SMILE, PRK or ICL in Los Angeles: Alternatives to LASIK Compared

Why you might be steered away from LASIK

The FDA's LASIK Surgery Checklist lists factors that can make someone a poor LASIK candidate, including thin corneas, dry eyes, large pupils in dim light, an unstable prescription, autoimmune or chronic disease, and steroid use. The AAO adds that LASIK requires corneas that are thick enough and healthy, plus a refractive error LASIK can treat.

Some of these factors rule out refractive surgery for now, such as a prescription that is still changing. Others may point toward a different procedure. Only an examining surgeon can tell which applies to you, so the most useful consultation question is simple: what exactly makes LASIK less suitable for me, and how does this alternative address it?

If you play contact or impact sports, ask each surgeon how the recommended procedure affects your return to training. For LASIK, the FTC's guidance is no impact sports for 4 weeks.

SMILE (small-incision lenticule extraction)

SMILE uses a laser to form a small disc of tissue, called a lenticule, inside the cornea, which is then removed through a small incision. According to the AAO, the laser part takes about 30 seconds.

• Treats: nearsightedness and astigmatism. LASIK is indicated in the U.S. for farsightedness; SMILE is not.
• Incision: 2 to 3 mm for SMILE, compared with 20 mm for LASIK, per an AAO Young Ophthalmologists article.
• Track record: available in the U.S. since 2016; LASIK since 1999.
• Dry eye: SMILE has shown less dry eye at six months, according to the same AAO article.
• Surgery day: you need someone to drive you home, and vision may be blurry right after.
• If results aren't ideal: problems can often be improved with glasses, contacts or more laser surgery.

Newer data cut the other way on sharpness. In October 2025 the AAO publicized a 60-patient study in which each person had wavelight plus LASIK in one eye and SMILE Pro in the other. At three months, 98% of the LASIK eyes reached 20/12.5 or better, compared with 82% of the SMILE Pro eyes. That's one study with short follow-up, so treat it as a question to raise with surgeons rather than a verdict.

PRK

PRK is a laser refractive procedure. The FDA names it, alongside RK and LASIK, when it lists previous refractive surgery as a reason LASIK may not be right for someone. Our review of official PRK patient information isn't finished, so this guide doesn't describe its technique, recovery time or results. Rather than repeat claims we haven't checked, here's what to ask a surgeon who recommends it:

• Why PRK rather than LASIK or SMILE for my eyes?
• What does recovery look like day by day, and how much time off work should I plan for?
• How many follow-up visits are included in the price?
• What are the specific risks for my prescription and corneas?
• If I need a touch-up, what does it involve and cost?

ICL (implantable collamer lens)

An ICL is a phakic intraocular lens: a lens implanted inside the eye while your natural lens stays in place. Key facts from the sources we reviewed:

• The Visian ICL was FDA-approved in December 2005, according to University of Michigan Health.
• The EVO ICL followed in 2022; EyeWiki dates FDA approval of EVO, EVO+ and the toric version to March 2022.
• EyeWiki describes EVO as the only FDA-approved posterior chamber phakic IOL in the U.S.
• It's made by STAAR Surgical in Monrovia, in the San Gabriel Valley.

These criteria come from one approval record for one model. Newer versions may carry different labeling, and measurements such as anterior chamber depth can only be taken in an exam. Ask the surgeon which lens they propose and what its labeling says.

The options side by side

Paying for an alternative

The FDA notes that most medical insurance won't pay for refractive surgery, and all of these procedures are refractive surgery. The only verified price comparison we found is the AAO's 2019 average: $2,361 per eye for SMILE versus $2,246 for femtosecond LASIK. We found no verified figures for PRK or ICL. Ask each practice for a written, itemized quote that says whether it's per eye, which follow-up visits are included and what any additional procedure would cost.

Where to ask about these options in Los Angeles

Not every practice offers every procedure, and that can shape what you hear. A practice without SMILE or ICL may not bring them up. Among academic centers, UCLA's Stein Eye Center Calabasas lists LASIK and laser vision correction plus cataract and refractive services, USC Roski's Glendale clinic lists refractive consultations, and its Arcadia clinic lists cataract and refractive surgery. Call and ask which of SMILE, PRK and ICL they perform before booking.

For any surgeon, academic or private, run through our verification steps and compare at least two consultations, as the FDA recommends. If LASIK is back on the table, our LASIK guide covers recovery and cost questions in detail.

Questions for every consultation

1. Which of these procedures do you perform, which would you rule out for me, and why?
2. Which of my measurements make one option a better fit than another?
3. Realistically, will I still need glasses for reading or night driving?
4. What problems do you see most often after this procedure, and how are they managed?
5. Who handles follow-up, and how often will I need to come in?
6. What is the total cost, in writing?