Alternatives to LASIK

Article Overview

Photorefractive keratectomy (PRK) is a minimally invasive and doesn’t involve making a corneal flap with an excimer laser. It's an excellent alternative for people with thin corneas.

Laser epithelial keratomileusis (LASEK) is a minimally invasive procedure that involves making an epithelial flap instead of a thicker corneal flap. 

Small incision lenticule extraction (SMILE) is a highly specialized procedure that removes a disc-shaped piece of the cornea (lenticule) to reshape it. 

Intraocular lens implants (IOLs) are artificial lenses implanted to replace the natural lens. They’re common during cataract surgery.

Phakic intraocular lenses (IOLs) are artificial lenses placed behind the iris and in front of the natural lens to correct vision. Or, they may also be placed between the cornea and iris.

Refractive lens exchange (RLE) is similar to cataract surgery, but is actually for those without cataracts. RLE is permanent and can correct farsightedness, nearsightedness, and astigmatism.

6 Best Alternatives to LASIK

LASIK eye surgery is one of several revolutionary treatments for visual problems. 

Since its FDA approval in 1999, LASIK has undergone various developments to make it safer and increase its chances of success.

Today, 95% of LASIK beneficiaries report positive results many years down the line.¹

However, not everyone with vision problems is a good candidate for LASIK eye surgery. For example, LASIK won't work if you have thin corneas. LASIK surgery requires a thick cornea to create a corneal flap. 

The corneal flap is a piece of the cornea that is cut and briefly folded back to allow for laser treatment. This procedure isn’t possible if you have thin corneas. 

Other factors such as age, eye diseases, and general health might also disqualify you from LASIK. Luckily, there are alternatives to LASIK that can help you achieve perfect vision. 

Below are the five best alternatives:

1. Photorefractive Keratectomy (PRK)

Photorefractive keratectomy (PRK) is a vision correction surgery and a LASIK alternative. 

During PRK eye surgery, the corneal epithelium is removed.² This is the thin top layer of the cornea. Removing this layer exposes the cornea for treatment with an excimer laser. 

PRK is different from LASIK, which requires cutting into the cornea to make a foldable flap. LASIK also requires a thick cornea, while PRK does not. 

PRK is an excellent option for patients with thin corneas and those prone to dry eyes. 

Candidacy 

You qualify for PRK if you:

• Are at least 18 years or older
• Have generally healthy eyes
• Aren’t pregnant or nursing
• Don't have underlying diseases, such as diabetes, that can affect healing

Complications  

• Glare and halos around lights, especially at night
• Corneal scarring
• Corneal haze (cloudiness in the cornea)
• Infections of the cornea

Pros 

• Better vision
• No flap is created during surgery
• Ideal for thin corneas
• Low risk of long-term complications
• High chances of success

Cons

• Risk of under-correction or overcorrection
• Might create worse vision than before (loss of best-corrected vision)
• Risk of vision loss
• Chances of dry eyes
• Require bandage contact lenses to cover the eyes until you recover

Costs 

Because PRK is considered elective surgery, it is unlikely insurance will cover it. Similar to LASIK, though, your vision insurance will likely cover some of the costs of initial examinations. You might have to cover a portion on your own.

The exact cost of PRK depends on several factors, including your provider, location, and pre- and post-care services provided, among others. Expect to pay between $1,800 and $4,000.

2. Laser Epithelial Keratomileusis (LASEK)

Laser epithelial keratomileusis, or LASEK, is similar to both LASIK and PRK. It’s a great alternative. 

LASEK is ideal for people with thin corneas, a factor that disqualifies them from LASIK surgery.³

During LASEK, the epithelium is removed and softened with a diluted alcohol solution. Then it’s folded back. The corneal shape is altered using the excimer laser, and the epithelial flap is replaced. It's held into position by a contact lens to facilitate healing.

