SMILE LASIK vs. LASEK: Is the Recovery Period Really That Different?

October 20, 2026

SMILE LASIK vs. LASEK: Is the Recovery Period Really That Different?

Evidence from randomized controlled trials directly comparing recovery times for SMILE and LASEK remains limited. A Cochrane review of trials comparing the procedures found no trials that reported postoperative pain scores [1].

Visual acuity at 12 months did not differ significantly between the procedures. When LASEK and LASIK were compared, the proportions of patients achieving uncorrected visual acuity (vision measured without glasses) of 20/20 or better were similar [1].

Questions like this appear on Naver Knowledge iN:

“I’d like to know how much the recovery speed actually differs between SMILE LASIK and LASEK, and which procedure causes more pain. I spend a lot of time working on a computer, so I’d also appreciate an explanation of when I could return to work after surgery.”

How do the three procedures differ in the way they treat the cornea?

The three procedures involve different layers of the cornea, the transparent membrane at the front of the eye. The Korea Disease Control and Prevention Agency (KDCA) lists laser-assisted in situ keratomileusis (LASIK), laser-assisted subepithelial keratectomy (LASEK), and phakic intraocular lens implantation among the surgical options for myopia [5].

LASIK: A flap is created in the cornea and lifted. The underlying tissue is reshaped with a laser, and the flap is then repositioned.

LASEK: No corneal flap is created. Instead, the epithelial layer on the corneal surface is removed before the underlying tissue is reshaped.

SMILE: A lens-shaped piece of tissue is created within the cornea and removed through a small incision. Unlike the other two procedures, SMILE does not involve creating a corneal flap or removing the surface epithelium.

Is there a definite ranking of which procedure allows the fastest recovery?

There is not yet sufficient primary evidence to establish a definitive numerical ranking of recovery times. The Cochrane review identified four trials involving 392 participants and 538 eyes comparing LASEK with LASIK, but only three trials involving 154 participants provided data that could be used in the analysis [1].

None of those three trials reported postoperative pain scores [1]. They also did not report visual loss or quality of life at 12 months [1].

In other words, some of the outcomes patients care about the most are missing from the comparative evidence.

So, what has been established?

The available evidence suggests that visual outcomes at 12 months do not differ significantly between the procedures. The risk ratio for achieving uncorrected visual acuity of 20/20 or better was 0.96 for LASEK compared with LASIK [1].

In the same comparison, the risk ratio for achieving uncorrected visual acuity of 20/40 or better was 0.90 [1]. For both figures, the confidence interval crossed 1, meaning the results did not establish a statistically significant difference between the procedures [1].

A review comparing LASEK with photorefractive keratectomy (PRK) found a similar result. Across 11 trials involving 428 participants, the risk ratio for achieving uncorrected visual acuity of 20/20 or better at 12 months was 0.98 [2].

How did SMILE LASIK differ from conventional LASIK?

The differences between SMILE and LASIK were observed in tear-related symptoms and corneal sensation rather than visual acuity. A meta-analysis comparing the two procedures found no significant differences in any of the visual outcomes assessed within six months after surgery [3].

Dry-eye symptoms, however, differed. At six months, dry-eye symptom scores were higher in the LASIK group [3].

Corneal sensation also differed. At six months, corneal sensitivity—the cornea's ability to perceive stimulation—was lower in the LASIK group [3].

Outcome	Findings at 6 months
Uncorrected visual acuity of 20/20 or better	No significant difference between the procedures [3]
Loss of one or more lines of best-corrected visual acuity	No significant difference between the procedures [3]
Achieving a refractive outcome within ±1.0 diopter (D) of the target	No significant difference between the procedures [3]
Dry-eye symptom scores	Higher in the LASIK group [3]
Corneal sensitivity	Lower in the LASIK group [3]

The authors rated the quality of evidence in this meta-analysis as low to very low [3].

Does the difference in dry-eye symptoms persist?

The difference in corneal sensitivity had narrowed by around six months. A meta-analysis of five studies involving 245 participants and 363 eyes found that central corneal sensitivity was similar between the two groups before surgery [4].

At one week, one month, and three months after surgery, corneal sensitivity was lower in the LASIK group [4]. By six months, the two groups had similar levels of sensitivity [4].

The authors cautioned that the findings should be interpreted carefully because the number of included studies was small [4].

Do better laser systems produce better results?

There is no clear evidence that differences in laser technology lead to significantly different visual outcomes. A Cochrane review analyzed 33 randomized trials involving 1,499 participants and 2,797 eyes, comparing wavefront-guided refractive surgery with conventional approaches [6].

The risk ratio for achieving uncorrected visual acuity of 20/20 or better was 1.03 [6]. No significant differences were found in the proportion of patients maintaining their best-corrected visual acuity or achieving a refractive outcome within ±0.5 D of the target [6].

The findings were also similar when optimized and guided wavefront approaches were compared. At 12 months, the risk ratio for achieving uncorrected visual acuity of 20/20 or better was 1.00 [6].

What should you consider when choosing a procedure?

The deciding factor should not be the procedure's name, but the characteristics of your individual eyes. Because the available evidence does not establish clear overall superiority of one procedure over another, factors such as corneal thickness, refractive error, and tear-film condition become important in determining which options are suitable for you.

Some outcomes were reported specifically in the LASEK-versus-LASIK comparison. The proportion of patients achieving a refractive outcome within ±0.5 D of the target was lower in the LASEK group than in the LASIK group [1]. In one trial, refractive regression was reported in 8 of 37 eyes in the LASEK group, compared with none of the 39 eyes in the LASIK group [1].

Corneal haze was uncommon. At six months, mild haze was observed in 1 of 76 eyes in the LASEK group and in none of the eyes in the LASIK group [1].

The quality of evidence for all these findings was rated as very low or low [1].

What should you ask during your consultation?

During your consultation, focus on your individual measurements and how they affect your eligibility for each procedure.

1. Corneal thickness: What is my corneal thickness, and does it allow me to undergo a procedure that reshapes the cornea?

2. Refractive error: How much corneal tissue would need to be removed to achieve my intended correction?

3. Tear-film condition: What do my preoperative tear-film tests show? Do I already have dry-eye symptoms?

4. Procedure recommendations: If you recommend a different procedure, which specific measurements or findings are driving that recommendation?

5. Next steps: If the intended refractive outcome is not achieved, what options would be available afterward?

6. The prevalence of myopia provides useful background. According to the KDCA, myopia affects approximately 70–90% of the total population in some Asian countries, 30–40% in Europe and the United States, and 10–20% in Africa [5].

7. There are also options that do not involve removing corneal tissue. Procedures that implant a lens inside the eye are discussed in articles about intraocular lens implantation.

8. To determine which procedure is suitable for your eyes, consult an ophthalmologist and undergo a comprehensive examination that includes corneal thickness measurements, refractive assessment, and tear-film testing.

Sources

This article provides general information based on Cochrane systematic reviews, peer-reviewed scientific literature, and publicly available information from the Korea Disease Control and Prevention Agency. It does not recommend any specific surgical procedure or laser system. The procedures suitable for your eyes should be determined through a comprehensive eye examination and consultation with an ophthalmologist.

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