People are steered away from LASIK for different reasons. The FDA flags contact sports and an unstable prescription. The AAO lists severe dry eye, corneal scars or disease and keratoconus, among others. And some prescriptions are too high to correct safely with corneal surgery at all, according to the AAO. Each reason points in a different direction, and only an examination can tell you which applies to you. What follows is a map of the options so your consultation can be a real conversation.
| Option | How it works | Designed for | Recovery notes |
|---|---|---|---|
| SMILE | A laser forms a small disc of tissue (lenticule) under the corneal surface and removes it through a small incision | Nearsightedness and astigmatism, with a prescription unchanged for a year and a healthy cornea | The laser portion takes about 30 seconds |
| PRK (photorefractive keratectomy) | A laser procedure; a bandage contact lens is placed afterward | Our sources don't define a target group, so ask why it's suggested for you | Some eye pain possible for 2–3 days; blurry vision at first |
| Phakic IOL (ICL) | A lens placed in front of or behind the iris while the natural lens stays in | High prescriptions that can't be safely corrected with corneal surgery | Drops for 2–3 weeks, per an older AAO article |
| Refractive lens exchange | The natural lens is replaced with an artificial one, much like cataract surgery | May be an option for severe farsightedness, where LASIK isn't recommended | Ask the surgeon; the procedure is done much like cataract surgery |
SMILE: a small-incision laser option
The AAO describes SMILE (small incision lenticule extraction) as a newer laser surgery that treats nearsightedness and astigmatism. A laser forms a disc-shaped piece of tissue under the corneal surface, then makes a small incision through which the tissue is removed. The laser part takes about 30 seconds.
To qualify, the AAO says your prescription should be unchanged for the past year and your cornea and eye must be healthy. If problems occur, they can often be improved with glasses, contacts or more laser surgery. The American Refractive Surgery Council, an industry group, says the FDA approved SMILE in 2016 and that it costs about the same as LASIK.
Good questions to ask: Does SMILE treat my whole prescription? Why SMILE rather than LASIK or PRK for my eyes? What would happen if I needed a touch-up later?
PRK: what recovery looks like
PRK (photorefractive keratectomy) is a laser vision procedure, and the AAO describes its recovery in some detail:
- A bandage contact lens is placed on the eye after surgery.
- You need someone to drive you home.
- Some eye pain is possible for 2–3 days.
- Vision is blurry at first.
- You wear sunglasses outdoors for as long as your doctor advises.
Risks include under- or overcorrection and loss of best-corrected vision. The AAO says about 90% of patients reach 20/40 or better without glasses or contacts.
If you spend much of your week outdoors, have a comfortable pair of sunglasses ready before surgery day, and ask your surgeon how long to keep wearing them. Line up your ride home in advance too.
ICL and other phakic IOLs: for high prescriptions
Phakic intraocular lenses, sometimes called implantable contact lenses or ICL, are designed for high prescriptions that can't be safely corrected with corneal surgery. The lens is placed in front of or behind the iris, and your natural lens stays in.
An AAO technology assessment reports that the FDA-approved Visian ICL is indicated for myopia of 3 to 15 diopters, with reduction of myopia from 15 to 20 diopters. For myopia of −8 diopters or more, it says phakic IOLs may give better vision than corneal laser surgery.
The same assessment lists long-term concerns: endothelial cell loss, cataract, secondary glaucoma and dislocation of the lens. An older AAO news article notes that drops are used for 2–3 weeks after a phakic IOL, versus a week to 10 days after laser surgery.
Because an implanted lens is a long-term commitment, ask how the surgeon will monitor you over the years, how often you'll be checked for the concerns above, and what would happen if the lens ever moved.
Refractive lens exchange: replacing the natural lens
Refractive lens exchange (RLE), also called clear lens extraction, replaces your natural lens with an artificial one and is done much like cataract surgery. It may use multifocal or accommodating lenses, and the AAO says it may be an option for severe farsightedness, where LASIK is not recommended. For how lens surgery works and what lens upgrades can cost, see our cataract surgery guide.
