Contoura LASIK vs. SMILE
Understanding Contoura LASIK and SMILE
Contoura LASIK is a type of topography-guided laser vision correction that uses detailed mapping of your cornea to create a personalized treatment plan. Traditional LASIK reshapes the cornea based on your eyeglass prescription, while Contoura uses thousands of data points to address unique irregularities in the curve of your eye.
This advanced approach can improve not only how much you see, but also how well you see, potentially delivering sharper contrast and better night vision than older LASIK techniques. Benefits depend on your individual corneal shape and healing response.
SMILE stands for Small Incision Lenticule Extraction. During this procedure, we use a femtosecond laser to create a tiny disc-shaped piece of corneal tissue, called a lenticule, inside the cornea.
We then remove the lenticule through a small incision that measures only two to four millimeters. Because no flap is created, SMILE preserves more of the cornea's structural integrity and leaves more nerves intact. Both procedures still remove corneal tissue. Biomechanical weakening can occur with either procedure, and corneal ectasia remains a rare but serious risk.
The most important difference is how we access and reshape your cornea. Contoura LASIK requires creating a hinged flap on the corneal surface, then using an excimer laser to reshape the tissue underneath before replacing the flap.
- Contoura creates a flap and, in most practices, uses a femtosecond laser for the flap and an excimer laser for reshaping
- SMILE requires no flap and uses one laser
- Contoura offers topography-guided customization
- SMILE involves a smaller incision and less surface disruption
Both procedures effectively treat nearsightedness, also known as myopia. Contoura LASIK corrects myopia and astigmatism. Standard LASIK can correct hyperopia, but Contoura topography-guided hyperopia is not FDA approved in the United States.
SMILE is currently approved by the FDA primarily for myopia and mild to moderate astigmatism. In the United States, SMILE is typically approved for myopia from about -1.00 D to -10.00 D with up to about 3.00 D of astigmatism. SMILE is not currently FDA approved for hyperopia.
Determining If You're a Candidate
To qualify for either procedure, you need healthy eyes free of active disease or infection. Your prescription should have been stable for at least one year, and your corneas must be thick enough to safely remove or reshape tissue.
- Age generally 18 or older, often 21 or older for best stability
- No current eye infections, inflammation, or injuries
- Adequate corneal thickness confirmed by imaging
- Stable refraction without significant recent changes
- Realistic expectations about outcomes
Contoura LASIK is an excellent choice if you have corneal irregularities that affect your quality of vision, such as higher-order aberrations (subtle optical imperfections that affect clarity and night vision). The topography-guided treatment can smooth out these imperfections.
You may also benefit from Contoura if you need correction for both nearsightedness and astigmatism, or if you want the most customized treatment available to optimize visual sharpness and reduce glare or halos. Benefits depend on your individual corneal shape and healing. We will show you maps and simulations to set realistic expectations.
SMILE works especially well for patients with moderate to high myopia who want to minimize disruption to the corneal surface. Because the procedure leaves the outer layers mostly intact, it may result in fewer or less intense dry eye symptoms, though dry eye can still occur with either procedure.
We often recommend SMILE if you have an active lifestyle, play contact sports, or work in environments where a flap-related injury could occur. The absence of a flap reduces the risk of dislodging tissue during the healing period or later.
Certain eye conditions and systemic diseases can make laser vision correction unsafe or ineffective. We carefully screen for these issues during your consultation.
- Keratoconus or other corneal ectatic disorders
- Severe dry eye syndrome that is not well controlled
- Uncontrolled diabetes or autoimmune diseases
- Cataracts or glaucoma requiring treatment
- Pregnancy or nursing, due to hormonal fluctuations
- History of herpetic eye disease or recurrent corneal erosions
- Corneal dystrophies such as epithelial basement membrane dystrophy
- Significant allergic eye disease with frequent rubbing
- Recent isotretinoin use or other medications known to affect corneal healing
- Suspicious or unstable corneal tomography even without diagnosed keratoconus
If Contoura LASIK or SMILE is not right for you, we can discuss other vision correction options that may better suit your needs.
- PRK or topography-guided PRK for thinner corneas or those who prefer no flap
- Phakic ICL for higher myopia or when corneal tissue preservation is preferred
- Refractive lens exchange for hyperopia or when presbyopia is the dominant concern
- Deferring surgery while treating dry eye or blepharitis to optimize the ocular surface
- Corneal cross-linking for progressive ectatic disease, with or without later refractive correction
Your age affects both candidacy and expected outcomes. If you are under 21, your prescription may still be changing, which makes it wise to wait for greater stability.
Prescription limits also matter. Contoura LASIK is typically used for myopia up to about -9.00 D with up to about 3.00 D of astigmatism. SMILE is often used for myopia from about -1.00 D to -10.00 D with up to about 3.00 D of astigmatism. Exact ranges vary by laser platform and your surgeon will confirm whether your values fall within safe, approved parameters.
Your Pre-Procedure Eye Exam and Testing
We begin with a full eye exam that checks your current prescription, eye pressure, and the health of each part of your eye. This includes examining your retina, optic nerve, lens, and cornea to rule out conditions that could interfere with surgery or healing.
