You Want a Treatment Built From Your Eye's Map
Wavefront-guided LASIK corrects the subtle irregularities of your individual optics, not just your glasses prescription. SMILE treatments are not wavefront-guided.
LASIK vs. SMILE: Which Is Right for You?
LASIK and SMILE are both laser procedures for nearsightedness, but they work differently — and only one can be customized to a 3D map of your eye. Here is an honest comparison from a Los Angeles practice that has performed refractive surgery since 1980.
The Short Answer
LASIK reshapes the cornea beneath a thin flap with an excimer laser and can be wavefront-guided to your eye's individual map. SMILE (small incision lenticule extraction) uses a single femtosecond laser to cut a thin disc of tissue inside the cornea and removes it through a small incision — no flap.
For most patients, custom all-laser LASIK delivers faster visual recovery, treats a wider range of prescriptions (including farsightedness), and is simpler to fine-tune if an enhancement is ever needed. SMILE's advantage is a flap-free cornea, which some surgeons favor for very active patients or those prone to dry eye. Berg-Feinfield performs custom bladeless LASIK, PRK, and EVO ICL rather than SMILE — here is why, and how to decide which procedure fits your eyes.
Compare Side by SideLASIK vs. SMILE — Side by Side
Two femtosecond-laser procedures, two different approaches to the cornea. Here is how they compare on the points that matter to patients.
| LASIK | SMILE | |
|---|---|---|
| How the cornea is treated | A femtosecond laser creates a thin flap; an excimer laser reshapes the cornea beneath it, and the flap is repositioned. | A femtosecond laser cuts a thin lenticule inside the cornea, which the surgeon removes through a small incision of a few millimeters. |
| Corneal flap | Yes — a thin, laser-made flap | No flap — a small incision instead |
| Customization | Wavefront-guided treatment built from a 3D map of your eye (iDesign 2 captures 1,200+ measurements) | Based on your glasses prescription; not wavefront-guided |
| Prescriptions treated | Nearsightedness, farsightedness, and astigmatism | Nearsightedness (−1.00 to −10.00 D) with astigmatism up to −3.00 D per FDA labeling; not approved for farsightedness |
| Minimum age (FDA labeling) | 18 | 22 |
| Visual recovery | Sharp for most patients by the next morning | Typically a few days to reach best vision |
| Dry eye | Temporary dryness is common in the first weeks and usually resolves | Some studies report less dryness in the early recovery period |
| Enhancements | The flap can be lifted for a straightforward touch-up | More involved — usually a surface treatment (PRK) over the treated area |
| Track record | FDA-approved since 1999, with decades of long-term outcome data | FDA-approved since 2016 (astigmatism added 2018) |
| Long-term results | Comparable for well-selected candidates — outcomes depend more on candidacy, diagnostics, and surgeon experience than on the procedure name. | |
Neither procedure is "better" in the abstract. The right choice depends on your prescription, corneal thickness and shape, dry-eye status, age, and how quickly you need to be back at work. That is why every recommendation at Berg-Feinfield starts with a complete diagnostic evaluation, not a sales conversation.
When LASIK Is the Better Choice
For most candidates with healthy corneas, custom all-laser LASIK remains the procedure of choice in Los Angeles — for reasons that go beyond speed.
You Are Farsighted or Have Mixed Astigmatism
SMILE is FDA-approved only for nearsightedness with astigmatism. LASIK treats nearsightedness, farsightedness, and astigmatism.
You Need to See Clearly Tomorrow
Most LASIK patients see well by the next morning and are back at work within a day or two. SMILE vision typically takes several days to sharpen.
You Have a Mild Prescription
SMILE's approved range starts at −1.00 D. Low prescriptions, and patients under 22, fall outside its labeling but are routinely treated with LASIK.
You Want a Simple Path to an Enhancement
If a touch-up is ever needed, a LASIK flap can be lifted and treated. After SMILE, enhancements usually require a separate surface procedure.
You Value a Long Track Record
LASIK has more than 25 years of FDA-approved outcome data behind it; the platforms we use are the current generation of that lineage.
When SMILE May Be Worth Considering
SMILE is a legitimate, FDA-approved procedure with real advantages for a specific group of patients. Here is who tends to benefit — and what we recommend instead.
