Key points
- SMILE removes a small disc of corneal tissue through a small incision and is FDA-approved for nearsightedness and astigmatism.
- PRK treats nearsightedness, farsightedness and astigmatism. Recovery is slower than LASIK, but eye injuries afterward are less likely to cause complications.
- Phakic lenses are implanted without removing your natural lens and, in the US, are approved only for nearsightedness.
- In 2017 the AAO reported phakic lens surgery at about $4,000 per eye, versus $1,500 to $3,000 for laser surgery.
The three options side by side
| Option | How it works | What it treats | Recovery notes |
|---|---|---|---|
| SMILE | A laser creates a small disc of corneal tissue (the lenticule), removed through a small incision | Nearsightedness and astigmatism (FDA-approved) | Procedure takes about 10–15 minutes; vision may be blurry right afterward |
| PRK | The outer corneal layer may be removed with a brush, then a laser reshapes the cornea | Nearsightedness, farsightedness and astigmatism | Eye pain for 2–3 days, medications for several weeks, slower than LASIK |
| Phakic IOL (ICL) | A lens is implanted in the eye while your natural lens stays in place | Nearsightedness (US approval) | Surgery takes about 15 minutes per eye |
SMILE: small-incision lenticule extraction
SMILE is a newer type of laser refractive surgery, FDA-approved for nearsightedness and astigmatism. A laser creates a disc of tissue inside the cornea, called a lenticule, which is removed through a small incision. The procedure takes about 10 to 15 minutes, and your vision may be blurry right afterward.
According to the AAO, people who may not be candidates include those with corneal abrasions or disease, advanced glaucoma, a cataract affecting vision, or uncontrolled diabetes. Risks include infection, blindness, and vision that ends up under- or over-corrected.
PRK: photorefractive keratectomy
PRK reshapes the cornea with a laser. The outer layer of the cornea may be removed with a brush first, and it grows back within several days, according to Cleveland Clinic. PRK treats nearsightedness, farsightedness and astigmatism.
What PRK recovery involves
- Someone must drive you home after surgery.
- Expect eye pain for 2 to 3 days and blurry vision at first.
- Most people shouldn't drive for at least a few days.
- You'll need medications for several weeks.
- Wear sunglasses outdoors for as long as your doctor advises.
- Overall, recovery is slower than with LASIK.
Cleveland Clinic notes that eye injuries after PRK are less likely to cause complications than after LASIK. If you play contact sports or your work carries a risk of eye injury, ask your surgeon how that factors into your case, and check whether your employer has rules on refractive surgery.
As with other laser procedures, the AAO notes that vision may end up under- or over-corrected.
ICL and other phakic intraocular lenses
Many people search for "ICL." The AAO uses the broader term phakic intraocular lens, or phakic IOL: a lens implanted in the eye without removing the natural lens. In the US, phakic lenses are approved only for nearsightedness, and the surgery takes about 15 minutes per eye (AAO).
An AAO technology assessment found phakic IOLs work for nearsightedness and nearsighted astigmatism, and describes two FDA-approved designs: one fixed to the iris and one placed in the posterior chamber. For nearsightedness of −8 diopters or more, phakic IOLs may give better vision than laser corneal surgery and may be safer than refractive lens exchange.
Reported complications include loss of corneal endothelial cells, cataract, secondary glaucoma, iris atrophy and dislocation of the lens after trauma. Because the lens stays in your eye, ask the surgeon how they will monitor it over the years.
What about refractive lens exchange?
Refractive lens exchange is another lens-based surgery you may hear about. We found no AAO patient page on it. In a 2011 article for eye professionals, one surgeon described ideal candidates as farsighted people with presbyopia from their late 40s to early 60s, and another was cautious about nearsighted patients because lens surgery carries retinal risks. If it's offered to you, ask why it suits your eyes better than the options above.
How costs differ
In 2017, the AAO reported phakic lens surgery at about $4,000 per eye, compared with $1,500 to $3,000 per eye for laser surgery. VSP's member price maximums list PRK at $1,500 per eye, below its LASIK maximum of $1,800 (VSP). These are national figures, not Boston quotes. According to the FDA, most medical insurance won't pay for refractive surgery. Our LASIK guide lists questions to ask about any quote.
Questions to bring to a Boston consultation
- Which of these options do you offer, and which would you rule out for my eyes, and why?
- What did my measurements show that points toward this procedure?
- How many of these procedures do you perform each year, and where?
- What will recovery mean for my work, driving and exercise?
- For a lens implant: how will you monitor my eye in the years after surgery?
- What does the price include, and what would a second procedure cost?
Before you book, confirm the surgeon's license and board certification with our verification guide.
Frequently asked questions
Is SMILE better than LASIK?
Neither is right for everyone. SMILE is FDA-approved for nearsightedness and astigmatism, and which suits you depends on an exam. A surgeon who offers both can explain their reasoning for your eyes.
Why would a surgeon suggest PRK instead of LASIK?
Reasons vary by patient. One point Cleveland Clinic makes is that eye injuries after PRK are less likely to cause complications than after LASIK. Ask your surgeon for the specific reason in your case.
How long does PRK recovery take?
The AAO says to expect eye pain for 2 to 3 days. Cleveland Clinic says the outer corneal layer grows back within several days, most people shouldn't drive for at least a few days, and medications are needed for several weeks.
Can ICL correct farsightedness?
In the US, phakic lenses are approved only for nearsightedness, according to the AAO.
Does insurance pay for these procedures?
According to the FDA, most medical insurance won't pay for refractive surgery. Check your own plan before you count on coverage.
Sources
- What is small incision lenticule extraction (SMILE)? — American Academy of Ophthalmology
- Photorefractive keratectomy (PRK) — American Academy of Ophthalmology
- PRK eye surgery — Cleveland Clinic
- Phakic intraocular lens implantation for the correction of myopia — American Academy of Ophthalmology
- Phakic intraocular lenses for nearsightedness — American Academy of Ophthalmology
- Getting clear on refractive lens exchange — AAO EyeNet
- LASIK eye surgery cost — VSP
- When is LASIK not for me? — U.S. Food and Drug Administration
Last verified: November 6, 2026. Facts on this page were checked against the linked sources on that date. No practice pays to appear on this site.