TransPRK Eye Surgery: Suitability, Procedure, Risks and Recovery

Author: Dr Val Phua
Estimated reading time: 21 minutes

Transepithelial photorefractive keratectomy, commonly called TransPRK, is a surface laser vision-correction procedure used to reduce dependence on spectacles or contact lenses.

During TransPRK, an excimer laser removes the thin surface layer of the cornea—the epithelium—and then reshapes the underlying corneal stroma.

A protective bandage contact lens is placed over the eye while the epithelium grows back.

Unlike LASIK, TransPRK does not create a permanent corneal flap.

Unlike conventional PRK, the epithelium is removed by laser rather than being loosened with alcohol or removed mechanically by the surgeon.

TransPRK can treat selected patients with:

Myopia, or short-sightedness
Hyperopia, or long-sightedness, on selected platforms
Regular astigmatism
Presbyopia using monovision in appropriately counselled patients
Residual refractive error after selected previous eye procedures

Modern single-step TransPRK combines epithelial removal and stromal refractive treatment into one programmed laser sequence.

Potential advantages include:

No LASIK flap
No mechanical or alcohol-assisted epithelial removal
A relatively short treatment sequence
Preservation of more residual load-bearing stromal tissue than equivalent LASIK
Suitability for selected patients with relatively thin corneas
Suitability for some contact-sport or trauma-risk occupations
Availability of wavefront-optimised or topography-guided treatment on selected platforms

Possible disadvantages include:

Pain or discomfort during the first several days
A bandage contact lens
Slower visual recovery than LASIK
Greater early visual fluctuation
A longer course of postoperative eye drops
Risk of corneal haze
More prolonged healing than flap-based laser surgery

Systematic reviews generally find that single-step TransPRK is effective for myopia and astigmatism. Final efficacy and predictability are broadly comparable with conventional PRK and, in suitable patients, with LASIK or SMILE. However, recovery speed, discomfort and safety findings vary between laser systems, study populations and treatment ranges.

TransPRK remains an operation on healthy corneal tissue.

Possible complications include:

Slow epithelial healing
Infection
Corneal haze
Dry eye
Glare, halos or starbursts
Under-correction or over-correction
Residual astigmatism
Regression
Corneal scarring
Corneal ectasia
Rare loss of corrected vision

The most important part of TransPRK is therefore the assessment performed before the laser is used.

The Quick Answer

What Is TransPRK?

TransPRK is a surface laser procedure in which the excimer laser removes both:

The corneal epithelium
The calculated amount of underlying stromal tissue required to correct the prescription

The epithelium grows back over the following several days.

Is TransPRK the Same as PRK?

TransPRK is a form of PRK.

The difference lies mainly in how the epithelium is removed.

In conventional PRK, the epithelium may be removed using:

A blunt instrument
A rotating brush
Dilute alcohol
Another mechanical technique

In TransPRK, epithelial removal is performed by the excimer laser.

The refractive stromal treatment beneath the epithelium is based on the same general principle as PRK.

What Does “Single-Step” Mean?

In modern single-step TransPRK, the laser delivers epithelial and stromal ablation as one continuous programmed treatment.

Earlier transepithelial approaches sometimes used:

One separate epithelial-ablation step
Refocusing or reprogramming
A second stromal-refractive step

Single-step treatment reduces interruption between the two parts.

It does not mean that the epithelial and stromal tissue are biologically identical.

Is TransPRK Truly “No-Touch”?

The term “no-touch” is commonly used because no instrument or alcohol is required to scrape or loosen the epithelium before the stromal laser treatment.

However, the overall procedure is not literally contact-free.

The eye still requires:

An eyelid holder
Anaesthetic drops
Sterile preparation
Irrigation
Inspection by the surgeon
Placement of a bandage contact lens

“No-touch” refers primarily to laser epithelial removal.

What Does TransPRK Treat?

TransPRK is most commonly used for:

Myopia
Myopic astigmatism

Selected laser platforms may also treat:

Hyperopia
Hyperopic astigmatism
Mixed astigmatism
Presbyopia using monovision or specialised profiles

The available range depends on:

Corneal thickness
Corneal shape
Prescription
Optical-zone requirements
Planned treatment depth
Laser platform
Local regulatory approval
Surgeon assessment

A systematic review found evidence supporting single-step TransPRK for myopia and astigmatism, while the amount and quality of evidence for hyperopic treatment remain more limited.

Is TransPRK Painful?

The operation itself is usually not painful because anaesthetic drops numb the cornea.

Discomfort develops after the anaesthetic wears off because the surface epithelium has been removed.

Possible symptoms include:

Burning
Stinging
Watering
Light sensitivity
Grittiness
Difficulty opening the eyes
A foreign-body sensation
Fluctuating pain

Pain is usually most noticeable during the first 24 to 72 hours and improves as the epithelium heals.

Is TransPRK Less Painful Than Conventional PRK?

Possibly, but not in every study.

Some studies have found:

Less pain
Faster epithelial closure
Faster early visual recovery

after TransPRK than after conventional PRK.

Other randomised trials found:

Similar total healing time
Similar or greater early discomfort
No meaningful difference in final outcomes

The result may depend on:

Laser platform
Epithelial-ablation profile
Diameter of epithelial removal
Amount of stromal treatment
Cooling and irrigation
Bandage contact lens
Pain-control protocol
Individual healing response

TransPRK should therefore not be promoted as painless.