You Are Worried About a Flap
SMILE has no flap, which removes the small long-term risk of flap displacement. At Berg-Feinfield, patients with the same concern are usually excellent candidates for PRK, which also has no flap and is wavefront-guided.
You Have Significant Dry Eye
Some studies report less early dryness after SMILE. For patients with meaningful dry eye we typically treat the dry eye first, then consider PRK or EVO ICL, which leaves the cornea's surface untouched.
You Play Contact Sports or Serve in Uniform
A flap-free cornea is appealing for boxers, martial artists, and first responders. PRK offers the same flap-free advantage with custom treatment, and EVO ICL avoids corneal tissue removal entirely.
You Are Highly Nearsighted
SMILE treats up to −10.00 D. For high prescriptions, EVO ICL — an implantable lens that removes no tissue and is reversible — is often the safer, higher-quality option, and Dr. Berg was one of 50 U.S. surgeons in the original ICL trials.
Why Berg-Feinfield Performs Custom LASIK, PRK, and ICL Rather Than SMILE
Every practice makes choices about which procedures to offer. Here is the reasoning behind ours.
Customization Wins
iDesign 2 Advanced WaveScan maps more than 1,200 points on each eye and the Alcon WaveLight Pro treats to that map. SMILE cannot use a wavefront-guided profile, and we are not willing to give that up.
Every Candidate Has a Flap-Free Option
Patients who want to avoid a flap are offered wavefront-guided PRK; patients with high prescriptions or thin corneas are offered EVO ICL. Nobody is steered into LASIK by default.
50,000+ Procedures of Judgment
Dr. Alan Berg has performed more than 50,000 LASIK procedures and has practiced through every generation of refractive technology since radial keratotomy. That experience shapes who we treat — and who we advise to wait.
Straight Answers
If your evaluation shows you are not a good LASIK candidate, we will tell you, and we will explain which alternative fits — even when that means no surgery at all.
LASIK vs. SMILE — Your Questions Answered
Neither is better across the board. SMILE avoids a corneal flap and may cause less dryness early on, while LASIK recovers faster, can be wavefront-guided to your individual eye, treats farsightedness, and is simpler to enhance. Long-term visual results are comparable for well-selected candidates, so the surgeon's diagnostics and judgment matter more than the procedure name.
No. We perform custom bladeless LASIK, wavefront-guided PRK, EVO ICL, and refractive lens exchange. We chose this lineup because it gives every candidate a customized treatment and a flap-free option (PRK or ICL) without giving up wavefront guidance. If you are specifically set on SMILE, we will still give you an honest evaluation of your candidacy for any laser procedure.
Under FDA labeling, SMILE is for adults 22 and older with nearsightedness between −1.00 and −10.00 diopters and up to −3.00 diopters of astigmatism, with a prescription that has changed by no more than 0.50 D in the past year. It is not approved for farsightedness. LASIK candidates can be 18 and older and may be nearsighted, farsighted, or astigmatic.
LASIK. Most LASIK patients see clearly by the next morning and return to work within a day or two. SMILE patients typically need several days for vision to sharpen because the lenticule is removed through a small incision rather than beneath a lifted flap.
Some studies report less dryness after SMILE in the first months, likely because the smaller incision disturbs fewer corneal nerves. Dryness after LASIK is usually temporary and manageable. If you already have significant dry eye, the better path is often to treat it first and then consider PRK or EVO ICL, both of which we offer.
Enhancements after SMILE are more involved than after LASIK. Because there is no flap to lift, a touch-up usually means a surface procedure such as PRK over the treated area, with its longer recovery. After LASIK, the original flap can typically be lifted for a quick adjustment — one reason our fee includes an enhancement policy.
Pricing is similar for the two procedures at comparable practices; what varies far more is what the fee includes. Berg-Feinfield quotes one all-inclusive price per eye covering your evaluation, custom all-laser treatment, every post-operative visit, and our enhancement policy. See our LASIK cost in Los Angeles page.
Find Out Which Procedure Fits Your Eyes
Your free consultation includes corneal mapping, a complete candidacy evaluation, and an honest recommendation — LASIK, PRK, EVO ICL, or none of the above.