For many patients, night vision is the deciding factor in choosing a vision correction procedure. Halos around streetlights, glare from oncoming headlights, and reduced contrast sensitivity in dim conditions are common concerns, and for pilots, surgeons, athletes, and anyone who drives frequently at night, they are not abstract worries.
Both WaveLight® Plus LASIK and SMILE Pro can correct your prescription. But their approach to the optical imperfections that cause night vision problems is fundamentally different. Understanding that difference, and the clinical evidence behind it, will help you make a more informed decision. Patients comparing their options may also want to review WaveLight® Plus LASIK cost.
Related: SMILE Pro vs. WaveLight® Plus LASIK: Which Is Right for You?
What Causes Night Vision Problems After LASIK Eye Surgery?
Night vision problems after refractive surgery, including halos, glare, starbursts, and reduced contrast sensitivity, are caused primarily by higher-order aberrations. These are optical imperfections beyond simple nearsightedness and astigmatism that affect how light travels through the eye.
When the pupil dilates in low-light conditions, a larger area of the optical system is used to process incoming light. If aberrations are present in the outer zones of the optical pathway, those imperfections become more apparent, which is why patients who feel fine during the day may notice halos and glare when driving at night.
Higher-order aberrations are the optical imperfections responsible for halos, glare, starbursts, and reduced contrast at night. They are distinct from simple nearsightedness and astigmatism, which glasses and contacts can correct. higher-order aberrations often cannot be addressed with glasses or contacts at all.
The Fundamental Difference: Higher-Order Aberration Treatment
This is the core issue, and it explains why WaveLight® Plus LASIK and SMILE Pro produce different night vision outcomes.
SMILE Pro Does Not Treat Higher-Order Aberrations
SMILE Pro corrects your refractive error by removing a precisely shaped disc of corneal tissue called a lenticule. The lenticule shape is based on your prescription. SMILE Pro does not measure or treat higher-order aberrations. It has no wavefront or ray-tracing component.
This means that if you have pre-existing higher-order aberrations contributing to halos or glare while wearing your glasses or contacts, SMILE Pro will correct your prescription, but those underlying aberrations will remain untreated. Additionally, like all refractive procedures, SMILE Pro can induce new higher-order aberrations, particularly vertical coma, as a result of the surgery itself.
A peer-reviewed study comparing SMILE and wavefront-guided LASIK found significantly greater vertical coma aberration after SMILE (p = 0.036). Vertical coma is a specific type of higher-order aberrations that can affect visual quality under varying lighting conditions, including at night.
WaveLight® Plus LASIK Treats higher-order aberrations Across the Entire Optical System
WaveLight® Plus LASIK uses the INNOVEYES SightMap™ to build a complete three-dimensional model of your eye before treatment begins. This model captures higher-order aberrations from three sources that previous generation platforms could not fully address: the anterior cornea, the posterior cornea, and the crystalline lens. That full optical map is then used by the WaveLight EX500 excimer laser to calculate a treatment that corrects both your prescription and your individual higher-order aberrations in a single procedure.
The treatment is pupil-independent, meaning it accounts for how your visual system behaves as your pupil dilates in low-light conditions. This is a meaningful distinction for patients concerned about night vision.
Related: What Is SightMap™ Technology, and Why Does It Matter for LASIK?
What the Clinical Evidence Shows
The Kanellopoulos Head-to-Head Study
The most direct clinical comparison of WaveLight® Plus and SMILE Pro was presented at the 129th Annual Meeting of the American Academy of Ophthalmology in October 2025. In a contralateral study of 60 patients who received WaveLight® Plus in one eye and SMILE Pro in the other, the WaveLight® Plus platform produced significantly lower levels of higher-order aberrations and better astigmatism correction.