We also review your medical history, current medications, and any allergies. This ensures we identify any factors that might increase your risk or affect your recovery timeline.
Advanced imaging technology creates a detailed map of your corneal surface, measuring thousands of elevation points. For Contoura LASIK, this topography data guides the laser to smooth irregularities and optimize your visual outcome.
We also measure corneal thickness using a device called a pachymeter (a device that measures corneal thickness) or optical coherence tomography (high-resolution imaging of the eye). Adequate thickness is essential because both procedures remove tissue, and we must leave enough behind to maintain structural strength and prevent complications.
We also calculate your residual stromal bed and the percent tissue altered to keep these safety metrics within accepted limits, which helps minimize the risk of postoperative corneal ectasia.
We measure your pupil diameter in different lighting conditions. Large pupils can increase the risk of glare and halos after surgery, so knowing this helps us choose the safest treatment zone and predict how you will see at night. These tests help us lower the risk of glare and halos and tailor your treatment zone.
- Tear film quality and quantity tests for dry eye
- Schirmer test or tear breakup time measurement
- Evaluation of meibomian gland function
Contact lenses can temporarily change the shape of your cornea. As a general guide, stop soft spherical lenses for at least 3 to 7 days, soft toric or extended-wear lenses for 1 to 2 weeks, and rigid gas permeable or orthokeratology lenses for 3 to 4 weeks. We may extend these intervals and confirm stability with repeat topography before scheduling.
On the day of testing, avoid wearing eye makeup, lotions, or perfumes, as these can interfere with measurements and increase infection risk. Bring a list of your current medications and be prepared to discuss your health history in detail.
What Happens During Each Procedure
After numbing your eyes with drops, we use a femtosecond laser or a specialized blade to create a thin, hinged flap in the outer layer of your cornea. We gently lift this flap to expose the underlying tissue.
Next, we apply the excimer laser, which is programmed with your unique topography data. The laser removes microscopic amounts of tissue in a precise pattern, reshaping your cornea to correct your vision. We then reposition the flap, which adheres naturally without stitches.
We also numb your eye with drops before starting the SMILE procedure. A femtosecond laser creates a lenticule, which is a small, lens-shaped piece of tissue, within the middle layers of your cornea.
The same laser also makes a tiny incision on the side of your cornea. Through this opening, we carefully remove the lenticule. Your cornea then assumes a new shape that corrects your nearsightedness and astigmatism, and the small incision heals on its own.
Both procedures are performed under topical anesthesia, so you should not feel pain. You may notice pressure on your eye when the suction device holds it steady, and you might see dimming or flashing lights as the laser works.
Most patients describe the sensation as mild discomfort rather than pain. The entire experience is brief, and we talk you through each step to keep you comfortable and calm. Your vision may dim briefly during suction and we will cue you on fixation to keep you comfortable and on target.
The actual laser time for one eye is typically less than 30 seconds for SMILE and under one minute for Contoura LASIK. Including preparation, numbing, and all steps, each eye takes about 10 to 15 minutes.
You should plan to be in our office for about two hours total to allow time for final checks, paperwork, and post-procedure instructions. Someone will need to drive you home, as your vision will be blurry immediately afterward. Do not plan to drive until your day 1 exam confirms that your vision meets legal driving standards.
Recovery, Results, and Aftercare
Right after Contoura LASIK, you may experience mild burning, tearing, and light sensitivity. Your vision will be hazy at first but often clears significantly within a few hours. We recommend going home to rest with your eyes closed.
SMILE patients also notice tearing and light sensitivity, but many report less discomfort than with flap-based procedures. Vision may be blurry for the first day, and you should avoid rubbing your eyes or getting water in them during this critical early period.
Contoura LASIK patients often see well enough to return to most activities within one to two days. By the end of the first week, many people achieve functional vision, although fine-tuning continues for several weeks.
SMILE recovery can be slightly slower in the first few days, with vision gradually sharpening over one to two weeks. However, because the corneal surface remains mostly intact, many patients experience less dryness and irritation during the healing process.
Most patients achieve 20/20 vision or better after either procedure, though individual results vary. Contoura LASIK may deliver faster visual recovery, with many people noticing clear vision within 24 hours.
- SMILE vision typically stabilizes over one to four weeks
- Both procedures can reduce dependence on corrective lenses
- Fine detail and contrast may continue improving for three to six months
- Final outcomes depend on your initial prescription and healing response
- Not everyone reaches 20/20 uncorrected vision. Some patients require an enhancement procedure to fine-tune focus.
We will see you the day after surgery to check your healing and vision. Additional visits are usually scheduled at one week, one month, three months, and six months to monitor your progress and address any concerns.
You will use antibiotic drops to prevent infection and anti-inflammatory drops to control swelling. Lubricating drops help keep your eyes moist and comfortable. We provide a detailed schedule and written instructions to ensure you use each medication correctly. We may adjust or taper your anti-inflammatory drops based on your healing and eye pressure. Continue annual comprehensive eye exams after you are discharged from postoperative care.
