Hello, this is Goyang Shinsegae Eye Clinic.
During consultations for laser vision correction, we are often asked the following question:
“SMILE is very popular these days. Doesn’t that mean it is the better procedure?”
The short answer is no.
A more expensive procedure is not necessarily a better procedure.
Some of the latest-generation SMILE procedures may cost approximately KRW 4-5 million, largely because of the cost of dedicated laser platforms and disposable surgical components.
However, when choosing a vision correction procedure, there are factors that matter more than price.
We first need to evaluate whether the cornea is thick enough, the degree of myopia and astigmatism, the severity of dry eye, and whether a patient’s occupation or athletic activities increase the likelihood of trauma to the eye.
Some eyes are well suited to SMILE, while others may be more appropriate for 2-Day LASEK.
In particular, for patients with high myopia or high astigmatism, or for athletes who may frequently experience external impact to the face or eyes, the structural characteristics of surface ablation procedures such as LASEK may be especially important.
The first step is not choosing a procedure based on its name or price.
The priority is choosing the method that best matches the condition of your eyes.
Contents
1. SMILE Is Not Necessarily Better Just Because It Costs More
2. High Myopia or Astigmatism? 2-Day LASEK May Also Be Considered
3. Different Age Groups Require Different Considerations
4. Why Athletes May Choose 2-Day LASEK
5. Recovery and Regular Follow-Up After Surgery
6. Conclusion: The Best Procedure Is the One That Fits Your Eyes
1) SMILE Is Not Necessarily Better Just Because It Costs More
SMILE is a refractive procedure in which a thin disc of corneal tissue, called a lenticule, is created within the corneal stroma and removed through a small incision.
Because it does not require the creation of a large corneal flap and uses a relatively small incision, one of its advantages is relatively rapid early recovery.
However, the higher cost of SMILE does not mean that it is automatically the better option for every patient.
SMILE requires dedicated equipment and single-use surgical components, which contribute to the overall cost of the procedure.
These disposable components may account for a significant portion of the surgical fee.
While 2-Day LASEK may cost in the lower KRW 1 million range, SMILE procedures may cost approximately KRW 2–4 million depending on the platform and medical institution.
One reason for this difference is the use of a disposable patient interface, including the suction component required during SMILE surgery.
Depending on the system, these single-use components can be costly and are reflected in the overall surgical fee.
In comparison, 2-Day LASEK generally involves lower disposable equipment costs, which can make the procedure more affordable.
Another important factor is how much corneal tissue remains after surgery.
2-Day LASEK may preserve more of the cornea’s supporting structure because treatment is performed from the surface.
Preserving sufficient corneal tissue is important because excessive weakening of the cornea may increase the risk of complications such as corneal ectasia.
In comparison, SMILE removes tissue from within the corneal stroma, and the remaining biomechanical structure should therefore be carefully evaluated in each patient.
Corneal ectasia: A condition in which the cornea becomes structurally weakened after refractive surgery and progressively bulges forward.
Once corneal tissue has been removed, it does not regenerate to its original thickness.
For this reason, one of the most important considerations before surgery is how much healthy corneal tissue can safely remain after correction.
In patients with high myopia or in those for whom future enhancement procedures may need to be considered, corneal preservation can therefore become an important part of the surgical decision.
① Degree of myopia and astigmatism
② Corneal thickness
③ Expected residual corneal thickness after surgery
④ Astigmatic axis
⑤ Corneal topography
⑥ Retinal condition
⑦ Whether corneal cross-linking may be needed
When myopia is very high, a greater amount of tissue may need to be removed, which can reduce the amount of cornea remaining after surgery.
In these cases, the ophthalmologist may also determine whether an additional procedure such as corneal cross-linking should be considered.
Choosing SMILE simply because it is newer is not the right approach.
The procedure should instead be selected according to the patient’s individual corneal and refractive characteristics.
2) High Myopia or Astigmatism? 2-Day LASEK May Also Be Considered
The higher the degree of myopia, the greater the amount of corneal reshaping that may be required.
For patients with high myopia, the more important question is often not simply, “Can the surgery be performed?” but rather, “Will enough corneal tissue remain after surgery?”
Astigmatism also requires careful planning.
Correcting astigmatism involves more than simply addressing the refractive power.
The astigmatic axis must also be measured accurately because the refractive power of the eye differs depending on direction.
The laser treatment must therefore be aligned with the appropriate axis.