How Long Does TransPRK Take?

The complete procedure commonly takes approximately 10 to 20 minutes for both eyes.

The actual excimer-laser treatment may last less than one minute per eye, depending on:

Prescription
Laser speed
Epithelial-ablation profile
Optical-zone size
Astigmatic correction

Additional time is required for preparation, alignment, irrigation and bandage-lens placement.

How Quickly Does Vision Recover?

Vision is usually blurred during the first several days.

Recovery commonly progresses over:

Several days for basic indoor activity
Approximately one week for improving functional vision
Several weeks for sharper distance vision
One to three months for greater stability
Occasionally longer after high corrections or customised treatment

TransPRK generally recovers more slowly than LASIK and may recover more slowly than SMILE.

Is TransPRK Permanent?

The stromal tissue removed by the excimer laser does not grow back in its original form.

However, the eye may still change because of:

Continuing myopic progression
Epithelial remodelling
Corneal wound healing
Presbyopia
Cataract formation
Diabetes-related refractive fluctuation
Other age-related changes

Will I Never Need Spectacles Again?

Not necessarily.

Spectacles may still be required for:

Fine distance vision
Night driving
A small residual prescription
Reading after presbyopia develops
Prolonged computer work
Future cataract-related changes

The realistic goal is to reduce dependence on spectacles or contact lenses.

Understanding the Cornea

What Is the Cornea?

The cornea is the transparent curved tissue at the front of the eye.

It provides a large proportion of the eye’s focusing power.

Its principal layers include:

Epithelium
Bowman’s layer
Stroma
Descemet’s membrane
Endothelium

TransPRK removes the central epithelium and reshapes the anterior stroma.

What Is the Epithelium?

The epithelium is the thin protective cellular layer covering the front of the cornea.

It:

Protects the eye from microorganisms
Creates a smooth optical surface
Interacts with the tear film
Contains many sensitive nerve endings
Regenerates after injury

The epithelium normally grows back after TransPRK.

What Is the Stroma?

The stroma forms most of the corneal thickness.

It consists mainly of highly organised collagen.

The excimer laser removes microscopic amounts of stromal tissue to alter corneal curvature and focusing power.

Why Is TransPRK More Uncomfortable Than LASIK?

In LASIK, the surface epithelium remains largely intact on the corneal flap.

In TransPRK, the central epithelium is removed.

This exposes corneal nerve endings until the surface closes.

The resulting pain and light sensitivity are temporary but clinically significant.

How Does TransPRK Correct Vision?

Myopia

Myopia occurs when light focuses in front of the retina.

Patients can generally see near objects more clearly than distant objects.

Myopic TransPRK flattens the central cornea to reduce its focusing power.

Hyperopia

Hyperopia occurs when the eye has insufficient focusing power or is relatively short.

Hyperopic TransPRK removes tissue in a surrounding pattern to steepen the central cornea.

Hyperopic treatments are generally more sensitive to:

Centration
Latent hyperopia
Pupil size
Healing
Regression
Age-related lens changes

Published prospective studies show that hyperopic TransPRK can provide useful outcomes in selected patients, but predictability has generally been less consistent than for myopic treatment.

Astigmatism

Astigmatism occurs when the cornea has different curvatures in different meridians.

The laser applies an asymmetric ablation to reduce this difference.

Accurate correction depends on:

Reliable refraction
Corneal regularity
Treatment-axis alignment
Cyclotorsion compensation
Eye tracking
Centration
Wound healing

Presbyopia

Presbyopia is the age-related loss of the natural lens’s ability to focus at near.

TransPRK changes the cornea but does not restore the flexibility of the natural lens.

A patient with clear distance vision after TransPRK will still develop presbyopia.

Monovision TransPRK

Monovision is a strategy in which:

One eye is treated primarily for distance.
The other eye is left mildly short-sighted for intermediate or near vision.

Possible advantages include:

Reduced dependence on reading glasses
Use of a standard surface-ablation approach
No multifocal intraocular lens

Possible disadvantages include:

Reduced stereoacuity
Reduced depth perception
Reduced binocular distance sharpness
Night-driving difficulty
Failure to adapt

A contact-lens monovision trial may be useful before surgery.

How Does Laser Epithelial Removal Work?

A Programmed Epithelial Profile

The excimer laser is programmed to remove an estimated depth of epithelium over a specified diameter.

The epithelial profile is not necessarily the same on every platform.

It may be based on:

A population-derived epithelial model
A fixed central and peripheral thickness profile
Platform-specific nomograms
Measured epithelial mapping on selected systems
A transition zone between treated and untreated tissue

Is the Epithelium the Same Thickness in Everyone?

No.

Epithelial thickness varies:

Between individuals
Across different parts of the same cornea
With contact-lens wear
With dry eye
With keratoconus
After previous surgery
In response to stromal irregularity

This is clinically important.

If the true epithelium differs from the laser’s assumed model, part of the programmed epithelial treatment may:

Enter the stroma earlier than expected
Leave small areas of epithelium incompletely removed
Alter the effective stromal treatment
Affect early healing or refractive accuracy

This is one reason why TransPRK should not be assumed to be automatically more precise than every conventional PRK technique.

What Is Epithelial Remodelling?

