5 Best Alternatives to LASIK

PRK was actually the first laser vision correction procedure approved in the United States, and it remains an excellent choice for many patients in 2025. Instead of creating a corneal flap like LASIK does, PRK gently removes the thin outer layer of the cornea, called the epithelium, before reshaping the tissue underneath with a laser. This outer layer naturally grows back over several days.

We often recommend PRK for patients with thinner corneas, those in active careers or sports, or anyone who wants to avoid the potential risks associated with a corneal flap. The visual results are comparable to LASIK, though the recovery takes a bit longer. Most patients experience some discomfort for a few days while the epithelium heals, but we provide medications and special contact lenses to keep you comfortable during this time.

Unique considerations with PRK:

• Risk of corneal haze in higher prescriptions, often reduced with intraoperative mitomycin C
• Longer visual recovery than LASIK and SMILE
• Rare infection or delayed epithelial healing

LASEK combines elements of both PRK and LASIK. During LASEK, we loosen the epithelial layer with a dilute alcohol solution, gently move it aside, reshape the cornea with a laser, and then reposition the epithelium to act as a natural bandage. This technique may offer slightly faster healing than PRK for some patients while still avoiding the creation of a deeper flap.

• Discomfort and early healing are similar to PRK for most patients
• Suitable for patients with moderately thin corneas
• Preserves more corneal tissue than traditional LASIK
• Recovery is typically similar to PRK and slower than LASIK

In current practice, many surgeons prefer PRK, transepithelial PRK, or epi-LASIK for surface ablation.

SMILE represents one of the newer advances in laser vision correction and has gained popularity worldwide. Instead of removing surface tissue or creating a flap, the surgeon uses a femtosecond laser to create a small, lens-shaped piece of tissue (called a lenticule) inside the cornea. We then remove this lenticule through a tiny incision, which changes the corneal shape and corrects your vision.

Because SMILE requires only a small incision rather than a full flap, it may result in fewer dry eye symptoms and potentially stronger corneal stability. Currently, SMILE works best for treating nearsightedness and some levels of astigmatism. In the United States, SMILE is approved for myopia and myopic astigmatism and is not approved for hyperopia. Our ophthalmologist will determine if your prescription and corneal characteristics make you a good candidate for this innovative procedure.

Potential considerations with SMILE:

• Lower likelihood of postoperative dry eye for some patients compared with LASIK
• Enhancements, if needed, are usually performed with PRK or LASIK
• Rare interface inflammation or need for conversion in complex cases

If corneal laser is not advisable, there are options that improve stability or vision without reshaping the cornea.

• Corneal collagen cross-linking to halt progression in keratoconus or ectasia
• Intracorneal ring segments to regularize corneal shape in selected cases
• Specialty contact lenses such as scleral lenses for highly irregular corneas

In the weeks before your procedure, we provide specific instructions to ensure the best possible outcome. If you wear contact lenses, you will need to stop wearing them for a period before your surgery because they can temporarily change your corneal shape. As a general guide, stop soft lenses for at least one week, toric or extended-wear soft lenses for two weeks, and rigid gas-permeable lenses for two to four weeks, or as directed based on your cornea.

• Arrange for someone to drive you home after your procedure
• Stop wearing eye makeup for a few days before surgery
• Avoid using lotions or perfumes on the day of your procedure
• Eat a light meal before arriving unless instructed otherwise
• Bring sunglasses to wear on your way home
• Plan to pause eye makeup for at least one week after laser procedures and lens-based surgery
• Avoid swimming or hot tubs for at least two weeks after laser procedures and about four weeks after lens-based procedures
• Do not use over-the-counter redness relievers or new eye cosmetics in the week before surgery

Most vision correction procedures take less than 30 minutes, though you should expect to spend a couple of hours at our facility for preparation and post-procedure checks. We use numbing drops to keep you comfortable, so you should not feel pain during the surgery itself. You will be awake throughout the procedure, and we guide you through each step.

For laser procedures, you may notice a pressure sensation and see lights or blurry images while we work. For lens-based procedures, we may use additional medications to keep you relaxed. Immediately after your procedure, your vision will be blurry, and your eyes may water or feel gritty. These sensations are normal and part of the healing process.

Your specific restrictions depend on the procedure. Following these guidelines reduces the risk of complications and helps you heal predictably.

• Do not rub your eyes. Wear the provided protective shield at night for at least one week
• No swimming, hot tubs, or water directly in the eyes for two weeks after laser procedures and four weeks after lens-based procedures
• Avoid eye makeup for one week, and avoid dusty or dirty environments during early healing
• Limit strenuous exercise for several days, and avoid contact sports for several weeks as directed
• Use all prescribed drops on schedule. These usually include an antibiotic and a steroid. We will check eye pressure and adjust drops if needed
• Do not drive until your vision meets legal standards and you are cleared at a follow-up visit

Your recovery experience depends on which procedure you have. LASIK and SMILE patients often notice improved vision within hours, though it continues to sharpen over the following days and weeks. PRK and LASEK patients experience more gradual improvement, with vision becoming clearer as the epithelium heals over the first week.

During the early recovery period, your vision may fluctuate from day to day or even throughout a single day. You might experience sensitivity to light, mild discomfort, or a foreign body sensation. These symptoms are typically temporary. We provide prescription eye drops to prevent infection, reduce inflammation, and keep your eyes comfortable as they heal. Some patients are steroid responders and can have temporary pressure rises, so we monitor intraocular pressure during follow-up and adjust drops if needed.

Regular follow-up visits allow us to monitor your healing and ensure you are progressing as expected. Your first appointment is usually the day after your procedure, with additional visits scheduled at specific intervals over the following months. The exact schedule varies by procedure type, but most patients have visits at one day, one week, one month, three months, and six months.

• We check your vision at each visit to track improvement
• We examine your cornea to ensure proper healing
• We adjust your medication schedule as healing progresses
• We address any concerns or questions you have about your recovery
• We check your eye pressure and the ocular surface as needed to detect steroid response or dry eye flare-ups early

While complications are uncommon, knowing when to contact us immediately is important for protecting your vision and eye health. Some symptoms indicate problems that need urgent attention rather than waiting for your next scheduled appointment. We provide you with emergency contact information and clear instructions about warning signs.

Contact our office right away if you experience sudden vision loss, severe pain that does not improve with prescribed medications, increasing redness, discharge from your eye, flashes of light or new floaters, worsening hazy vision in PRK that does not improve with drops, or sudden onset of many new floaters. A significant increase in light sensitivity, a curtain or shadow appearing in your vision, or any injury to your eye during recovery also requires immediate evaluation. Early intervention can prevent minor issues from becoming serious problems.