissue: an implantable lens such as the EVO ICL sits inside the eye, and the cornea is left alone.

Within the corneal family, the differences come down to how the surgeon reaches the tissue being reshaped. That is where words like flap and flapless come from. If you are early in your research, this framing makes consultations much easier to follow, because the first thing a surgeon is usually deciding is which family your eyes belong in.

Source for the descriptions: Mass Eye and Ear, Laser Vision Correction. Recovery time, comfort and long-term considerations vary by person and procedure, and they belong in a conversation with your surgeon rather than a general chart.

LASIK: the familiar name

LASIK is the procedure most people have heard of, and it is the reference point the others are usually compared against. It reshapes the cornea, and its defining feature is the corneal flap. When Mass Eye and Ear describes SMILE, it does so by contrast: SMILE has no flap, unlike LASIK.

Because the flap is part of the procedure, the structure of your cornea matters. That is one reason a LASIK consultation usually includes detailed corneal measurements before anyone tells you whether you are a candidate. For a fuller look at candidacy, costs and how to choose a surgeon locally, see our LASIK and refractive surgery guide.

SMILE: laser reshaping without a flap

SMILE (often written ReLEx SMILE) is the newest name on this list for many patients. Mass Eye and Ear describes it as minimally invasive, with no corneal flap. It still belongs to the corneal family: the goal is to reshape the cornea, just without creating the flap that LASIK uses.

Availability is worth checking. Mass Eye and Ear says its Lexington site is one of the only facilities in New England that offers ReLEx SMILE. If SMILE interests you, ask early in the process whether a practice offers it at all, and at which location, so you are not comparing a procedure you cannot actually get nearby.

PRK: the option when the cornea is thinner or irregular

PRK also reshapes the cornea. Mass Eye and Ear describes it as an alternative to LASIK and SMILE for patients with thinner or irregular corneas who may not qualify for those procedures. In practice, that means PRK often comes up after the measurements are in, when a surgeon explains why one approach suits your eyes better than another.

If you are told you are not a LASIK candidate, that does not automatically mean laser vision correction is off the table. Ask directly whether PRK was considered and what in your measurements pointed toward or away from it.

EVO ICL: a lens implant instead of reshaping

The EVO ICL works on a different principle. According to Mass Eye and Ear, it is a small, soft lens implanted in the eye to correct nearsightedness and astigmatism. Unlike LASIK, PRK or SMILE, it does not reshape the cornea.

That distinction is the main reason ICL appears in the same conversation as the laser procedures. When corneal reshaping is not the right fit, or when a surgeon prefers to leave the cornea untouched, a lens-based approach may be discussed. Whether it suits you is a decision for your surgeon after examining your eyes.

What actually decides which procedure fits your eyes

Comparison articles, including this one, can only take you so far. The procedure that fits is determined by a refractive surgery evaluation, where your eyes are measured and examined. The hospital descriptions above point to the kinds of factors that come up:

• Corneal thickness and shape: PRK is specifically described as an option for thinner or irregular corneas.
• Your type of prescription: the EVO ICL is described as correcting nearsightedness and astigmatism.
• Whether a flap is appropriate for you: this is the dividing line between LASIK and SMILE.
• Whether reshaping the cornea is the right approach at all, or whether a lens implant makes more sense.
• What the practice offers: not every center performs all four procedures, so the options presented to you can reflect availability as well as your eyes.

What published outcome data looks like

One useful habit when comparing practices is to ask whether they publish results. Mass Eye and Ear's Cornea and Refractive Surgery Service posts its refractive surgery outcomes online. Here is what it reported for calendar year 2023:

Two things stand out. First, at this center more eyes were treated with SMILE than LASIK that year, a reminder that the newer flapless option is a mainstream choice there, not a niche one. Second, the service reports on enhancements and retreatments, meaning additional procedures after the first. Asking any practice how often its patients need retreatment, and how it measures that, is a fair and specific question.

Where these procedures are offered in Boston

Mass Eye and Ear, part of Mass General Brigham, lists LASIK, SMILE, PRK, EVO ICL and RLE on its laser vision correction page, with care in Boston and across New England. Its main campus is at 243 Charles Street, Boston, MA 02114, near the MBTA Red Line Charles/MGH stop and on the Mass General Brigham shuttle route. Self-parking is available at the Charles Street lot (handicap accessible) and the Storrow Drive lot, and valet runs at the Fruit Street entrance Monday to Friday, 5 a.m. to 4 p.m., excluding holidays, according to the Mass General Brigham directions page. Remember that SMILE is offered at the Lexington site.

Boston's other academic medical centers have ophthalmology departments too, but our research did not confirm which refractive procedures each one performs. Call before assuming:

• Tufts Medical Center Ophthalmology and New England Eye Center: 260 Tremont Street, Biewend Building, 9th to 11th floors, Boston, MA 02116. Phone 617.636.4600, open Monday to Friday, 8:00 am to 4:45 pm. By subway, the Orange Line Tufts Medical Center stop is closest, with Downtown Crossing and Boylston also nearby, per Tufts directions.
• Boston Medical Center Department of Ophthalmology: 850 Harrison Ave., 3rd Floor, Yawkey Center, Boston, MA 02118, with the BU Eye Surgery Center also listed. The subway does not go directly to the campus, but the Silver Line and several bus routes do, per BU Medical Campus directions.
• Beth Israel Deaconess Medical Center Eye Care and Surgery: lists subspecialties including cataract surgery, cornea and external disease, glaucoma and retina. The page we reviewed did not list LASIK-type refractive surgery. Phone 617-667-3391.

Private practices across Greater Boston also perform refractive surgery. For a broader overview of how to find and compare eye surgeons in the area, start at our Boston eye surgeon guide.

From comparison to decision: a practical sequence

1. Learn the two familiesUnderstand that LASIK, PRK and SMILE reshape the cornea and ICL is an implanted lens. This alone makes consultations easier to follow.
2. Check what each practice offersAsk which of the four procedures the practice performs, and at which location, before booking an evaluation.
3. Get a full evaluationLet the surgeon measure your eyes. Candidacy is decided by those measurements, not by preference alone.
4. Ask why, not just whatIf one procedure is recommended, ask why the others were ruled out for your eyes. A clear answer is a good sign.
5. Ask about resultsAsk whether the practice tracks outcomes and retreatment rates, and how it compares them with benchmarks.
6. Verify the surgeonLook up the surgeon's Massachusetts license before you commit. Our guide explains how.
7. Take your timeGet a second opinion if anything feels rushed or unclear. Elective surgery can wait until you are confident.

Check the surgeon, whatever the procedure

The procedure name matters less than who performs it and how carefully you were evaluated. In Massachusetts, the Board of Registration in Medicine licenses, regulates and disciplines physicians. Its Physician Profiles site lets you search by name, specialty, license number or ZIP code, with more search options available. The site does not support Internet Explorer in compatibility mode, so use a current browser.

For help with Physician Profiles, the board lists ma.profiles@mass.gov, and borim.info@mass.gov for general questions. The board's page also links to a complaint form. For the full checklist, including board certification and fellowship training, read how to check a Boston eye surgeon.

What about cost and insurance?

Prices and coverage vary by practice, procedure and plan, and this comparison does not attempt to quote them. Ask each practice for a written estimate that spells out what is included, such as the evaluation and follow-up visits, and check your own plan's benefits directly with your insurer. Our LASIK and refractive surgery guide covers the local cost questions in more depth.