After surgery, the new epithelium redistributes itself over the reshaped stroma.

It may become:

Thicker in some areas
Thinner in others
More uniform over time

Epithelial remodelling may contribute to:

Early refractive fluctuation
Regression
Changes in corneal optics
Variation between the programmed and achieved correction

Who May Be Suitable for TransPRK?

A suitable candidate generally has:

A stable spectacle prescription
Healthy corneal shape
Adequate corneal thickness
No keratoconus
No corneal ectasia
A manageable degree of refractive error
A sufficiently healthy tear film
No visually significant cataract
No uncontrolled ocular disease
Realistic expectations
The ability to attend follow-up appointments

Why Might TransPRK Be Recommended?

TransPRK may be considered when:

A permanent LASIK flap is undesirable
The cornea is relatively thin but remains structurally normal
Preserving more residual stromal tissue is important
The patient participates in contact sports
The occupation carries a risk of facial trauma
A surface treatment is preferred
There is a previous LASIK flap
Topography-guided surface regularisation is planned
The patient accepts a slower recovery

How Stable Must the Prescription Be?

The prescription should generally remain stable for at least approximately one year.

Continuing change increases the possibility that myopia or astigmatism will return after surgery.

Instability may occur with:

Young age
Progressive myopia
Pregnancy
Breastfeeding
Poorly controlled diabetes
Hormonal change
Certain medications
Developing cataract

Is There a Minimum Age?

TransPRK is generally not performed below 18 years of age.

Age alone is not sufficient.

A patient in the late teens or early twenties may still have progressive myopia.

Is There a Maximum Age?

There is no universal maximum age.

Older patients require assessment for:

Presbyopia
Early cataract
Dry eye
Glaucoma
Macular degeneration
Corneal endothelial disease
Near-vision expectations

When lens changes are already present, cataract surgery may provide a more appropriate long-term solution.

Who May Not Be Suitable for TransPRK?

TransPRK may be inappropriate or require particular caution in the presence of:

Keratoconus
Suspicious corneal tomography
Corneal ectasia
Insufficient corneal thickness
Unstable refraction
Severe dry eye
Active blepharitis
Active corneal infection
Previous herpetic keratitis
Uncontrolled glaucoma
Active uveitis
Visually significant cataract
Poorly controlled diabetes
Active autoimmune disease
Poor epithelial healing
Pregnancy or breastfeeding
Unrealistic expectations
Inability to attend follow-up

Are Thin Corneas Automatically Suitable for TransPRK?

No.

TransPRK may preserve more residual stromal tissue than an equivalent LASIK procedure because no flap is created.

However, a thin cornea may still have:

Keratoconus
Abnormal posterior elevation
Abnormal thickness distribution
Reduced biomechanical reserve
An excessive planned treatment depth

A recent systematic review found encouraging PRK and TransPRK outcomes in selected thin but otherwise normal corneas. This should not be interpreted as permission to treat corneas with suspicious topography or tomography.

Pregnancy and Breastfeeding

Elective TransPRK is generally postponed during pregnancy and breastfeeding.

Possible concerns include:

Refractive fluctuation
Corneal-curvature changes
Tear-film instability
Medication exposure
Hormonal effects on healing

Measurements should be repeated after stability has returned.

Diabetes

Well-controlled diabetes does not automatically exclude every patient.

Suitability depends on:

Glucose stability
HbA1c
Prescription stability
Diabetic retinopathy
Corneal sensation
Ocular-surface health
Wound healing
General medical health

Poorly controlled diabetes may increase the risk of:

Fluctuating vision
Slow epithelial healing
Infection
Unpredictable refractive results

Autoimmune Disease

Active autoimmune or connective-tissue disease may increase the risk of:

Severe dry eye
Delayed healing
Inflammation
Infection
Corneal ulceration
Corneal melting
Unpredictable outcomes

Stable disease requires individual assessment and, where appropriate, medical coordination.

Contact Lenses Before Assessment

Contact lenses may temporarily alter corneal shape and epithelial thickness.

They should be stopped before definitive measurements.

The required interval depends on:

Soft or rigid lenses
Duration of wear
Orthokeratology
Corneal warpage
Repeat measurement stability

Rigid gas-permeable and orthokeratology lenses may require a substantially longer period of discontinuation.

The Pre-TransPRK Assessment

The assessment must answer:

Can the prescription be treated accurately?
Can the cornea be treated safely?
Is TransPRK preferable to conventional PRK, LASIK, SMILE or ICL?
Is the ocular surface healthy enough to heal?
Does the patient accept the recovery period?

Medical and Ocular History

Important information includes:

Previous eye surgery
Contact-lens wear
Dry eye
Eye rubbing
Corneal infection
Recurrent corneal erosion
Herpetic eye disease
Glaucoma
Retinal disease
Diabetes
Autoimmune disease
Pregnancy plans
Medication
Contact sports
Occupational requirements

Visual-Acuity Testing

Both unaided and corrected vision are measured.

Corrected vision helps determine the eye’s visual potential.

TransPRK cannot correct reduced vision caused by:

Amblyopia
Retinal disease
Optic-nerve damage
Corneal scarring
Neurological disease

Manifest Refraction

The subjective spectacle prescription is measured carefully.

Small errors may affect:

Treatment depth
Astigmatic correction
Refractive accuracy
Binocular balance

Cycloplegic Refraction

Dilating drops temporarily relax accommodation.

