Procedures
LASIK vs PRK vs SMILE vs EVO ICL vs Lens Exchange: What Each One Is
As of September 2026, LASIK, PRK, SMILE, EVO ICL, and refractive lens exchange are the five main vision correction procedures in the US. Each method changes vision by physically altering the cornea or lens in different ways. The LASIK Index tracks how many practices offer each option, but only an eye exam can determine if a patient is suitable, according to the FDA.
By The LASIK Index editorial team · Published · Updated · Editorial policy
Key takeaways
- 810 of 839 practices in The LASIK Index perform LASIK.
- PRK is available at 658 practices, while SMILE is offered at 88.
- EVO ICL and lens exchange are performed at 482 and 390 practices, respectively.
- LASIK, PRK, and SMILE reshape the cornea, while EVO ICL and lens exchange involve the eye's lens.
- The FDA states that only a full eye examination can determine candidacy for any refractive procedure.
What does LASIK physically do to your eye?
LASIK reshapes the cornea to correct vision. The American Academy of Ophthalmology says a flap is created in the cornea and the tissue underneath is reshaped with an excimer laser. The flap is then replaced.
According to the FDA, this permanently changes the shape of the cornea. LASIK is considered a corneal procedure because it does not involve the lens of the eye.
How is PRK different from LASIK?
PRK also uses an excimer laser to reshape the cornea, but without creating a flap. The American Academy of Ophthalmology reports that the outer cell layer is removed and the laser is applied directly to the corneal surface.
This makes PRK a surface ablation procedure. Like LASIK, PRK treats the cornea and does not alter the lens.
What is SMILE and why is it less common?
SMILE removes a small lens-shaped piece of corneal tissue using a femtosecond laser, according to the American Academy of Ophthalmology. The surgeon extracts this tissue through a short incision, changing the cornea's shape.
SMILE is available at 88 practices in The LASIK Index, which is 10.5 percent. SMILE's lower adoption may reflect its newer technology and narrower FDA-approved uses compared to LASIK and PRK.
| Item | Share of practices |
|---|---|
| LASIK | 96.5% (810) |
| PRK | 78.4% (658) |
| SMILE | 10.5% (88) |
| EVO ICL | 57.4% (482) |
| Refractive lens exchange | 46.5% (390) |
How do EVO ICL and lens exchange work?
EVO ICL and refractive lens exchange are lens-based procedures. The American Academy of Ophthalmology states that EVO ICL involves placing an implantable collamer lens inside the eye, behind the iris and in front of the natural lens.
Refractive lens exchange replaces the eye’s natural lens with an artificial one, using the same technique as cataract surgery. Neither procedure reshapes the cornea.
How many practices offer each procedure?
LASIK is performed at 810 of 839 practices in The LASIK Index. PRK is available at 658 practices, EVO ICL at 482, and refractive lens exchange at 390.
SMILE is the least common, offered at 88 practices. EVO ICL and lens exchange are also less widespread than LASIK or PRK, possibly due to their more complex surgical requirements and more limited indications.
- LASIK: 810 practices
- PRK: 658 practices
- SMILE: 88 practices
- EVO ICL: 482 practices
- Lens exchange: 390 practices
Who decides which procedure you can have?
The FDA states that only a complete eye examination can determine if someone is a candidate for LASIK, PRK, SMILE, EVO ICL, or lens exchange. Factors like prescription stability, corneal thickness, and eye health must be evaluated by an ophthalmologist.
The FDA also notes that some jobs prohibit certain refractive procedures and that medical insurance usually does not cover these surgeries.
The short version
LASIK, PRK, and SMILE are corneal reshaping procedures, while EVO ICL and lens exchange alter the lens. LASIK is the most widely available, but SMILE and ICL are far less common. Only an in-person eye examination can determine which procedure, if any, is appropriate, according to the FDA.
Questions people ask
Are all five procedures approved for everyone?
No. The FDA says that candidacy for LASIK, PRK, SMILE, EVO ICL, or lens exchange depends on a full eye exam and factors such as age, prescription stability, and eye health. Not everyone will qualify.
Can you choose which procedure you want?
Patients cannot simply choose any procedure. The FDA states that only an ophthalmologist, after a thorough examination, can determine which refractive procedure is suitable based on individual eye characteristics and medical history.
How are LASIK and PRK similar?
Both LASIK and PRK use an excimer laser to reshape the cornea, according to the American Academy of Ophthalmology. The main difference is that LASIK creates a flap, while PRK removes the surface layer without a flap.
Why are lens procedures less common than LASIK?
EVO ICL and lens exchange are performed at fewer practices, with 482 and 390 respectively, compared to 810 for LASIK. Their lower frequency may reflect their complexity and narrower indications, as shown by The LASIK Index data.
Sources
- The LASIK Index directory data, 839 practices. Methodology
- FDA: What is LASIK?
- FDA: When is LASIK not for me?
- American Academy of Ophthalmology: What is refractive surgery?
This guide is general information, not medical advice. Decisions about eye surgery belong with you and an ophthalmologist who has examined your eyes.