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China is one of the largest refractive surgery markets in the world — more than one million laser myopia procedures are performed in China each year, and China leads the world in annual SMILE (Small Incision Lenticule Extraction) procedures [1]. The equipment at leading Chinese centres (Zeiss VisuMax / VisuMax 800, Alcon WaveLight) and the procedure portfolio are on par with leading Western centres, while prices typically sit at 50–70% of US levels. This article works through the real differences between SMILE, femto-LASIK, and ICL, each procedure’s eligibility, post-operative outcomes, and typical costs — and is plain about who should not undergo these procedures.

1. The Core Differences Among the Three Main Procedures

Procedure Incision How it works Suitable refractive range Cornea requirement
SMILE (small-incision lenticule extraction) 2–4 mm (small incision) Femtosecond laser creates a lenticule in the corneal stroma, which is then removed Myopia up to ~1000 D, astigmatism up to ~500 D Sufficient corneal thickness (typically ≥ 480 μm)
Femto-LASIK (FS-LASIK) ~20 mm corneal flap Femtosecond laser creates the flap; excimer laser performs the ablation Myopia up to ~1200 D, astigmatism up to ~600 D Sufficient corneal thickness
TransPRK (full-laser surface) No flap; excimer ablation directly at the surface Excimer laser ablates from the corneal surface Myopia up to ~600 D Suitable for thinner corneas
ICL (Implantable Collamer Lens) 3 mm corneal incision; lens placed inside the eye A soft phakic IOL is placed behind the iris; no corneal tissue removed Myopia up to ~1800 D, astigmatism up to ~600 D First choice for thin corneas or very high myopia

2. SMILE — Why China Has Become the World’s Largest Market

SMILE was developed by Zeiss in Germany and received CE marking in 2011 [2]. Its core advantages:

  1. No flap — avoids the rare but real flap-related complications of conventional LASIK
  2. Small incision — less corneal nerve disruption, so post-op dry eye tends to be milder than after LASIK
  3. Better preservation of corneal biomechanics — a theoretical advantage for occupations involving impact or vigorous physical activity
  4. No prolonged patient fixation required intraoperatively — laser delivery takes about 23 seconds per eye

Why uptake has been so rapid in China:

  1. China has one of the highest myopia rates globally (over 50% of adolescents are myopic)
  2. Both public and private ophthalmology centres have invested heavily in VisuMax platforms
  3. Chinese surgeons accumulate SMILE volume at scale — single-centre annual SMILE volumes above ten thousand cases are not unusual [3]

3. Femto-LASIK — Still the Broadest-Coverage Procedure

FS-LASIK combines a femtosecond laser flap with excimer laser ablation. Its strengths:

  1. Widest refractive correction range (myopia up to ~1200 D, astigmatism up to ~600 D, and some hyperopia)
  2. Rich customisation options — wavefront-guided, topography-guided, Q-value optimised
  3. Mature equipment platforms — Alcon WaveLight EX500, Zeiss MEL90, and others with extensive clinical track records

Compared with SMILE:

  1. SMILE has a smaller incision but visual recovery may be slightly slower than LASIK in the first 1–2 weeks
  2. Long-term outcomes for LASIK and SMILE are not statistically different in most published studies [4]

4. ICL — First Choice for High Myopia or Thin Corneas

ICL (Implantable Collamer Lens) is manufactured by STAAR Surgical in Switzerland and is implanted between the iris and the natural lens. Annual ICL volume in China is among the highest globally.

ICL advantages:

  1. No corneal tissue is removed — the only option for patients with insufficient corneal thickness or atypical corneal shape
  2. Widest myopia range (up to ~1800 D)
  3. Reversible — the lens can be explanted (rarely needed in practice)
  4. Visual quality is often judged superior to laser surgery, particularly for high myopia

ICL limitations:

  1. Higher cost
  2. Intraocular surgery — theoretically higher risk of infection, cataract, and glaucoma than laser surgery, though absolute risk remains very low
  3. Requires sufficient anterior chamber depth, which must be measured carefully preoperatively

5. Who Should Not Have Refractive Surgery (A Realistic List)

  1. Under 18 — generally not advised (refraction has not stabilised)
  2. Refractive change over 50 D in the past 2 years — unstable; wait
  3. Keratoconus or suspected keratoconus — contraindication
  4. Significant dry eye — proceed with caution
  5. Significant retinal disease (history of retinal detachment, severe diabetic retinopathy) — treat the primary condition first
  6. Pregnancy or lactation
  7. Certain autoimmune conditions in active phase
  8. Insufficient corneal thickness (for laser procedures)

Any centre that does not run these screenings before offering you a full refractive surgery package — leave.