This is particularly useful for:

Younger patients
Hyperopia
Accommodative spasm
Inconsistent refraction
Avoiding excessive myopic treatment

Corneal Topography

Topography maps anterior corneal curvature.

It helps identify:

Regular astigmatism
Irregular astigmatism
Contact-lens warpage
Decentration
Keratoconus-like patterns
Previous laser-treatment zones

Corneal Tomography

Tomography assesses the three-dimensional corneal structure.

It may analyse:

Anterior elevation
Posterior elevation
Corneal thickness
Thickness distribution
Curvature
Corneal volume
Ectasia-risk indices

Normal visual acuity does not exclude early keratoconus.

Pachymetry

Pachymetry measures corneal thickness.

The surgeon considers:

Starting thickness
Programmed epithelial depth
Stromal ablation depth
Residual stromal thickness
Percentage of tissue altered
Optical-zone size
Corneal shape
Age
Prescription

A single thickness number does not establish safety.

Epithelial Thickness Mapping

Epithelial OCT or other epithelial mapping may identify:

Central epithelial thickness
Peripheral epithelial variation
Contact-lens warpage
Early keratoconus
Epithelial compensation over stromal irregularity
Previous laser-treatment patterns

Epithelial mapping may be particularly relevant when a laser epithelial profile is being planned.

Corneal Biomechanical Assessment

Selected clinics use devices that assess how the cornea deforms in response to an air pulse.

Biomechanical data may add information about ectasia risk.

It should be interpreted alongside:

Tomography
Topography
Pachymetry
Age
Prescription
Family history
Eye-rubbing history

Tear-Film and Dry-Eye Assessment

The ocular surface should be assessed for:

Tear-film instability
Corneal staining
Conjunctival staining
Meibomian gland dysfunction
Blepharitis
Reduced tear production
Contact-lens-related inflammation

An unstable tear film may reduce the reliability of:

Refraction
Corneal topography
Wavefront measurements
Treatment planning
Postoperative visual quality

Pupil and Centration Assessment

The surgeon may assess:

Pupil size
Pupil centre
Corneal vertex
Visual axis
Fixation
Angle kappa

These may influence:

Treatment centration
Optical-zone selection
Night vision
Glare
Halos
Coma

Eye-Pressure Measurement

Eye pressure is measured to assess glaucoma risk.

After TransPRK, conventional pressure readings may appear artificially lower because the cornea has become thinner and biomechanically altered.

Future eye-care providers should be informed about the refractive surgery.

Dilated Retinal Examination

The retina and optic nerve may be examined for:

Retinal tears
Lattice degeneration
Retinal detachment
Myopic macular degeneration
Glaucoma
Other causes of reduced visual potential

Correcting the spectacle prescription does not remove the retinal risks associated with high myopia.

How Is TransPRK Performed?

Step 1: Confirming the Treatment

Before surgery, the team confirms:

Patient identity
Correct eye
Prescription
Treatment profile
Laser calibration
Corneal measurements
Astigmatism axis
Planned optical zone

Step 2: Anaesthetic Drops

Anaesthetic drops numb the corneal surface.

The eyelids and surrounding skin are cleaned.

A small eyelid holder keeps the eye open.

Step 3: Eye Alignment

The patient looks towards a fixation light.

The laser system may use:

Pupil recognition
Limbal registration
Eye tracking
Cyclotorsion compensation
Corneal-vertex alignment

The exact functions depend on the platform.

Step 4: Laser Epithelial Removal

The excimer laser removes the programmed epithelial layer.

The ablation normally includes:

A central epithelial depth
A peripheral epithelial profile
A transition zone

No alcohol or mechanical scraping is routinely required.

Step 5: Stromal Refractive Ablation

The laser continues into the stromal treatment.

It removes microscopic tissue according to the intended correction.

Possible profiles include:

Wavefront-optimised
Aspheric
Wavefront-guided
Topography-guided
Aberration-neutral
Platform-specific customised treatments

Step 6: Mitomycin C When Indicated

Mitomycin C may be applied briefly to the treated surface in selected cases.

It is used to reduce the activity of stromal cells involved in corneal haze.

The decision depends on:

Treatment depth
Degree of myopia
Astigmatism
Previous corneal surgery
Haze risk
Surgeon protocol

A randomised study of TransPRK found that mitomycin C reduced early haze but temporarily influenced epithelial regeneration, with differences becoming less evident after the early postoperative period.

Mitomycin C is a potent medication and should not be treated as a harmless routine rinse.

Step 7: Irrigation

The cornea is irrigated with sterile solution.

This helps:

Cool the surface
Remove debris
Remove residual medication
Improve comfort

Step 8: Bandage Contact Lens

A soft bandage contact lens is placed over the cornea.

It:

Protects exposed nerve endings
Reduces eyelid friction
Supports epithelial healing
Improves comfort

Step 9: Final Examination

The surgeon checks:

Treatment centration
Corneal surface
Bandage-lens position
Immediate postoperative appearance

No stitches are usually required.

Can Both Eyes Be Treated Together?

Yes.

Bilateral same-day treatment is common.

Advantages include:

One recovery period
Less binocular imbalance
Fewer separate procedure visits

The disadvantage is that both eyes may be painful and blurry at the same time.