Beyond higher-order aberrations levels, the visual acuity outcomes were striking: 98% of WaveLight® Plus eyes achieved 20/12.5 or better, compared to 82% with SMILE Pro. Every WaveLight® Plus eye was within a quarter-diopter of the target prescription, and more than 80% gained an additional line of vision beyond their pre-surgical baseline. (Kanellopoulos AJ. Presented at: 129th Annual Meeting of the American Academy of Ophthalmology; October 18, 2025; Orlando, FL.)
The Bala Real-World Outcomes Study
In a real-world study of 200 patients treated with WaveLight® Plus, there was no clinically significant increase in higher-order aberrations after surgery. 100% of patients achieved 20/20 or better, 89% achieved 20/16 or better, and 50% achieved 20/12.5, a level of visual acuity sharper than what most patients had experienced with glasses or contacts. (He C, Bala C. J Cataract Refract Surg. 2023;49(11):1140–1146.)
What SMILE Pro Studies Show About LASIK Night Vision
SMILE Pro produces good overall outcomes, and in patients with straightforward prescriptions and no significant pre-existing higher-order aberrations, reports show satisfactory night vision results. However, SMILE Pro consistently shows two limitations relevant to night vision: it does not treat pre-existing higher-order aberrations, and it induces vertical coma as a documented post-operative effect.
Who Benefits Most From WaveLight® Plus for LASIK Night Vision?
WaveLight® Plus night vision advantages are most clinically meaningful for:
- Patients who already experience halos, glare, or reduced contrast at night with glasses or contacts
- Pilots, surgeons, professional drivers, and athletes who require sharp, reliable night vision
- Patients with larger pupils, who are more susceptible to higher-order aberrations effects in low-light conditions
- Those with moderate to high prescriptions, where higher-order aberrations tend to be more prominent
- Patients who want the most comprehensive optical customization available
A Note From Dr. Feinerman
Night vision is one of the most common concerns I hear from patients, particularly those in demanding professions or those who drive frequently. SMILE Pro is a well-designed procedure and for patients with straightforward prescriptions and no significant higher-order aberrations, it can produce good results. But it does not address the root cause of night vision problems for patients who already experience them.
WaveLight® Plus can treat the root cause of night vision problems. By mapping and treating higher-order aberrations across the entire optical pathway before surgery, it gives us the ability to address both the prescription and the underlying optical imperfections that affect how you see at night. As always, my recommendation begins with your evaluation. Every eye is different, and the right technology is the one best suited to your specific optical profile and visual goals.
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Frequently Asked Questions
Does SMILE Pro treat higher-order aberrations?
No. SMILE Pro corrects refractive error by removing a lenticule of corneal tissue based on your prescription. It does not measure or treat higher-order aberrations. Patients with pre-existing higher-order aberrations contributing to halos or glare will carry those aberrations into their post-operative vision.
What causes halos and glare after laser eye surgery?
Halos, glare, and starbursts after laser eye surgery are caused primarily by higher-order aberrations. When the pupil dilates in low-light conditions, optical imperfections in the outer zones of the visual pathway become more apparent, which is why these symptoms are most noticeable when driving at night.
Can WaveLight® Plus LASIK improve my night vision beyond what glasses provided?
Yes, in many cases. Because WaveLight® Plus treats higher-order aberrations across the entire optical system, including sources that glasses and contacts cannot correct, patients often experience sharper night vision after surgery than they had with their previous correction. In a real-world study of 200 patients, 50% achieved 20/12.5 vision, sharper than most had experienced with glasses or contacts. (He C, Bala C. J Cataract Refract Surg. 2023;49(11):1140–1146.)
Who is most likely to benefit from WaveLight® Plus for night vision?
Patients who already experience halos, glare, or reduced contrast at night while wearing glasses or contacts are the most likely to see meaningful night vision improvement with WaveLight® Plus. This includes pilots, surgeons, professional drivers, athletes, and patients with larger pupils or higher prescriptions where higher-order aberrations tend to be more prominent.
Related: SMILE Pro vs. WaveLight® Plus LASIK: Which Is Right for You?