LASIK vs PRK vs TransPRK: Which Is Right for You?

Written by Vasileios Skouteris MD, FEBO, Ophthalmic Surgeon

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How does laser eye surgery work?
LASIK: correction beneath a thin flap
PRK: surface correction without a flap
LASIK vs PRK vs TransPRK compared
Who is suitable for laser eye surgery for myopia?
When is laser not the answer?
Risks and realistic expectations
When to contact your ophthalmologist after surgery
Frequently Asked Questions

LASIK or PRK? Both procedures use an excimer laser to reshape the curvature of the cornea and correct short-sightedness, astigmatism or long-sightedness. LASIK offers faster recovery with less discomfort, while PRK and TransPRK do not create a flap and are often a better fit for a thin cornea or for contact sports.

How does laser eye surgery work?

The cornea is the clear “dome” at the front of the eye and provides most of its focusing power. In laser eye surgery, the excimer laser removes, with great precision, a layer of corneal tissue a few hundredths of a millimetre thick so that light focuses correctly on the retina. In myopia the cornea is made flatter in the centre, in hyperopia it is made steeper, and in astigmatism the difference in curvature between the axes is smoothed out.

The key difference between the techniques does not lie in the laser that performs the correction. It lies in how we reach the corneal layer where the correction is made, and that determines recovery, discomfort and suitability.

LASIK: correction beneath a thin flap

In LASIK, a very thin flap is first created on the surface of the cornea, nowadays usually with a femtosecond laser. The flap is lifted, the excimer laser performs the correction in the underlying layer, and the flap is then put back in place, where it stays without stitches.

Because the surface layer of the eye stays essentially intact, most patients see well enough from the next day and feel only mild discomfort for a few hours. However, the flap never fully regains the original mechanical strength of the cornea and, rarely, it can shift after a hard blow, even years later. LASIK also requires adequate corneal thickness, so that a safe residual bed remains after the correction.

PRK: surface correction without a flap

In PRK, the epithelium, the thin outer layer of the cornea, is removed with a special solution or mechanically, and the excimer laser is applied directly to the surface. At the end, a bandage contact lens is placed on the eye and stays for a few days until the epithelium regrows.

Without a flap, more tissue is preserved and there is no risk of displacement after an injury. The trade-off is recovery: for the first 2-4 days most people have burning, watering and sensitivity to light, and vision stabilises gradually over a few weeks. Drops are needed for a period, as instructed by the surgeon, to support healing and prevent corneal haze.

What is different about TransPRK?

TransPRK is a no-touch variation of PRK: the excimer laser itself removes the epithelium and performs the correction in a single step. The area of epithelium removed matches the treatment zone exactly, and no alcohol solution is used. Some studies show slightly faster healing and less discomfort compared with conventional PRK. The recovery, however, still follows the pattern of a surface procedure.

LASIK vs PRK vs TransPRK compared

Criterion	LASIK	PRK	TransPRK
Technique	Flap created with a femtosecond laser, correction underneath it	Epithelium removed with solution or mechanically, correction on the surface	Epithelium removal and correction by laser in one no-touch step
Recovery	Functional vision usually from the next day	Return to office work usually in about one week, stabilisation over weeks	Similar to PRK, sometimes slightly faster
Discomfort	Mild, for a few hours	Moderate, mainly in the first 2-4 days	Moderate, often slightly milder than PRK
Who it suits	Adequate corneal thickness, need for a quick return	Borderline corneal thickness, jobs with a risk of being hit	As for PRK, when a no-touch method is preferred
Thin cornea	Often unsuitable	Often preferred	Often preferred
Contact sports	Less suitable because of the flap	Suitable	Suitable

The table is a guide. In the long term, the visual results of the methods are broadly comparable when the patient has been selected correctly. That is why the decision is based on the findings of the assessment, not on a preference for the “fastest” technique.

Who is suitable for laser eye surgery for myopia?

