If you’ve been told you’re a candidate for LASIK or PRK, you might assume the decision is already made. But today, patients often have more than one viable option and the best choice isn’t always the most familiar one.
LASIK, PRK, SMILE, and EVO ICL™ can all deliver excellent vision correction. The difference lies in how they work, how they interact with your eye’s anatomy, and which trade-offs matter most for your long-term outcomes.
With over 25,000 procedures performed, Dr. Rex Hamilton approaches this decision by looking beyond eligibility alone. The goal isn’t just to find a procedure that works — it’s to identify the one that best fits your individual eyes.
Understanding the Four Procedures
Each option corrects vision differently, and those differences matter.
LASIK uses two lasers, one which creates a thin flap in the front of the cornea and a second which reshapes the corneal tissue underneath. Recovery is typically quick, often within a day with minimal lifestyle restrictions for 1 week.
PRK also reshapes the cornea but does so without creating a flap. PRK uses the same laser to reshape the cornea as LASIK. With no flap, PRK requires the removal of the surface “skin” cells of the cornea which regenerate over several days following the laser reshaping, which means a longer recovery but similar long-term results.
SMILE (Small Incision Lenticule Extraction) uses a single laser to remove a small piece of tissue through a tiny incision. There’s no flap, and less disruption to the corneal surface compared to LASIK. Because the incision is so small and there is no flap, there are no lifestyle restrictions the day after the procedure.
EVO ICL takes a different approach. Rather than reshaping the cornea, it places a lens inside the eye to correct vision without removing tissue. Vision is typically excellent the following day with minimal lifestyle restrictions for 1 week.
All four are established, effective procedures. The key is understanding where each one fits.
What Many Patients Don’t Realize
If you qualify for LASIK, you may also be a candidate for SMILE, PRK, or EVO ICL. The decision isn’t just about eligibility — it’s about which procedure aligns best with your eye structure, visual goals, and long-term comfort.
A Balanced Comparison
| Feature | LASIK | PRK | SMILE | EVO ICL |
|---|---|---|---|---|
| Price of Surgery | $2,500–$4,000 per eye($209–230/month with financing) | $2,500–$4,000 per eye($209–230/month with financing) | $2,500–$4,000 per eye($209–230/month with financing) | $5,000–$6,000 per eye($459/month with financing) |
| Approach | Corneal reshaping with flap | Surface reshaping | Small-incision tissue removal | Implantable lens |
| Best For | Mild–moderate prescriptions with adequate corneal thickness | Thin corneas or active lifestyles with flap concerns | Mild–moderate prescriptions; dry eye concerns or flap-free preference | Higher prescriptions, thin corneas or non-corneal candidates |
| Dr. Hamilton’s Recommended Ranges | Nearsightedness (low corrections below −2.0D) Farsightedness (up to +5D) Astigmatism (high corrections above 2D) | Rarely used due to long recovery but capable of treating nearsightedness, astigmatism, farsightedness | Nearsightedness (moderate corrections from −2.0D up to −7D) Astigmatism (low to moderate from 0.5 up to 2D) | Nearsightedness (moderate to high corrections from −7D up to −20D) Astigmatism (from 1D up to 4D) |
| Recovery | 24 hours | 4 days of intermittent discomfort; 1 month before vision has stabilized | 24 hours and no lifestyle restrictions | 24 hours |
| Dry Eye Impact | Most significant effect and longest duration | Similar to LASIK | Minimal effect and short duration | Minimal effect and short duration |
| Reversibility | No | No | No | Yes |
| OK for Thinner Corneas | No | Yes | Yes | Yes |
How Dr. Hamilton Evaluates the Right Option
1. Corneal Thickness and Structure
Corneal health is foundational.
LASIK requires sufficient thickness to safely create a flap and reshape the cornea. PRK and SMILE reduce some of those constraints, with SMILE preserving more of the cornea’s surface structure.
For patients who prefer to avoid corneal alteration altogether — or who aren’t ideal candidates — EVO ICL may be considered.
2. Prescription Strength
Not all procedures perform equally across all prescription ranges.
LASIK, PRK, and SMILE are highly effective for mild to moderate nearsightedness. As prescriptions increase, corneal reshaping introduces optical imperfections, such as spherical aberration, that may be noticeable during dim lighting environments.
EVO ICL extends into higher prescription ranges, making it an option for patients outside typical laser treatment limits. In addition, EVO ICL maintains the natural shape of the cornea which typically affords excellent, high quality vision in healthy eyes.
3. Dry Eye Considerations
Dry eye is one of the most important quality-of-life factors after surgery.
Because LASIK involves a flap, it can temporarily affect corneal nerves involved in tear production. PRK also affects the corneal nerves and, therefore, is associated with transient dry eye symptoms (e.g. intermittent blurred vision typically later in the day and possible sandy gritty feeling). SMILE however — thanks to its smaller incision — tends to preserve more of the corneal nerve network and is not associated with significant or prolonged dry eye symptoms.
For many patients concerned about dryness, SMILE represents a thoughtful balance: effective vision correction with less disruption to the ocular surface and immediate (post-op day 1) return to all activities.
4. Long-Term Vision Changes
No procedure stops natural aging of the eye.