The patient may require assistance with:

Transport
Medication
Meals
Childcare
Daily activities

Wavefront-Optimised TransPRK

Wavefront-optimised treatment aims to reduce the induction of spherical aberration by adjusting peripheral laser delivery.

It does not use a completely individualised measurement of every higher-order aberration.

Wavefront-Guided TransPRK

Wavefront-guided treatment incorporates optical measurements from the entire eye.

It may be considered when:

Measurements are repeatable
Higher-order aberrations are clinically important
Registration is reliable
The platform supports the treatment

Topography-Guided TransPRK

Topography-guided treatment is based primarily on measured corneal shape.

It may be used to:

Regularise corneal optics
Correct refractive error
Improve treatment centration
Reduce selected corneal asymmetry
Treat selected irregular corneas

A 2024 comparison found favourable outcomes with both wavefront-optimised and topography-guided TransPRK. Differences between treatment profiles should be interpreted in the context of patient selection, planning and platform rather than assuming that one is universally superior.

Is SmartSurface the Same as TransPRK?

SmartSurface is a proprietary treatment approach available on certain laser platforms.

Other manufacturers use different names and algorithms for transepithelial surface ablation.

These systems may differ in:

Epithelial profile
Ablation sequence
Laser spot pattern
Thermal control
Treatment speed
Optical-zone planning
Eye tracking

The term TransPRK therefore describes a category of procedures rather than one identical treatment on every laser.

What Happens Immediately Afterwards?

After the anaesthetic wears off, the eyes may feel:

Painful
Gritty
Watery
Sensitive to light
Difficult to open
Hazy

Symptoms are commonly greatest during the first one to three days.

The Bandage Contact Lens

The bandage lens normally remains until the epithelium has closed sufficiently.

This commonly takes approximately three to five days.

The lens may remain longer when:

Healing is incomplete
The epithelial edge is unstable
The surface remains irregular
Another healing risk is present

A study comparing bandage-lens removal on day four and day seven after TransPRK did not show a universal long-term advantage for either fixed schedule. Removal should be based on epithelial healing and clinical findings.

Can I Remove the Bandage Lens Myself?

No.

It should be removed by the eye-care team.

Premature removal may:

Disrupt the healing epithelium
Increase pain
Delay recovery
Increase infection risk

If the lens falls out, contact the clinic.

Eye Drops After TransPRK

Medication commonly includes:

Antibiotic drops
Steroid drops
Preservative-free lubricants
Pain-relieving medication
Other ocular-surface treatment when indicated

Patients should:

Wash their hands
Avoid touching the bottle tip to the eye
Use drops according to schedule
Space different drops apart
Avoid stopping steroid medication without advice

Pain Control

A pain-management plan may include:

Bandage contact lenses
Oral analgesia
Cold compresses
Topical non-steroidal anti-inflammatory medication
Lubricating drops
Rest in a dim environment

Evidence reviews support multimodal pain control after surface ablation, but no single regimen is ideal for every patient. Prolonged or excessive use of topical anaesthetic or anti-inflammatory medication may delay healing or cause corneal toxicity and should be medically supervised.

Trials have reported reduced early pain using cold bandage lenses or lenses soaked in selected anti-inflammatory medication. These methods should not be self-administered outside a surgical protocol.

The First 24 Hours

Possible symptoms include:

Burning
Watering
Light sensitivity
Blurred vision
Eyelid swelling
Difficulty keeping the eyes open
Fluctuating pain

Patients should rest and use medication as directed.

Days Two to Four

Discomfort commonly improves as the epithelial defect becomes smaller.

Vision may remain:

Hazy
Fluctuating
Sensitive to light
Different between the eyes

After Bandage-Lens Removal

The surface may still feel:

Dry
Gritty
Sensitive
Variable between blinks

Vision does not become immediately perfect when the epithelium closes.

The new epithelial surface remains immature and irregular initially.

The First Week

Many patients can perform basic indoor activities.

Vision may not yet be suitable for:

Driving
Detailed computer work
Fine visual tasks
Night work
Hazardous occupations

The First Month

Vision usually becomes progressively clearer.

Temporary symptoms may include:

Dryness
Glare
Halos
Starbursts
Ghosting
Fluctuation
Reduced contrast

Three to Six Months

The epithelial profile, stromal healing, tear film and corneal nerves continue to stabilise.

High prescriptions and customised treatments may require longer.

How Soon Can I Return to Work?

This depends on:

Occupation
Visual demands
Pain
Light sensitivity
Screen use
Need to drive
Dust exposure
Whether both eyes were treated

Some patients return to office work within approximately one week.

Others need longer.

Can I Use a Computer or Phone?

Yes.

Screens do not reverse the laser treatment.

However, prolonged screen use reduces blinking and may worsen:

Dryness
Burning
Fluctuating vision
Eye fatigue

When Can I Drive?

Driving should resume only when:

Vision meets the legal standard
The patient feels confident
Glare is manageable
Depth perception is adequate
The surgeon has not advised otherwise

Patients should not drive home after treatment.

When Can I Exercise?

Gentle walking is usually possible early.

Strenuous exercise may need to be avoided temporarily.

Patients should avoid:

Sweat entering the eyes
Eye rubbing
Dusty environments
Facial trauma
Contact sports

When Can I Swim?

Swimming is generally avoided during early healing.