Candidacy 

You qualify for LASEK if you:

• Are at least 18 years or older
• Have a stable vision for at least 1 year
• Don’t have certain eye diseases, such as cataracts or glaucoma
• Aren’t taking certain medications, such as steroids, that can affect healing
• Are free of diseases, such as diabetes or rheumatoid arthritis, that may interfere with healing
• Want to eliminate the need for eyeglasses or contacts

Side Effects 

• Feeling like something is in your eyes
• Seeing halos around objects
• Poor night vision
• More pain and discomfort compared to LASIK 
• Dry eyes
• Inflammation and Infections
• Sensitivity to light

Pros

• Ideal for thin or flat corneas
• High chances of success
• Vision can become 20/40 or better 
• Long-lasting 

Cons

• Possibility of undercorrection or overcorrection
• Thinning of the cornea over time
• Prolonged recovery period that can last between 6 and 9 months

Costs

The cost of the LASEK procedure is almost similar to LASIK and PRK. Although it may differ based on the facility and other factors, expect to pay about $1,800 to $5,000. 

Additionally, your insurance coverage might leverage some costs. 

3. Small Incision Lenticule Extraction (SMILE)

Small incision lenticule extraction (SMILE) is also a laser-based refractive surgery.⁴ During SMILE, a surgeon uses a femtosecond laser to adjust the shape of the cornea.

The laser cuts a disc-shaped piece within the cornea. This disc-shaped piece is known as the "lenticule," which gives the procedure its name.

The surgeon then makes an incision and pulls out the lenticule. This reshapes the cornea. 

Small incision lenticule extraction takes about 30 minutes to complete.

Candidacy 

You qualify for SMILE if you:

• Are 18 years or older
• Have an eye prescription that has remained stable over the last year
• Have nearsightedness between -1 and -10
• Have up to 0.5 diopters of astigmatism
• Want to eliminate the need for eyeglasses

Complications 

• Dry eyes
• Epithelial defect (does not affect the visual outcome)
• Infectious keratitis (rare)
• Epithelial ingrowth due to accidental implanting of migrated epithelial cells
• Diffuse lamellar keratitis or DLK (a noninfectious inflammatory condition)

Pros

• Eliminates the flap-related complications of LASIK
• Low incidence of complications if done correctly⁷

Cons

• Requires high expertise to perform
• Increases risk of undercorrection compared to LASIK
• Involves a prolonged recovery
• Requires bandage contact lenses after treatment

Costs

The cost of the SMILE procedure has reduced drastically since its creation and as its popularity has increased. 

According to Market Scope U.S. Refractive Surveys of 2019, the average cost of SMILE is about $2,361 per eye.⁸

This price might vary depending on your location, pre-and post-surgical care services provided, and the complexity of your surgery.

4. Intraocular Lens (IOL) Implants

An intraocular lens (IOL) implant is an artificial lens inserted into your eyes to replace the natural lens. IOL is commonly used to treat cataracts and is a great alternative to LASIK.

The lens is made of clear plastic material and comes in four types:⁹

Monofocal IOL. This is the most common, and its focus is fixed. For example, you can only see distant objects and might need glasses for close objects.

Multifocal implants. These allow you to see objects at different distances. Sometimes, they cause halos or glares around lights.

Accommodating IOLs. These are the most flexible and work just like the natural eye lens. With accommodating IOLs, you're less likely to need reading glasses.

Toric IOLs. These are lenses used during cataract surgery to reduce the effects of postoperative astigmatism.

Candidacy

 You qualify for IOLs if you have:

• Severe myopia (nearsightedness greater than -10 or -11 diopters)
• Cataracts
• Excellent macular function
• Healthy eyes/corneal surfaces
• Monovision contacts that aren’t helping
• A desire to eliminate the need for glasses

Side Effects  

• Blurry vision, especially as your eyes adjust to the lenses
• Sensitivity to light
• Dry eyes
• Mild pain and inflammation
• Increased intraocular pressure
• Retinal detachment

Pros

• Encourages a more active life without needing glasses
• Requires minimal to no upkeep
• Is cheap compared to replacement glasses and corrective lenses

Cons

• Often causes halos and glares at night
• Might require glasses to enhance vision
• Increases chances of cataract surgery complications

Costs

The price of intraocular lenses is determined by the surgeon you choose and the surgery location. 

A lens implant typically costs between $1,500 and $3,000 per eye. This surgery is considered elective and isn’t covered by insurance, unless your doctor diagnoses you with a cataract. 

If the cataract is significant, your insurance may cover the majority of the procedure. In many cases, only monofocal IOLs are covered.

However, you save money compared to repurchasing prescription glasses and/or contact lenses throughout your life.

5. Phakic Intraocular Lens Implants

If your prescription is too high for laser eye surgery, phakic IOLs or implantable collamer lens (ICL) may be ideal for you.