Match your situation to the right questions
| What you were told | What the sources say | Ask the surgeon |
|---|---|---|
| Your prescription is too high for LASIK | FDA: results are generally not as good with very large prescriptions; AAO: phakic IOLs are designed for high prescriptions | Would a phakic IOL or another option fit, and what long-term checks would I need? |
| You have dry eye | AAO: severe dry eye rules out LASIK; FDA study: up to 28% reported new dry eye symptoms after LASIK | How was my dry eye measured, and does it affect every option or only LASIK? |
| You play contact sports | FDA lists boxing, wrestling, martial arts and other contact sports as a reason you may not be a good candidate for refractive surgery | Which option, if any, suits my sport, and when could I return to it? |
| Your prescription changed recently | FDA (refractive surgery) and AAO (SMILE) look for a prescription stable over the past year | When should I come back to be measured again? |
| Your cornea isn't suited to LASIK | AAO lists corneal scars, corneal disease and keratoconus as reasons not to have LASIK | Which options don't rely on reshaping my cornea, and why? |
| You're over 40 and want to read without glasses | FTC: LASIK can't correct presbyopia; AAO: RLE may use multifocal or accommodating lenses | What are my options for near vision, and what are the trade-offs? |
Getting a second opinion in San Diego
A second consultation makes sense when you're advised to have a more involved procedure, such as an implanted lens, or when two practices disagree. Sharp HealthCare lists laser vision correction surgery among its eye services, and UC San Diego Health's Shiley Eye Institute describes itself as the only academic institution in the area combining full clinical eye care with research (both checked November 2026). Independent practices are another route. Whatever the setting, use our surgeon checklist and ask the first practice for copies of your measurements to bring along.
Frequently asked questions
Is SMILE better than LASIK?
Neither is better for everyone. The AAO says SMILE treats nearsightedness and astigmatism in people with a stable prescription and a healthy cornea. A surgeon who examines you can explain which fits your eyes.
Does SMILE cost more than LASIK?
The American Refractive Surgery Council, an industry group, says SMILE costs about the same as LASIK. We found no San Diego-specific price, so ask for a written quote.
How uncomfortable is PRK recovery?
The AAO says some eye pain is possible for 2–3 days, vision is blurry at first and a bandage contact lens is placed after surgery. You'll also need someone to drive you home.
Who is ICL for?
The AAO says phakic IOLs such as ICL are for high prescriptions that can't be safely corrected with corneal surgery. The FDA-approved Visian ICL indication covers myopia of 3 to 15 diopters, with reduction from 15 to 20 diopters.
What are the long-term concerns with ICL?
An AAO technology assessment lists endothelial cell loss, cataract, secondary glaucoma and lens dislocation. Ask how often you'll be checked over the years.
What if I'm farsighted?
The AAO says refractive lens exchange may be an option for severe farsightedness, where LASIK isn't recommended. It's done much like cataract surgery.
Sources
- What is small incision lenticule extraction (SMILE)? — American Academy of Ophthalmology
- Photorefractive keratectomy (PRK) — American Academy of Ophthalmology
- Refractive surgery alternative procedures — American Academy of Ophthalmology
- Phakic intraocular lens implantation for the correction of myopia — American Academy of Ophthalmology
- Phakic IOLs for correction of myopia (technology assessment) — American Academy of Ophthalmology
- Phakic intraocular lenses for nearsightedness — American Academy of Ophthalmology
- LASIK laser eye surgery — American Academy of Ophthalmology
- SMILE eye surgery — American Refractive Surgery Council
- When is LASIK not for me? — U.S. Food and Drug Administration
- What are the risks and how can I find the right doctor for me? — U.S. Food and Drug Administration
- LASIK Quality of Life Collaboration Project — U.S. Food and Drug Administration
- The basics of LASIK eye surgery — Federal Trade Commission
- Eye care services — Sharp HealthCare