Not a LASIK Candidate? ICL, SMILE and PRK Options, at Home and Abroad

At one US eye practice, 69.4% of the people screened for LASIK over two years were told it wasn't right for them, according to a 2025 study in Cureus of 648 patients seen in 2022 and 2023. Among those under 45, the three biggest reasons were an irregular corneal map (43.5%), a cornea that was too thin (24.5%) and a prescription too strong to treat (20.7%). So if you've just heard "you're not a LASIK candidate", you're in a very big club, and there are other options worth asking about.

This guide walks through what usually sits behind a "no", which alternatives fit which reason, what they cost at home and abroad, and what to ask before you book anything. If you're still at the start, our complete guide to LASIK abroad covers the basics first.

Why was I told I'm not a LASIK candidate?

Most people are turned down for one of a few measurable reasons: a cornea that's too thin for a flap, a corneal map that hints at weakness such as keratoconus, a prescription too strong for laser to correct well, or age-related focusing loss that LASIK can't fix. Each one points toward a different alternative.

LASIK works by cutting a thin flap in the cornea, folding it back and reshaping the tissue underneath with a laser. That needs enough cornea left over afterwards to stay strong. A 2025 overview in The Ophthalmologist puts the usual floor at a residual stromal bed of at least 250 microns once the laser's done.

Residual stromal bed is the layer of cornea left untouched under the LASIK flap after the laser removes tissue. Surgeons calculate it before surgery from your corneal thickness and prescription, because too little of it raises the risk of the cornea bulging over time.

The same Cureus study found that for people 45 and over, the leading barrier was presbyopia, the stiffening of the eye's natural lens that makes reading up close harder. Laser on the cornea doesn't fix that, which is why older patients often get pointed toward lens-based options instead. It's worth asking the clinic that turned you down for the exact reason and your numbers in writing: corneal thickness in microns, your full prescription, the corneal map result and your pupil size in dim light.

What are the alternatives to LASIK?

There are three main ones. PRK and SMILE still reshape the cornea with a laser but skip the LASIK flap, so they leave more of it intact. An implantable collamer lens (ICL) doesn't touch the cornea at all: a thin lens goes inside the eye, in front of your natural lens, and corneal thickness stops mattering.

The American Academy of Ophthalmology made the same point in a 2018 answer on thin corneas: PRK or SMILE may work depending on how thin the cornea is, and an implantable lens is an option where thickness doesn't matter. At the time it noted SMILE didn't treat astigmatism, but the FDA approved SMILE for astigmatism later in 2018, so that's no longer a reason to rule it out.

An implantable collamer lens (ICL) is a soft, permanent lens an eye surgeon places through a tiny opening, between the iris and your own lens. It's sometimes called a phakic lens, which simply means your natural lens stays in place. It can be removed or exchanged if needed.

How well do SMILE and ICL actually work?

For SMILE, the FDA's own approval data is the clearest benchmark: of 328 people checked six months after treatment, 88% could see 20/20 or better without glasses and all but one reached 20/40. For ICL, the 2022 FDA trial of the EVO lens put 90.5% of eyes within half a diopter of target at six months.

The SMILE figures come from the FDA's September 2016 approval announcement, which listed dry eye, glare and halos among the more common problems people reported afterwards. Approval covered people 22 and older.

The ICL numbers come from the EVO lens's US clinical trial, published in Clinical Ophthalmology in 2022: 629 eyes of 327 people, with 98.9% within one diopter of target and 52.3% of eyes actually gaining lines of best-corrected sharpness. The FDA approval that March covered nearsightedness from -3.00 to -20.00 diopters, with up to 4.00 diopters of astigmatism, and it requires a measured front chamber depth of at least 3.00 mm, because the lens needs room. In February 2026 the FDA widened the age range from 21-45 to 21-60, Healio reported, after three-year data from the same trial.

Every option has downsides, and ICL has its own list. A 2011 review of the Visian ICL literature by Fernandes and colleagues found cataract was the main problem after surgery, in 5.2% of 2,592 eyes, and older age and stronger prescriptions are linked to higher rates. Your eye surgeon will also track pressure inside the eye and the count of cells lining the back of the cornea. That's why ICL needs follow-up visits for years, something to plan for if the surgery happens in another country.

Photo by Navy Medicine on Unsplash

How much does ICL cost in the US compared with abroad?

ICL usually costs more than laser because you're paying for a custom lens as well as the surgery. US eye practices publish ranges of about $3,000 to $7,500 per eye, so both eyes can run $6,000 to $15,000. Published hospital packages in Bangkok come to about $2,800 to $3,300 per eye before travel.

Always check whether a figure is per eye or for both eyes, because both are common and the difference doubles the bill. Here's what we found published:

The line items that most often get added after the quote are worth asking about one by one. One Bangkok hospital's package states plainly that it covers the operating room, medicines and a single follow-up exam per eye, and that the pre-ICL eye assessment is separate. A toric lens, the version that also corrects astigmatism, is a different lens from the standard one, so ask for it to be priced on its own line. Brinton Vision, a St. Louis practice, puts the lens alone at $500 to $1,500 per eye, which gives you a feel for how much of any quote is the lens itself. And ask how many days you need to stay after surgery before you book flights.

For a broader look at laser prices by country, see our guide to LASIK costs by country.

Who actually does the surgery, and what should I check?

ICL, SMILE and PRK should all be done by a licensed ophthalmologist, a medical doctor who specializes in eye surgery. Ask for the surgeon's full name in writing, look them up on the country's official medical register, and ask how many of that specific procedure they've done.

These are the questions that matter most before you commit to any of the three:

1. What exactly ruled out LASIK? Get the reason and your numbers in writing: corneal thickness, prescription, corneal map result, pupil size.
2. Which option fits that reason? A thin but otherwise normal cornea may still suit PRK or SMILE. An irregular map or a very strong prescription usually points toward ICL.
3. Who will operate? A named ophthalmologist, with their registration checkable.
4. What's in the price? Assessment, lens type (standard or toric), medicines, how many follow-up visits, and what happens if the lens needs repositioning or exchange.
5. What happens after I fly home? Who reads your follow-up results, and what records do you leave with?

What happens with follow-up once I'm home?

Plan it before you leave. The CDC's Yellow Book chapter on care abroad asks travelers to arrange follow-up with a provider at home before they go, and that matters more for ICL than for laser, because the lens is checked over years rather than weeks.

In practice that means booking an optometrist or ophthalmologist near home who's willing to see you after surgery elsewhere, and bringing back your surgical report: the procedure, the lens model and size if you had ICL, the vault measurement, and your prescriptions for drops. With laser, most of the early checks happen in the first days and weeks, and our LASIK recovery timeline shows how that usually fits around a flight home. With ICL, expect pressure checks and periodic cell counts long after the trip. Before any money changes hands, our guide on what to ask before paying a deposit covers the questions that protect it.

How JetWell handles this

You don't pick a clinic from a list with JetWell. You tell Jett, our AI concierge, what's going on with your eyes, and JetWell matches you with a clinic in our network. Your Care Plan lists what's included, and everything on it is price-locked; anything not on it, such as an extra assessment or a toric lens upgrade, is extra, so check the plan line by line before you travel. Eligible bookings can add JetCover, optional protection for travel and for what happens if something goes wrong. If you're weighing laser options, our SMILE vs LASIK guide goes deeper on the two, or you can ask Jett about vision correction.