Trans PRK, PRK, and LASIK: Modern Laser Eye Surgery Without a Flap

Trans-PRK is a specialized laser procedure in ophthalmology in which doctors remove and smooth out irregularities on the surface of the cornea. They also ablate the underlying corneal stroma using an excimer laser.

Unlike with PRK, the doctor does not have to remove the corneal epithelium by hand during trans-PRK. No mechanical manipulation of the cornea is necessary for trans-PRK, as both surgical steps are performed using a laser.

Trans-PRK is the successor to PRK, the oldest laser eye surgery method @ Vadim /AdobeStock

Trans-PRK is suitable for people with:

• Mild to moderate nearsightedness
• A very thin cornea or 
• Large pupils

Trans-PRK is primarily used to treat nearsightedness (up to -6 diopters) and astigmatism (up to 5 diopters). The procedure is also possible for patients with existing presbyopia. In such cases, trans-PRK specialists surgically adjust one eye for distance vision and the other for near vision.

The following conditions are not suitable for trans-PRK:

• Chronic, progressive corneal disease
• Cataracts
• Glaucoma with severe visual field loss
• Macular degeneration

Trans-PRK is typically performed on an outpatient basis. The patient is given a mild sedative and eye drops beforehand to numb the eye locally. Eyelid retractors are used to keep the eye open.

The laser is used to remove the corneal epithelium and the underlying tissue in a single step. Overall, trans-PRK specialists require only a few minutes to perform this laser surgery.

Health insurance plans typically do not cover the costs of surgeries to correct refractive errors. This also applies to trans-PRK. The cost per eye for this procedure is in the low four-digit range.

Patients should therefore clarify in advance which services are included and whether there will be additional costs for follow-up examinations.

The healing process following trans-PRK is crucial to the success of the surgery. The corneal epithelium regenerates over the first three to four days. 

This process is often accompanied by pain, as the exposed nerve endings in the cornea are irritated after the procedure. To protect the eye and support corneal healing, patients wear contact lenses during the first few days.

Vision often deteriorates shortly after surgery. However, this is a result of the laser treatment. The deterioration resolves within the first six weeks.

If vision does not improve or improves only slightly, a follow-up surgery is necessary.

As with any surgery, trans-PRK also carries risks, such as:

• Scarring of the cornea
• Dry eyes
• Deterioration of vision in low light
• Infections

As a general rule, the more frequently major corrections are required, the higher the likelihood of complications.

The choice of specialist is crucial to the success of trans-PRK. This procedure is performed by trans-PRK specialists in the fields of ophthalmology and refractive surgery.

Above, you will find a list of selected specialists and clinics that specialize in this procedure.

In conclusion, trans-PRK treatment is a modern and minimally invasive method in the field of refractive surgery. As an advancement of traditional PRK, trans-PRK treatment eliminates mechanical steps and works exclusively with a laser on the corneal surface. In this procedure, the outermost layer of the cornea is precisely ablated using an excimer laser, enabling accurate correction of refractive errors. This method is a particularly suitable alternative to Femto-LASIK or traditional LASIK for patients with thin corneas.

The Trans-PRK procedure is efficiently organized and typically takes only a few minutes per eye, with both eyes often treated in a single session. After Trans-PRK surgery, a protective lens or therapeutic contact lens is inserted to support the healing of the outermost layer of the cornea. The healing process generally takes 3 to 5 days, with the cornea regenerating significantly during the first three to four days. The Trans-PRK method thus enables a long-term life without glasses and provides a lasting improvement in vision.

When comparing Trans-PRK and LASIK, it is evident that the LASIK procedure is more invasive due to the flap, whereas Trans-PRK is particularly gentle on the eye’s surface. However, the success of Trans-PRK depends heavily on a thorough preoperative examination and the patient’s individual suitability. The main advantages of Trans-PRK lie in its high safety profile and the precise correction of nearsightedness. Nevertheless, patients should note that health insurance plans generally do not cover the costs, so the cost of treatment usually must be paid out of pocket, even though statutory health insurance plans cover the costs only in exceptional cases. Overall, Trans-PRK is a modern procedure in the field of refractive surgery that delivers impressive results.