6. Hospitals to Consider

Hospital City
Zhongshan Ophthalmic Centre, Sun Yat-sen University Guangzhou
Beijing Tongren Hospital Ophthalmology Beijing
Eye and ENT Hospital of Fudan University Shanghai
Eye Hospital, Wenzhou Medical University Wenzhou
Peking Union Medical College Hospital Ophthalmology Beijing
Zhongshan Ophthalmic Centre Shenzhen branch Shenzhen
Aier Eye Hospital Group flagship facilities (Beijing / Shanghai / Guangzhou / Wuhan / Chengdu) Multiple cities
Beijing Huaxia Eye, Beijing PRK Eye Beijing

7. Typical Process

  1. Preoperative evaluation (1–2 days): refraction, corneal topography, corneal pachymetry, fundus, dry eye assessment, IOL Master (for ICL patients)
  2. Stop contact lens wear 1 week before evaluation: soft lenses 1 week, hard or ortho-K lenses 2–4 weeks
  3. Surgery day: SMILE / LASIK 5–10 minutes per eye; ICL 15–20 minutes per eye
  4. Day-1 post-op review: mandatory
  5. 1-week, 1-month, 3-month reviews

Typical in-China duration for international patients: 7–10 days (including preoperative evaluation and early post-op review).

8. Real Costs (USD, 1 USD = 6.5 RMB)

Procedure Public tertiary High-end private / Aier flagship
TransPRK (both eyes) 1,500–2,500 2,200–3,500
Femto-LASIK (both eyes) 1,800–2,800 2,500–4,000
SMILE (both eyes) 2,500–3,500 3,200–5,000
ICL (both eyes, no astigmatism correction) 4,500–6,500 5,500–8,500
Toric ICL (both eyes, astigmatism correction) 5,500–8,000 7,000–10,000

US reference: LASIK both eyes USD 4,000–6,000; SMILE both eyes USD 5,000–7,000; ICL both eyes USD 8,000–13,000 [5].

9. Postoperative Outcomes and Long-term Data

  1. Laser surgery (SMILE / LASIK): more than 90% of patients achieve uncorrected vision of 20/20 (1.0) at 1 year; 10-year follow-up shows stable refraction [4][6]
  2. ICL: subjective visual quality is often rated higher than laser surgery (particularly for high myopia); long-term data beyond 10 years shows stable lens position and low complication rates
  3. Refractive regression: roughly 5–10% of laser patients experience mild regression over 5–10 years, generally within a range that remains functionally acceptable
  4. Dry eye: common at 1–6 months post-op, mostly self-limited

10. What MedCareInChina Can and Cannot Do on the Refractive Surgery Pathway

Our two products are Remote Consultation and In-China Accompanied Care.

  1. Remote Consultation: a USD 800 single-expert consultation with an ophthalmologist who reviews your home-country eye-care records and gives an initial opinion on procedure eligibility
  2. In-China Accompanied Care: hospital accompaniment with translation through preoperative evaluation, surgery, and early post-op reviews

What we do not do: insurance reimbursement, remote optometric follow-up (please see your home-country ophthalmologist for this).

11. Action Checklist

  1. Complete a thorough eye examination in your home country (refraction, corneal topography, pachymetry, fundus)
  2. Stop soft contact lenses 1 week before departure; hard lenses or ortho-K 2–4 weeks before
  3. Engage a remote consultation to assess procedure suitability
  4. Apply for an S2 visa
  5. Plan 7–10 days in China
  6. After returning home, schedule follow-up at 1 month, 3 months, 6 months, and 1 year

Sources

[1] Carl Zeiss Meditec — Global SMILE procedure statistics (annual report): https://www.zeiss.com/ [2] American Academy of Ophthalmology — SMILE (Small Incision Lenticule Extraction) Overview: https://www.aao.org/ [3] Chinese Medical Association Ophthalmology Branch, Cornea Disease Group — Chinese Refractive Surgery Guidelines [4] Reinstein DZ et al. — SMILE vs LASIK long-term outcomes review, Journal of Refractive Surgery [5] All About Vision — US refractive surgery cost benchmarks: https://www.allaboutvision.com/ [6] FDA Approval Summary — SMILE for myopia and astigmatism