Which Is the Best Laser Eye Surgery?
Here is how SMILE Pro, Femto-LASIK and No Touch differ, what the scientific data say, and how we find the right method for you.
There is no single best laser eye surgery for everyone; the best method is the one that suits your eye. Corneal thickness and map, the type and amount of your prescription, dry eye and your lifestyle decide the choice. Studies show that, in a suitable patient, one-year vision results of the methods are close to each other. The real differences are in recovery time, comfort and corneal safety.
Why is there no single best laser eye surgery?
This is one of the questions my patients ask most often. My answer is always the same:
“There is no best laser; there is the most suitable laser for your eye.”
— Prof. Dr. Fırat Helvacıoğlu, from his video explanation
The scientific data support this view. A Cochrane review compared LASIK with surface laser (PRK). It found that LASIK corrected vision faster and with less pain, but that the results of the two methods were similar after one year. A meta-analysis compared SMILE with Femto-LASIK in high myopia. It found no difference in uncorrected vision, although the SMILE group had slightly fewer optical errors (aberrations). Another Cochrane review compared wavefront-guided and conventional treatments, and it also showed no significant difference in results.
In short, all of these methods work well in a carefully selected patient. Success depends on using the right method on the right eye.
Which is the best laser eye surgery?
In one minute, Prof. Dr. Fırat Helvacıoğlu explains how the laser methods differ and how the method is chosen for each person.
Three main methods
Laser methods fall into three main groups, depending on the corneal layer where the correction is made:
- Surface lasers — No Touch and PRK: The top layer of the cornea (epithelium) is removed, and the correction is made directly on the surface. In No Touch, the laser does this without any instrument touching the eye. Because there is no incision or flap, the corneal tissue is thinned the least. For this reason, doctors prefer it in thin corneas and for patients who do not want a flap. You may feel stinging and watering for the first 3–4 days, and vision becomes clear in 1–2 weeks.
- Flap lasers — Femto-LASIK (iLASIK) and Q-LASIK: A femtosecond laser first creates a thin flap. Then the correction is made underneath, and the flap is laid back in place. Vision recovers very quickly, so most patients can return to work the next day. These methods cover a wide range of myopia, hyperopia and astigmatism.
- Small-incision laser — SMILE Pro: The correction is prepared inside the cornea as a small disc of tissue (lenticule). The surgeon then removes it through a small 2–4 mm incision. Because there is no flap, it is an advantage for people who play impact and contact sports. Studies have also shown that it preserves the biomechanical strength of the cornea better than LASIK. Doctors use it mainly for myopia and astigmatism.
Where do the three main laser methods work in the cornea?
The methods differ according to the corneal layer where the correction is made. Your corneal thickness, topography and lifestyle decide which one suits you.
- Surface laserIn No Touch and PRK, the epithelium is removed and the correction is made in the top layer. There is no incision or flap, and healing takes a few days.
- Flap laserIn LASIK, a thin flap is lifted first, and the correction is made underneath. Then the flap is laid back. Vision recovers very quickly.
- Small-incision laserIn SMILE Pro, the correction is prepared inside the cornea as a small disc of tissue (lenticule). It is then removed through a small incision.
Side-by-side comparison
| Feature | No Touch / PRK | Femto-LASIK / Q-LASIK | SMILE Pro |
|---|---|---|---|
| Incision / flap | None | Flap present | 2–4 mm incision, no flap |
| Time to clear vision | 1–2 weeks | Next day | A few days |
| Comfort in the first days | Stinging possible for 3–4 days | Usually comfortable | Usually comfortable |
| Suitable prescriptions | Myopia, hyperopia, astigmatism (mostly low to moderate) | Myopia, hyperopia, astigmatism | Myopia and astigmatism |
| Corneal thickness needed | Least | Most | Moderate |
| Contact / impact sports | Suitable | Caution because of the flap | Suitable |
The table is only a general guide; the limits vary from person to person according to your corneal measurements.
What decides the best laser eye surgery for you?