Pool, sea and spa water may contain:

Bacteria
Parasites
Chemicals
Irritants

When Can I Wear Eye Makeup?

Eye makeup should be avoided during early healing.

Old mascara, eyeliner and applicators may be contaminated.

When Can I Fly?

Uncomplicated TransPRK does not place gas inside the eye and usually does not prohibit flying.

However:

Aircraft cabins may worsen dryness.
Postoperative reviews should not be missed.
Access to urgent care should be considered.

Expected Visual Results

Modern TransPRK can provide excellent unaided distance vision in appropriately selected patients.

An 18-month study of myopia and astigmatism reported that more than 93% of eyes achieved unaided 20/20 vision or better and almost 98% were within 0.50 dioptres of the intended spherical target. These results describe a selected study population and should not be interpreted as a guarantee for every patient.

A separate cohort including mild, moderate and high myopia found that 98% of treated eyes were within one dioptre of the intended spherical-equivalent result at six months.

Outcomes depend on:

Prescription
Corneal shape
Ocular-surface health
Laser platform
Treatment profile
Optical-zone size
Healing response
Surgeon nomogram

Is 20/20 the Same as Perfect Vision?

No.

A standard high-contrast chart does not fully measure:

Contrast sensitivity
Glare
Halos
Night vision
Tear-film fluctuation
Ghosting
Visual comfort
Quality of vision

A patient may read 20/20 while still noticing optical symptoms.

High Myopia

TransPRK may be used for selected high-myopic eyes.

However, higher treatments require:

Greater stromal tissue removal
More careful residual-tissue calculations
Larger concern about optical-zone size
Greater haze consideration
More counselling regarding regression
Retinal assessment

Studies report useful outcomes in selected high-myopic eyes, but treatment becomes less predictable as the required correction and ablation depth increase.

An implantable collamer lens may be more appropriate when:

The prescription is very high
The cornea is thin
Excessive stromal tissue would be removed
Optical quality is a major priority
The eye is otherwise suitable for intraocular surgery

Dry Eye After TransPRK

TransPRK can cause temporary dry eye because it disrupts:

Corneal nerves
Corneal sensation
Reflex tearing
Blinking
Tear-film regulation

Possible symptoms include:

Burning
Grittiness
Fluctuating vision
Redness
Light sensitivity
Tired eyes
Excessive tearing

Is Dry Eye Less Common Than After LASIK?

Surface ablation avoids the deep circular nerve transection caused by a LASIK flap.

However, TransPRK creates a large epithelial defect and disrupts the superficial nerve plexus.

Dry-eye comparisons vary by:

Measurement method
Follow-up period
Patient selection
Treatment depth
Pre-existing ocular-surface disease

A 2025 comparative study found that both conventional PRK and TransPRK affected dry-eye measures, without establishing that either method eliminates the problem. Preoperative tear-film health remains a major predictor of postoperative comfort.

Treating Dry Eye

Management may include:

Preservative-free artificial tears
Lubricating gel
Warm compresses
Lid hygiene
Treatment of meibomian gland dysfunction
Anti-inflammatory eye drops
Punctal plugs
Autologous serum
Scleral lenses in severe cases

Corneal Nerve Recovery

Corneal nerves regenerate gradually after surface ablation.

Studies of PRK show that the nerve pattern and density recover over years rather than days.

Surface-ablation nerve recovery may be faster than after LASIK, although individual symptoms do not always correlate directly with microscopic nerve density.

Corneal Haze

Corneal haze is abnormal stromal light scatter or scarring after surface ablation.

It may appear as:

Fine subepithelial clouding
Grey opacity
Irregular stromal reflectivity
Dense scarring in severe cases

Why Does Haze Develop?

TransPRK triggers a wound-healing response involving:

Epithelial injury
Inflammatory signalling
Keratocyte activation
Myofibroblast formation
Extracellular-matrix deposition
Stromal remodelling

Who Is at Greater Risk?

Haze risk may be higher with:

High myopic correction
High astigmatic correction
Deep ablation
Previous corneal surgery
Delayed epithelial healing
Infection
Excessive ultraviolet exposure
Poor steroid adherence
Strong individual healing response

A Singapore study of PRK in a predominantly young Asian population found that higher myopia and astigmatism were associated with greater haze severity, although haze generally decreased with time.

When Does Haze Develop?

Haze may become visible:

Within several weeks
During the first few months
Occasionally later

Mild haze often improves.

Dense haze may cause:

Blurred vision
Glare
Reduced contrast
Irregular astigmatism
Loss of corrected vision

Preventing Haze

Measures may include:

Careful patient selection
Avoiding excessive treatment depth
Smooth ablation
Mitomycin C when indicated
Controlled steroid treatment
Good epithelial healing
Ultraviolet protection
Prompt treatment of inflammation or infection

Ultraviolet Protection

Patients are commonly advised to wear good-quality ultraviolet-blocking sunglasses outdoors during the early postoperative months.

This may be particularly important in:

Sunny climates
High-altitude environments
High corrections
Patients with previous haze

Sunglasses do not replace prescribed medication.

Treating Haze

Management depends on severity.

Options may include:

Steroid eye drops
Lubrication
Ocular-surface treatment
Observation for mild improving haze
Phototherapeutic keratectomy
Topography-guided surface treatment
Mitomycin C during retreatment
Corneal transplantation in extremely severe cases

Under-Correction and Over-Correction

The achieved result may differ from the intended target.

