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Refractive laser eye surgery · London

SMILE laser eye surgery, flapless, next-day vision.

A 20 to 30 minute correction of short sight and astigmatism on the Zeiss VisuMax 500 kHz or SMILE Pro 800 kHz - done by a named refractive surgeon, in a CQC-registered London clinic, with LASIK, PRESBYOND and ICL pathways in the same building if SMILE is not the right call.

A stethoscope on a clinical desk

Indicative pricing

What private SMILE costs in London.

Indicative ranges across UK private providers.

In short

£4,500 to £7,500, home the same day.

Procedure Indicative range
Refractive suitability consultation and Pentacam £250-£400
SMILE (both eyes, VisuMax 500 kHz) £4,500-£5,500
SMILE Pro (both eyes, VisuMax 800 kHz) £5,500-£7,500
LASIK (both eyes, comparison option) £3,500-£5,500
PRESBYOND blended vision (both eyes, over-45s) £4,800-£6,500
Second-opinion review of prior refractive assessment £200-£400

Prices vary by clinic, by surgeon seniority, by whether SMILE Pro is used, and by prescription complexity. Enhancement policies of 1 to 2 years are usually included.

When it helps

When SMILE is the right step - and when it is not.

The prescriptions and lifestyles that suit SMILE best, plus the eye features that mean a different refractive option is safer.

  • Myopia between -1 and -10 dioptres

    The core SMILE indication. Zeiss FDA-approved from -1 to -10 D since expansion in 2018, with best outcomes in the -3 to -8 D range.

  • Mild to moderate astigmatism up to -3 D

    Cylinder up to -3 D can be corrected. Toric SMILE requires careful cyclotorsion control - a surgeon experienced in astigmatic alignment matters.

  • Active lifestyle or contact-sport athlete

    No corneal flap means no flap dislocation risk from a knock to the eye - a reason many rugby players, martial artists and armed forces personnel prefer SMILE.

  • Contact lens intolerance or chronic discomfort

    Recurrent lens-related dryness, giant papillary conjunctivitis or infection. SMILE removes the daily hassle in a single 30-minute session.

  • Borderline dry eye (not severe)

    SMILE severs fewer corneal nerves than LASIK. Mild dry eye patients often do well - severe dry eye still needs PRK or a non-laser option.

  • Thin cornea - reconsider

    A corneal thickness under 480 to 500 microns, or a residual stromal bed calculation under 250 microns, means SMILE is off the table. PRK or an ICL is safer.

  • Hyperopia or presbyopia - not yet suitable

    SMILE does not treat long-sightedness or age-related reading loss.

  • Red flag: keratoconus or ectasia risk

    Any topographic asymmetry, forme fruste keratoconus or family history of ectasia is an absolute contraindication. Pentacam picks this up.

Refractive options

SMILE is one option in a family of refractive procedures.

What each option actually involves, and which fits which eye. For very high myopia over -10 D or thin corneas, an ICL or PRK usually beats SMILE.

  • SMILE (VisuMax 500 kHz)

    The original flapless technique. Femtosecond laser sculpts a lenticule inside the cornea in about 26 seconds; the surgeon extracts it through a 3 to 4 mm micro-incision.

  • SMILE Pro (VisuMax 800 kHz)

    The 2022 upgrade. Faster 800 kHz laser cuts the lenticule in around 10 seconds, with automated centration and cyclotorsion compensation. Smoother patient experience, tighter alignment.

  • LASIK (femto-LASIK)

    A femtosecond flap is lifted, an excimer laser reshapes the bed, and the flap is repositioned. Broader indication range - myopia, hyperopia and higher astigmatism - but the flap is permanent.

  • PRK / LASEK / TransPRK

    Surface ablation with no flap and no lenticule. The workhorse for thin corneas or borderline topography. Slower visual recovery - 4 to 7 days - but the strongest structural safety.

  • PRESBYOND blended vision

    Zeiss LASIK profile that expands each eye is depth of focus and blends them for reading. The go-to for motivated over-45s who want to drop reading glasses without a lens exchange.

  • ICL (implantable Collamer lens)

    A phakic lens placed behind the iris. First choice for very high myopia (over -10 D), thin corneas or dry eye that rules laser out. Reversible; requires an intraocular procedure.

  • Toric IOL / RLE

    Refractive lens exchange with a toric or multifocal intraocular lens - reserved for older patients where cataract is imminent, not a first-line refractive option.

  • Second-opinion review

    A specialist review of your Pentacam, refraction and prior consult notes - sometimes the answer is a different procedure or a wait, not the one you were quoted.

Safety and recovery

What to expect afterwards - honestly.

SMILE is one of the safest refractive procedures ever developed. The things worth planning are the short dry-eye window, night halos in the first weeks, and the enhancement conversation.

  • Topical anaesthetic only

    The whole procedure is done under numbing drops - no needles, no general anaesthetic. A mild oral sedative is available but rarely needed.

  • Suction loss during lenticule creation

    Rare but described. If the eye loses contact with the laser part-way through, the surgeon pauses, reapplies suction and completes or converts to PRK. No lasting visual harm.