Conditions like presbyopia will still occur over time, regardless of which option you choose. Presbyopia occurs when the natural lens of the eye (the focusing element of the camera) starts to lose its focussing power. This leads to difficulty with near vision (e.g. cell phone, reading, etc.). All four procedures are designed for long-term correction of nearsightedness, farsightedness and astigmatism but do not directly address presbyopia.
Once presbyopia has occurred and patients are dependent on reading glasses, the best option for vision correction is Refractive Lens Exchange. Using LASIK/PRK/SMILE/EVO in presbyopic patients is possible but they all represent temporary, not permanent solutions.
Laser procedures permanently reshape the cornea. EVO ICL offers a lens-based approach that can be adjusted if needed and does not alter the natural corneal shape. For some patients, that flexibility is meaningful, particularly if they have a high prescription and/or are near presbyopic age.
Where Each Procedure May Offer Advantages
Each procedure has strengths, depending on your anatomy and priorities.
- LASIK remains a widely used option that is highly accurate for high astigmatism and farsightedness, has a long track record and is associated with a fast visual recovery.
- PRK is the procedure with the longest track record (longer than LASIK) and used to be for patients with thinner corneas or those who may not be ideal candidates for flap-based procedures. SMILE has largely replaced PRK for these patients.
- SMILE offers a minimally invasive approach with no corneal flap and a smaller incision, which may reduce disruption to the eye’s surface and is often preferred by nearsighted patients with or without astigmatism who are seeking a less invasive alternative to LASIK. There are no lifestyle restrictions the day after the SMILE procedure.
- EVO ICL provides a lens-based solution without reshaping the cornea, making it a strong option for higher nearsighted astigmatic prescriptions or patients who are not ideal candidates for laser procedures.
Rather than one procedure being universally better, the goal is to match the approach to the individual eye.
Cost Considerations
Cost varies depending on the procedure and individual case.
- LASIK, SMILE and PRK typically range from $2,500 to $4,000 per eye
- EVO ICL generally ranges higher, around $5,000 to $6,000 per eye
The Long-Term Cost of Contacts
It’s worth putting these numbers in perspective. Contact lenses aren’t a one-time expense. They are an ongoing commitment that adds up significantly over time. When you factor in the lenses themselves, annual eye exams, and cleaning supplies, the average contact lens wearer can spend roughly $950 per year. Over 20 years, that’s nearly $19,000 — often more than the cost of a permanent vision correction procedure.
For many patients, vision correction surgery isn’t just a medical decision. It’s a financial one that pays for itself over time.
Most vision correction procedures are not covered by insurance, though HSA and FSA funds are often applicable. Financing is available through Dr. Hamilton’s practice for all options.
Cost matters — but it’s only one part of the equation.
What This Means for You
There isn’t a universally “best” procedure.
LASIK remains widely used and effective. SMILE offers a modern, less invasive laser option. PRK can be valuable for specific corneal conditions. EVO ICL provides an alternative for patients who aren’t ideal candidates for corneal procedures or prefer a different approach.
The patients who tend to achieve the best outcomes aren’t those who arrive set on a specific procedure. They’re the ones who come in open to a thorough evaluation and a discussion of all appropriate options. After a comprehensive evaluation, Dr. Hamilton will typically make a strong recommendation, based on more than 25 years of experience, as to the best procedure for each individual patient.
How This Decision Changes After 40
If you’re approaching 40 or have already crossed that threshold, the conversation around vision correction becomes more nuanced.
Presbyopia — the gradual loss of near vision — affects everyone with age. None of the four procedures — LASIK, PRK, SMILE, or EVO ICL — prevent or eliminate it. While these treatments can reduce or eliminate the need for glasses for distance, reading glasses may still be needed over time.
For this reason, age and lifestyle play an important role in determining the most appropriate approach. Some patients may benefit from adjustments in treatment strategy, timing, or expectations based on how their vision is likely to change. In many instances, the Refractive Lens Exchange procedure may be the best option for vision correction in the presbyopic age range.
Dr. Hamilton discusses this in more detail in his article on vision correction after 40, including how treatment planning may differ and what options to consider. If age is part of your decision, it’s a helpful resource to review before your consultation.
Schedule a Consultation
If you’re considering vision correction in Beverly Hills or Los Angeles, a consultation is the best place to start. Dr. Rex Hamilton will evaluate your eyes, walk you through your options, and help you understand which procedure aligns with your anatomy, lifestyle, and long-term goals.
FAQ
For some patients, yes — particularly those concerned about dry eye or who prefer a flap-free procedure. For others, LASIK may still be the better fit.
Yes. Qualifying for LASIK does not automatically make it the best option. Multiple procedures may be appropriate depending on your clinical profile. EVO ICL can treat nearsighted prescriptions as low as −3D.
LASIK, SMILE and EVO ICL all offer quick visual recovery. With SMILE there are no lifestyle restrictions the day after surgery. PRK has the longest vision recovery.
Yes. Age-related changes such as presbyopia occur regardless of the procedure you choose. Refractive Lens Exchange can be done later in life even if you have previously had LASIK/SMILE/PRK/EVO ICL.