Possible causes include:

Measurement variation
Epithelial-profile variation
Biological healing
Epithelial remodelling
Laser-tissue interaction
Treatment centration
High prescription
Astigmatic-axis error
Dry eye

Management may include:

Observation
Spectacles
Contact lenses
Enhancement
Treatment of the ocular surface

Regression

Regression means that part of the refractive error returns after treatment.

Possible contributors include:

High preoperative prescription
Epithelial thickening
Stromal remodelling
Continuing axial elongation
Age-related lens changes
Individual wound healing

Enhancement After TransPRK

An enhancement may be considered when:

A meaningful residual prescription remains
The prescription is stable
The cornea remains structurally suitable
Haze is absent or manageable
The ocular surface is healthy
The expected benefit exceeds the risk

A repeat surface treatment may be possible in selected patients.

How Long Before an Enhancement?

The result should be stable.

This may require:

Several months
Longer after high corrections
Resolution of dry eye
Resolution of haze
Stable topography and refraction

Enhancement should not be rushed while epithelial and stromal remodelling continue.

Slow Epithelial Healing

The epithelium usually closes within several days.

Healing may be delayed by:

Diabetes
Severe dry eye
Corneal dystrophy
Older age
Previous corneal surgery
Medication toxicity
Infection
Poor ocular-surface health

Delayed closure increases the risk of:

Pain
Infection
Haze
Scarring
Irregular epithelium

Infection

Infectious keratitis after TransPRK is uncommon but potentially sight-threatening.

The cornea is particularly vulnerable while:

The epithelium remains open
The bandage contact lens is present
Topical steroid treatment is being used

Warning signs include:

Increasing pain
Increasing redness
Worsening vision
Thick discharge
Marked light sensitivity
A white corneal spot
Symptoms worsening after initial improvement

Urgent antimicrobial treatment is required.

Sterile Corneal Infiltrates

Not every white corneal spot is an infection.

Sterile inflammatory infiltrates can occur.

However, infection must be excluded urgently because delay can cause permanent scarring.

Recurrent Corneal Erosion

The new epithelium normally attaches securely.

Rarely, recurrent episodes may cause:

Sudden pain on waking
Watering
Light sensitivity
Foreign-body sensation
Blurred vision

Treatment may include:

Lubricating ointment
Hypertonic saline
Bandage contact lens
Anti-inflammatory therapy
Further surface treatment

Corneal Ectasia

Corneal ectasia is progressive thinning and bulging of the cornea.

It may cause:

Increasing myopia
Increasing astigmatism
Ghosting
Reduced corrected vision
Irregular corneal shape
Contact-lens dependence

Is Ectasia Less Common After TransPRK Than LASIK?

Reported ectasia appears less common after PRK-type surface ablation than after LASIK.

Avoiding a flap preserves more of the anterior load-bearing cornea.

However, TransPRK does not eliminate ectasia risk.

A systematic review identified ectasia after PRK, LASIK and SMILE, including occasional cases without an obvious recognised risk factor.

Risk Factors for Ectasia

Possible risk factors include:

Keratoconus
Suspicious tomography
Abnormal posterior elevation
Abnormal thickness distribution
Young age
High tissue removal
Thin residual stroma
Eye rubbing
Family history
Progressive corneal asymmetry

Treating Ectasia

Management may include:

Corneal cross-linking
Spectacles
Rigid contact lenses
Scleral lenses
Intracorneal ring segments
Specialised topography-guided treatment
Corneal transplantation in advanced disease

Should TransPRK Be Combined with Cross-Linking?

Some clinics combine surface ablation with prophylactic cross-linking in eyes considered to have borderline biomechanical risk.

This may be called:

TransPRK Xtra
PRK Xtra
Combined surface ablation and cross-linking

Current evidence does not justify treating a clearly keratoconic or structurally unsuitable cornea merely because cross-linking is added.

Comparison studies remain heterogeneous, and long-term evidence is limited.

Loss of Corrected Vision

Rarely, an eye may not see as clearly with spectacles after TransPRK as it did before surgery.

Possible causes include:

Haze
Scarring
Infection
Irregular astigmatism
Ectasia
Decentration
Severe dry eye
Retinal or optic-nerve disease

The risk is low in carefully selected patients but cannot be reduced to zero.

Night-Vision Symptoms

Possible symptoms include:

Glare
Halos
Starbursts
Ghost images
Smearing around lights
Reduced contrast

Possible causes include:

Dry eye
Residual refractive error
Higher-order aberrations
Large pupils
Small effective optical zone
Decentration
Haze
Healing

Symptoms often improve as the cornea stabilises.

TransPRK Versus Conventional PRK

Both procedures remove the epithelium and reshape the anterior stroma.

Possible Advantages of TransPRK

No alcohol-assisted epithelial loosening
No mechanical epithelial scraping
Short, standardised laser sequence
Potentially faster early recovery on some platforms
Potentially less early discomfort in some studies
Reduced manual epithelial manipulation

Possible Advantages of Conventional PRK

The surgeon can directly control epithelial-removal depth and area
Less dependence on an assumed epithelial profile
Established technique across many laser platforms
Ability to adapt epithelial removal to the actual corneal surface
Similar final visual and refractive outcomes

A 2025 randomised study found conventional PRK and TransPRK to be similarly safe and effective at six months, with no overall patient preference. Meta-analyses likewise suggest that final refractive performance is broadly comparable.