The phakic procedure involves placing implantable contact lenses behind the iris and in front of the natural eye lens to correct your refractive errors.⁹ This procedure takes about 15 minutes per eye.

Visian ICL is the latest version of the Phakic implants used to correct a wide range of myopia (nearsightedness). The lens is intended for permanent use, but the procedure is reversible at any time.

Phakic IOL is quite different from regular IOLs and refractive lens exchange (RLE) because it preserves natural lenses. 

In other IOLs and RLE, the natural lens is removed and replaced with an artificial one.

Note: Visian ICL is a specific brand of ICL (posterior chamber IOL). Another brand is Verisyse, which is an anterior chamber IOL. It's placed between the cornea and iris.

Candidacy 

You may qualify for Phakic IOL if you:

• Are between 21 and 45 years old
• Aren’t a good LASIK candidate 
• Have moderate to severe myopia
• Have minor to no astigmatism
• Have good general eye health with no history of trauma
• Do not take medications such as steroids that can interfere with healing
• Have at least six months to a year of unchanged vision correction prescriptions
• Aren’t pregnant or breastfeeding
• Aren’t allergic to local anesthetic eye drops

Side Effects 

• Glares, halos in low level lighting
• Blurry vision
• under correction or overcorrection
• Increased intraocular pressure (glaucoma)
• Clouding of the natural lens (cataracts)
• Endothelial cell loss
• Eye infections

Pros 

• Ideal for patients with higher amounts of myopia (-3.0 diopters to -20.00 diopters)
• Results in clearer vision (20/20 or better)
• Works for patients who are ineligible for LASIK
• Minimal to no maintenance
• Completely reversible 
• A long-term solution
• No risk of dry eyes
• No need for glasses or contact lenses after ICL

Cons 

• Not covered by insurance because it’s an elective surgery
• Has an age limit of 21 to 45 years
• More expensive than laser treatments

Costs

The phakic procedure costs about $4,000 or more per eye. Because refractive surgery is considered elective, insurance will not cover it.

The cost may also vary from one provider to the other. Phakic IOL is worth it if you’re aiming for a long-term solution for myopia.

6. Refractive Lens Exchange (RLE)

Refractive lens exchange surgery is a LASIK and PRK alternative. It's similar to cataract surgery but is done on patients without cataracts.

RLE is used to correct farsightedness, nearsightedness, and astigmatism. 

The procedure involves implanting artificial lenses in the eyes to enhance vision.¹⁰ This way, it eliminates the need for replacement lenses and glasses.

Because RLE uses artificial lenses that are permanent, it has a long-lasting visual outcome.

Candidacy 

You qualify for RLE if you:

• Are over 50 and are experiencing early stages of cataract development
• Don't qualify for LASIK eye surgery or PRK
• Wish to treat presbyopia (inability to focus on near objects)
• Want to eliminate the need for glasses

Side Effects  

• Temporary blurring
• Increased sensitivity to light
• Halos and rings around lights

Pros

• Beneficial to aging eyes
• Provides a permanent solution and better visual quality
• Avoids the burden and cost of glasses and replacement contact lenses
• Involves a short recovery period
• Prevents cataract development

Cons

• Not ideal for some eye conditions
• More invasive than LASIK
• Costs more than LASIK

Costs

RLE is also an elective surgery and is not covered by insurance. 

Generally, the cost of RLE can range anywhere from $2,500 to $4,500 per eye.

Which Procedure is Right for You?

The right vision correction procedure for you depends on needs. Each of the above procedures are effective and safe.

If you don't qualify for LASIK, your doctor will thoroughly examine your refractive error, eye health, and general health before recommending an appropriate alternative.

LASIK is most appropriate if you have thick corneas. For thin corneas, PRK and LASEK are the best options. These are less invasive alternatives and don't require a corneal flap. 

SMILE involves making an incision in the cornea by using a laser and cutting out a lenticule. This reshapes the cornea without the risk of corneal flap complications.

IOL implants and RLEs are most appropriate when replacing the eye’s natural lens. These implants offer a more permanent and long-lasting solution compared to other corrective procedures.

If you have eye diseases or are ineligible for laser vision surgery for any reason, glasses and contact lenses might be the best option for you. 

You may also need to wear glasses to enhance visual outcomes after recovery.