Not everyone is a candidate for refractive surgery. The main suitability criteria are:

Age of at least 18, so that the eye has finished developing. A slightly older age is often preferred.
A stable prescription, with no significant change for at least one year.
Adequate thickness and a normal shape of the cornea on topography and tomography.
A degree of myopia, hyperopia or astigmatism within the limits that can be corrected safely.
A healthy eye surface. Significant dry eye must be brought under control before any procedure.
No active conditions, such as uncontrolled diabetes, certain autoimmune diseases, or eye inflammation or infection.
Not during pregnancy or breastfeeding, because hormonal changes temporarily affect the prescription.

What is checked in the pre-operative assessment?

The assessment includes measuring your prescription with and without cycloplegic drops, corneal topography and tomography, pachymetry, measuring the pupil in low light, evaluating the tear film, measuring intraocular pressure and examining the back of the eye. If you wear contact lenses, you will be asked to stop wearing them for some days beforehand, because they temporarily alter the shape of the cornea and can change the measurements.

When is laser not the answer?

Keratoconus, even at an early stage, is generally a contraindication to refractive laser surgery, and to LASIK in particular, because removing tissue weakens an already unstable cornea. That is why topography is one of the most critical tests in the assessment: it also detects early, suspicious findings that are not yet causing symptoms.

From around the age of 45, presbyopia changes the picture. Laser corrects the prescription, but it does not restore the ability to focus up close. At this age we discuss options such as monovision or, in some patients, lens-based procedures. In very high myopia or a very thin cornea, phakic intraocular lenses may be a safer option than laser.

Risks and realistic expectations

Like any surgical procedure, laser eye surgery has possible side effects. The most common are temporary dry eye, glare or halos around lights at night in the first few months, and under- or over-correction, which may need an enhancement treatment. Less often, infection, corneal haze after PRK or flap problems after LASIK can occur. The goal is a significant reduction in dependence on glasses and contact lenses, not a guarantee of perfect vision in every situation.

The cost depends on the technique and the findings of the assessment, and you are informed after the examination.

When to contact your ophthalmologist after surgery

After any technique, contact your surgeon immediately if you develop:

Pain that gets worse instead of gradually improving.
A sudden drop in vision.
Marked redness or a pus-like discharge.
A blow to the eye in the first few weeks.

To find out which method suits your eyes, book a pre-operative assessment at our clinic in Neo Psychiko, Athens.

Frequently Asked Questions

Does laser eye surgery hurt?

Anaesthetic drops are used during the procedure, so most people feel only pressure or mild discomfort. If there is pain, it comes afterwards. With LASIK it is usually mild and lasts a few hours. With PRK and TransPRK the discomfort is stronger in the first few days and is managed with the instructions and medication your doctor provides.

Are the results of laser eye surgery permanent?

The correction made to the cornea is permanent, but this does not mean the eye stops changing. A small return of myopia is possible in some patients, and with age presbyopia and later cataract will develop, as in everyone. That is why regular eye examinations continue after the procedure.

Are both eyes treated on the same day?

In most cases yes, especially with LASIK, where recovery is quick. With PRK and TransPRK, some patients prefer to have the two eyes treated a few days apart, so that they always have one eye with better vision during the first week. The decision is made together with your surgeon, depending on your needs.

When can I drive after LASIK or PRK?

After LASIK, many patients meet the vision standard for driving within a few days, while after PRK it usually takes longer. Do not drive until your doctor has confirmed at the post-operative check that your vision is adequate. Night driving may take longer, because of glare around lights in the first few weeks.

Questions about your case?

Dr. Skouteris will examine you at his practice in Neo Psychiko and explain your options.

Call 210 677 0007 Book an appointment

About the author

Dr. Vasileios Skouteris, MD, FEBO

Ophthalmic surgeon trained at the John Radcliffe University Hospital in Oxford and Fellow of the European Board of Ophthalmology (FEBO).

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LASIK, PRK or TransPRK: Which Laser Eye Surgery Is Right for You?