2-Day LASEK uses an excimer laser to reshape the corneal surface and underlying stromal tissue after epithelial removal.
For patients with high myopia or astigmatism, the following factors should be carefully evaluated:
① Degree of myopia and astigmatism
② Corneal thickness
③ Expected residual corneal thickness after surgery
④ Astigmatic axis
⑤ Corneal topography
⑥ Retinal condition
⑦ Whether corneal cross-linking may be needed
When myopia is very high, a greater amount of tissue may need to be removed, which can reduce the amount of cornea remaining after surgery.
In these cases, the ophthalmologist may also determine whether an additional procedure such as corneal cross-linking should be considered.
Choosing SMILE simply because it is newer is not the right approach.
The procedure should instead be selected according to the patient’s individual corneal and refractive characteristics.
3) Different Age Groups Require Different Considerations
“What is the minimum age for LASIK or LASEK?”
This is another question we frequently hear.
In general, laser vision correction is considered after ocular growth has stabilized and when there has been no significant change in the refractive prescription for at least approximately one year.
Being in your 40s does not automatically mean that laser vision correction is no longer an option.
However, presbyopia often begins to develop during this period.
For this reason, the surgical target should not be determined based on distance vision alone.
Near vision and everyday visual needs should also be considered when planning correction.
By the late 50s, the condition of the natural crystalline lens becomes increasingly important.
If cataracts have already developed or are beginning to progress, it may be more appropriate to first consider the condition of the lens and the overall cataract treatment plan rather than proceeding with LASIK or LASEK alone.
Q&A
Q. Can I have 2-Day LASEK if I have astigmatism?
A. Yes, depending on the degree and characteristics of the astigmatism.
The amount and axis of astigmatism are carefully measured so that laser treatment can be applied according to the appropriate direction.
Q. Does everyone with high myopia need corneal cross-linking?
A. No.
Corneal cross-linking is not automatically required for every patient with high myopia.
The decision is based on factors such as the amount of correction required, corneal thickness, corneal shape, and the amount of tissue expected to remain after surgery.
Q. Can people in their 40s undergo laser vision correction?
A. Yes, in selected cases.
However, presbyopia and the condition of the natural crystalline lens should be evaluated in addition to myopia and astigmatism.
4) Why Athletes May Choose 2-Day LASEK
Athletes have an additional consideration that may be less relevant for many other patients.
That factor is external trauma.
Some sports, such as soccer or baseball, involve the possibility of being struck by a ball.
Combat sports may involve direct impact to the face and eyes.
Golf involves less direct trauma, but precise distance judgment and visual focus can have an important effect on performance.
One of the main structural characteristics of 2-Day LASEK is that it does not create a corneal flap.
This can be an important consideration for athletes who frequently rub their eyes or participate in sports where impact to the face or eyes is possible.
Many athletes also wear contact lenses for long periods of time.
When competing while wearing contact lenses, wind and dust may cause irritation, while dryness may make vision temporarily less clear or stable.
Having to continuously pay attention to contact lens discomfort during competition can also interfere with concentration.
For athletes, refractive surgery is therefore not simply about achieving clearer vision.
The ophthalmologist should also consider the competition schedule, recovery period, most important working distance, risk of external trauma, and the degree of myopia and astigmatism.
For athletes who place particular importance on a flap-free corneal structure, 2-Day LASEK may therefore be one of the procedures considered.
5) Recovery and Regular Follow-Up After Surgery
The process of laser vision correction does not end when the surgery itself is finished.
During the early recovery period, vision may appear hazy or fluctuate in clarity.
Vision generally improves as healing progresses, and by around one month, patients may begin to see a more stable result.
At the one-month follow-up examination, we do not simply check the visual acuity chart.
■ Whether any residual myopia, hyperopia, or astigmatism remains
■ Whether the laser treatment is appropriately centered
■ Whether corneal thickness and structure are stable
■ Whether corneal topography shows any unusual findings
■ Whether corneal haze or other postoperative changes are present
These factors should be evaluated together.
Some patients ask:
“I can see well now. Do I still need to come back for follow-up appointments?”
The answer is yes.
Certain postoperative changes may not appear immediately after surgery and can instead develop several weeks or months later.
For this reason, regular follow-up examinations should not be discontinued simply because vision seems clear.
The speed of recovery varies from patient to patient, but ongoing ophthalmic monitoring for an appropriate period remains an important part of postoperative care.
Thank you.
