Femtosecond laser-assisted LASIK in the SMILE era: a mini review of patient-centered procedure selection

Femtosecond laser-assisted in situ keratomileusis (FS-LASIK) remains a mature corneal refractive procedure, but its role is being reshaped by small-incision lenticule extraction (SMILE), transepithelial photorefractive keratectomy, and phakic intraocular lens implantation. This Mini Review proposes a phenotype-centered expert framework, derived from the available literature, for considering when FS-LASIK's strengths--customized excimer ablation, rapid rehabilitation, enhancement flexibility, presbyopic planning, and hyperopic treatment--may outweigh its flap-related and ocular surface limitations. Evidence is synthesized across visual outcomes, optical quality, ocular surface effects, corneal nerves, biomechanics, regression, epithelial thickness mapping, artificial intelligence-assisted screening, and evolving lenticule platforms. Rather than ranking procedures, the review outlines clinical scenarios in which FS-LASIK, SMILE, TransPRK, or phakic intraocular lens implantation may be appropriate.