Many Contoura LASIK patients return to desk work within one to two days, while SMILE patients may need two to three days depending on visual demands. Avoid rubbing your eyes, swimming, and hot tubs for at least two weeks. Wear protective eye shields while sleeping for at least the first week after LASIK and for several nights after SMILE. Avoid eye makeup for one week to lower infection risk.
You can resume light exercise such as walking almost immediately, but we recommend waiting one week for moderate workouts. For contact or high-impact sports, wait at least 4 weeks after LASIK and 2 to 4 weeks after SMILE, and always wear sport-specific eye protection. Discuss any occupation or activity with risk of direct eye trauma with your surgeon.
Both procedures offer long-lasting results, and most patients enjoy stable vision for many years. However, your eyes can still change over time due to aging or other factors.
If your vision regresses, we may recommend an enhancement procedure to fine-tune your results. Enhancements are generally easier after Contoura LASIK because we can lift the original flap, whereas SMILE enhancements may require surface laser treatment or a different technique.
Risks, Side Effects, and When to Call Us
Dry eyes, glare, halos around lights, and light sensitivity are normal in the weeks following either procedure. These symptoms usually improve as your cornea heals and your tear film stabilizes.
- Fluctuating vision during the first few weeks
- Mild discomfort or foreign body sensation
- Increased tearing or watery eyes
- Difficulty with night driving due to halos
While most patients have safe, successful outcomes, certain rare complications can occur with any corneal refractive surgery.
- Corneal ectasia, a progressive thinning and bulging of the cornea that can impair vision
- Infection, including interface keratitis
- Steroid response with elevated eye pressure requiring medication adjustments
- Neuropathic corneal pain that persists beyond surface healing
- Retinal conditions unrelated to corneal surgery, especially in highly myopic eyes
Because Contoura LASIK involves creating a flap, there is a small risk of flap-related issues. The flap might shift, wrinkle, or develop inflammation underneath, a condition called diffuse lamellar keratitis (inflammation beneath the LASIK flap).
Flap complications are rare when the procedure is performed by an experienced surgeon and you follow aftercare instructions carefully. If a problem does occur, we can often reposition the flap or treat the inflammation promptly.
- Epithelial ingrowth under the flap
- Microstriae or flap striae affecting visual quality
- Interface debris requiring flap lift and irrigation
SMILE carries a low risk of incomplete lenticule removal, which can require additional intervention to extract remaining fragments. Some patients may also experience temporary inflammation or light sensitivity that lasts longer than expected.
Because SMILE is a newer procedure, long-term data is still accumulating. However, studies through 2025 show excellent safety and efficacy profiles, with complication rates comparable to or lower than traditional LASIK.
- Suction loss requiring procedural pause or conversion
- Cap tears or incisional issues
- Transient light sensitivity syndrome
While serious complications are uncommon, certain symptoms require urgent evaluation. Contact us right away if you experience sudden vision loss, severe pain that does not improve with prescribed medications, or signs of infection.
- Intense redness or discharge from the eye
- Sudden decrease in vision or new floaters
- Severe eye pain, sudden decrease in vision, or halos with eye pain
- Flashes of light or a curtain over your visual field
- Persistent pain that worsens instead of improving
Frequently Asked Questions
Both procedures deliver excellent precision, but the best choice depends on your specific prescription and corneal characteristics. Contoura LASIK offers topography-guided customization that can address higher-order aberrations, while SMILE provides outstanding results for moderate to high myopia with minimal surface disruption.
Most health insurance plans consider laser vision correction an elective cosmetic procedure and do not provide coverage. However, you can often use funds from a health savings account or flexible spending account to pay for treatment, and many practices offer financing options to make the cost more manageable.
Pricing varies by location, surgeon experience, and technology used, but Contoura LASIK and SMILE typically fall within a similar range. SMILE may cost slightly more at some centers due to the specialized laser platform required, while Contoura may carry a premium for its advanced topography-guided customization.
SMILE may be preferable if you have mild to moderate dry eye, because the smaller incision preserves more corneal nerves and results in less disruption to tear production. We may also recommend treating your dry eye before either procedure to optimize your comfort and healing.
If you are over 40, you likely have presbyopia, the natural age-related loss of near focusing ability. Neither Contoura LASIK nor SMILE reverses presbyopia, so you may still need reading glasses for close work even if your distance vision is corrected. We can discuss monovision or other strategies to reduce your dependence on readers.
Our eye doctor will consider your prescription, corneal shape, lifestyle, and personal preferences. If you play contact sports or have concerns about flap-related risks, SMILE may be ideal. If you want the most customized treatment or have astigmatism, Contoura LASIK might be the better fit. We will review all the data together to help you make a confident, informed decision.
Getting Help for Contoura LASIK vs. SMILE
Choosing between Contoura LASIK and SMILE is an important decision that affects your vision and quality of life. Our eye doctor will perform a thorough evaluation, explain your options in detail, and recommend the procedure that aligns with your unique needs and goals. Schedule a consultation to learn which advanced laser vision correction is right for you. Regardless of the procedure you choose, plan on regular annual eye exams to monitor long-term ocular health.