  • Opaque bubble layer

    Small gas bubbles in the stroma during laser cutting can make lenticule dissection harder. A surgeon with volume manages this without incident.

  • Lenticule fragmentation

    If a fragment is left behind, mild optical aberrations can result. Careful extraction technique and a well-designed access incision make this very uncommon in experienced hands.

  • Mild dry eye for 4 to 8 weeks

    Corneal nerve disruption causes transient dryness. Preservative-free lubricants and, occasionally, punctal plugs. Usually settles - a small minority have persistent symptoms.

  • Ectasia - rare but serious

    Post-laser corneal weakening under 1 in 5,000 cases when screening is done properly. Pentacam and residual stromal bed calculations are the safeguard - never skip the work-up.

  • Night-vision halos and glare

    Common in the first weeks, especially with larger pupils. Usually settles by 3 months. Occupational drivers should factor this in.

  • Enhancement rate around 2 to 5 per cent

    A minority need a top-up - usually PRK over the SMILE, occasionally a re-SMILE with a fresh lenticule. Most reputable UK clinics include enhancements for 1 to 2 years.

  • Red flags after surgery

    Worsening pain, sudden vision drop, marked redness or discharge - call the clinic or attend A&E the same day.

Reading your refractive report

Your SMILE report in four parts. Read the last one first.

Whether you have SMILE, SMILE Pro or a comparison LASIK, the report the surgeon sends you keeps to the same shape.

A quiet reminder

Refractive language is precise and can read coldly - ask your care team to explain anything that is unclear.

Ask your care team to explain anything that is unclear.

  1. 01 Header

    Prescription, corneal thickness and Pentacam summary

    Your pre-op sphere, cylinder and axis in both eyes, central corneal thickness (should be over 480 microns), and the Pentacam Belin-Ambrosio D score - a screen for ectasia risk.

  2. 02 Technique

    Laser platform, lenticule and access incision

    Which VisuMax was used (500 kHz standard SMILE or 800 kHz SMILE Pro), lenticule thickness and diameter, cap thickness (usually 120 to 130 microns), incision size and position.

  3. 03 Findings

    Intra-op events and residual stromal bed

    Any suction loss, opaque bubble layer, lenticule tear or difficult dissection - and the calculated residual stromal bed depth (should stay over 250 microns for long-term safety).

  4. 04 Impression

    Target refraction, aftercare and review schedule

    Read this first: your intended post-op refraction, drop regimen, when to resume driving and swimming, and your 1-day, 1-week, 1-month and 3-month review dates.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Elective refractive surgery is not usually funded by UK health insurers, though some corporate schemes offer contributions.

Frequently asked

Everything we get asked about SMILE.

Quick answers on suitability, SMILE Pro, LASIK comparisons, price and realistic outcomes.

  • What is SMILE laser eye surgery?

    SMILE stands for Small Incision Lenticule Extraction. A Zeiss VisuMax femtosecond laser sculpts a thin lens-shaped disc of tissue (a lenticule) inside your cornea, and the surgeon lifts it out through a 2 to 4 mm micro-incision. There is no corneal flap. The whole procedure takes about 20 to 30 minutes for both eyes and vision is usually usable by the next morning.

  • What is the difference between SMILE and SMILE Pro?

    SMILE Pro is the 2022 upgrade running on the Zeiss VisuMax 800 kHz platform. The lenticule is cut in about 10 seconds rather than 26, with automated centration and cyclotorsion compensation for better astigmatism alignment. Clinical outcomes are similar to standard SMILE but the patient experience is smoother, especially for anxious patients or high astigmatism.

  • How does SMILE compare with LASIK?

    The refractive outcomes are broadly similar. SMILE avoids a corneal flap, so there is no flap-dislocation risk from trauma and slightly less disruption of corneal nerves - the historical dry-eye advantage of SMILE is now less clear-cut in the literature, but the no-flap safety in athletes and armed forces personnel is real. LASIK still has a wider indication range including hyperopia and higher astigmatism. Your Pentacam and prescription decide which is right.

  • How much does SMILE cost privately in the UK?

    Roughly £4,500 to £5,500 for both eyes with standard SMILE on the VisuMax 500 kHz, and £5,500 to £7,500 for SMILE Pro on the 800 kHz. A refractive suitability consultation with Pentacam is £250 to £400 - often refunded against surgery. Most reputable clinics include 1 to 2 years of enhancements in the price.

  • Am I suitable for SMILE?

    You need to be over 21 with a stable prescription for at least 12 months, myopia between -1 and -10 dioptres, astigmatism up to about -3 D, a healthy cornea over 480 to 500 microns thick, and no signs of keratoconus or ectasia risk on Pentacam. SMILE does not correct hyperopia or presbyopia - for over-45s wanting to drop reading glasses, PRESBYOND blended vision is usually the better option.

  • What outcomes should I realistically expect?

    In experienced UK hands with proper screening, over 95 per cent of patients reach 20/25 uncorrected vision and around 99 per cent are within 1 dioptre of their target refraction at 3 months. Enhancement rates sit at 2 to 5 per cent. Night halos and mild dry eye in the first few weeks are common and usually settle by 3 months.

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