Factors related to your eye
- Corneal thickness and map (topography/tomography)
- Type and amount of your prescription
- Percentage of tissue to be altered (PTA)
- Dry eye and tear quality
- Pupil size in the dark
Factors related to your lifestyle
- Your job and how quickly you need to return to work
- Contact and impact sports (boxing, martial arts, football)
- Long screen time and night driving needs
- Near vision expectations after age 40
For example, surface laser may stand out for a patient with a thin cornea. Femto-LASIK may suit someone who wants a quick return and has a suitable cornea. SMILE Pro may suit a myopic patient who plays active sports. If you have irregular astigmatism or corneal irregularity left from a previous surgery, topography/wavefront-guided personalized treatments come into play. With high prescriptions that the cornea cannot safely correct with laser, however, an intraocular lens (ICL) may be a safer option.
How do we choose the best laser eye surgery at the exam?
We never base the decision on a single measurement. First, we evaluate all the structures of your eye and your prescription. Then we run detailed analyses of the cornea. Topography shows the surface shape, and tomography shows the back surface and thickness distribution. When needed, wavefront analysis shows the optical quality. With these data, we calculate a separate plan for each method. Together, we then choose the safest method that also best meets your priorities.
Our clinic presented its experience with trans-PRK in never-operated eyes at ESCRS 2019. The presentation covered the vision, topography and wavefront results of surface lasers.
You may also wonder how old methods differ from today’s lasers. If so, you can read our article “Is laser eye surgery harmful?”.
Frequently asked questions
In a suitable patient, the vision results of the two methods are close. SMILE Pro creates no flap, so it has an advantage for people who play contact sports and for corneal strength. Femto-LASIK, however, covers a wider range of prescriptions, including hyperopia. The choice depends on your corneal measurements.
In surface lasers, the top layer of the cornea (epithelium) grows back. This takes 3–4 days. During this time, you wear a protective lens, and you may feel stinging and watering. Vision becomes clear within 1–2 weeks.
Dryness can occur in the first months after any method. Surface lasers (no flap) and SMILE affect fewer corneal nerves, so dryness is usually milder than after LASIK. If you already have dry eyes, we take this into account when choosing the method.
We always take your preferences and lifestyle into account. However, the final decision is made together, among the methods that are safe for your eye according to the measurements.
It is usually possible after age 18, if your prescription has been stable for at least one year. Near vision changes after age 40, so we plan with this in mind. In some patients, a smart lens may be more suitable.
Related pages
References
- Shortt AJ, Allan BDS, Evans JR. Laser-assisted in-situ keratomileusis (LASIK) versus photorefractive keratectomy (PRK) for myopia. Cochrane Database Syst Rev. 2013;(1):CD005135. doi:10.1002/14651858.CD005135.pub3
- Fu Y, Yin Y, Wu X, et al. Clinical outcomes after small-incision lenticule extraction versus femtosecond laser-assisted LASIK for high myopia: a meta-analysis. PLoS One. 2021;16(2):e0242059. doi:10.1371/journal.pone.0242059
- Guo H, Hosseini-Moghaddam SM, Hodge W. Corneal biomechanical properties after SMILE versus FLEX, LASIK, LASEK, or PRK: a systematic review and meta-analysis. BMC Ophthalmol. 2019;19(1):167. doi:10.1186/s12886-019-1165-3
- Li SM, Kang MT, Wang NL, Abariga SA. Wavefront excimer laser refractive surgery for adults with refractive errors. Cochrane Database Syst Rev. 2020;12:CD012687. doi:10.1002/14651858.CD012687.pub2
- Santhiago MR, Smadja D, Gomes BF, et al. Association between the percent tissue altered and post-LASIK ectasia in eyes with normal preoperative topography. Am J Ophthalmol. 2014;158(1):87-95. doi:10.1016/j.ajo.2014.04.002
- Kaya Ünsal S, Helvacıoğlu F, Sunay E. Visual, refractive, topographic and wavefront outcomes of trans-photorefractive keratectomy in virgin eyes. 37th ESCRS Congress, Paris, September 2019 (paper).
This article is for patient information only and does not replace an examination or medical evaluation. Your suitable treatment is determined after an eye examination and measurements. Publication date: 25 September 2026.
Contact Prof. Dr. Fırat Helvacıoğlu with your questions
Prof. Dr. Fırat Helvacıoğlu · Veni Vidi Eye Clinic, Bağdat Cad. No: 257, Caddebostan – Kadıköy / Istanbul