Does TransPRK Always Heal Faster?

No.

Some platform-specific studies report faster healing after TransPRK.

Other randomised studies have found similar complete epithelial-closure times or faster healing rates after conventional epithelial removal once the initial defect size was considered.

The surgeon should not promise a painless or uniformly faster recovery.

TransPRK Versus LASIK

Both procedures use an excimer laser to reshape the cornea.

Possible Advantages of TransPRK

No permanent flap
No flap displacement
No flap striae
No flap-interface epithelial ingrowth
Greater residual stromal bed for an equivalent correction
Potential suitability for selected thinner corneas
Potential suitability for trauma-risk occupations

Possible Advantages of LASIK

Faster visual recovery
Less early pain
Faster return to work
Lower risk of surface haze
Easier enhancement through flap relifting

A 2026 meta-analysis found no statistically significant overall difference in efficacy or predictability between TransPRK and LASIK, although subgroup safety results favoured LASIK in some low-to-moderate myopic and astigmatic comparisons.

TransPRK Versus SMILE

SMILE removes a femtosecond-laser-created stromal lenticule through a small incision.

Possible Advantages of TransPRK

No permanent flap
No internal lenticule-dissection step
Availability of excimer wavefront- or topography-guided profiles
Straightforward surface enhancement
Broader use for hyperopia on selected platforms

Possible Advantages of SMILE

Less early pain
Faster epithelial recovery
Faster functional recovery
No large epithelial defect
Low surface-haze risk
Potentially stronger biomechanical preservation in some comparisons

The 2026 meta-analysis found no statistically significant overall difference in efficacy between TransPRK and SMILE, although individual comparisons differed and predictability estimates were heterogeneous.

TransPRK Versus ICL

An implantable collamer lens is placed inside the eye without removing the natural lens.

Possible Advantages of TransPRK

No intraocular implant
No intraocular surgery
No ICL sizing or vault issue
No ICL-related cataract or pressure complication
No long-term intraocular-lens monitoring

Possible Advantages of ICL

No corneal stromal tissue removal
Suitable for higher prescriptions
Often excellent optical quality
Removable or exchangeable
Useful when the cornea is unsuitable for laser treatment

ICL may be preferred when:

Myopia is high
The cornea is thin
The planned stromal removal is excessive
Corneal shape is unsuitable
Optical-quality preservation is a major priority

TransPRK for Athletes

TransPRK may appeal to people involved in:

Boxing
Martial arts
Rugby
Football
Military activity
Law enforcement
Jobs involving facial trauma

There is no LASIK flap that can later be displaced.

Protective eyewear remains important because TransPRK does not prevent traumatic injury to the cornea, lens or retina.

TransPRK After Previous LASIK

Surface ablation may treat selected residual prescriptions after LASIK.

Possible advantages include avoiding:

Lifting an old flap
Epithelial ingrowth
Flap tears
Flap striae
Interface inflammation

The surgeon must assess:

Existing flap thickness
Residual stromal tissue
Previous treatment
Corneal shape
Haze risk
Interval since LASIK

Topography-Guided TransPRK for Irregular Corneas

Topography-guided surface treatment may be used in selected irregular corneas to:

Regularise the anterior surface
Reduce higher-order aberrations
Improve corrected vision
Reduce refractive error

This is different from routine treatment of a normal myopic eye.

In keratoconus, topography-guided TransPRK may be combined with cross-linking to improve corneal regularity rather than to produce guaranteed spectacle-free vision.

The amount of tissue removed must remain limited.

TransPRK and Presbyopia

Standard TransPRK does not prevent ageing of the natural lens.

Possible strategies include:

Both eyes corrected for distance with reading glasses
Monovision
Mini-monovision
Leaving mild myopia intentionally
Considering a lens-based procedure

Cataract Surgery After TransPRK

Patients who undergo TransPRK may still develop cataracts.

Previous corneal laser treatment alters corneal power and can make intraocular-lens calculation more challenging.

Patients should retain:

Preoperative spectacle prescription
Corneal measurements
Operative report
Laser-treatment details

Modern post-refractive formulas improve accuracy, but refractive prediction remains less straightforward than in an untreated cornea.

Glaucoma Assessment After TransPRK

Conventional eye-pressure readings may underestimate pressure after surface laser treatment.

Future glaucoma assessment should consider:

Optic-nerve appearance
OCT nerve-fibre measurements
Visual fields
Corneal thickness
Alternative pressure-measurement methods

Retinal Risk After TransPRK

TransPRK changes corneal focusing power but does not shorten a highly myopic eye.

The patient may remain at increased risk of:

Retinal tears
Retinal detachment
Myopic macular degeneration
Macular schisis
Glaucoma

Urgent assessment is required for:

New flashes
A sudden increase in floaters
A curtain or shadow
Sudden visual loss

Common Myths

“TransPRK Does Not Touch the Eye”

Misleading.

The laser removes the epithelium, but the eye still requires drops, an eyelid holder, irrigation and a bandage contact lens.

“TransPRK Is Completely Painless”

False.

The operation is numbed, but pain or discomfort is expected during epithelial healing.

“TransPRK Always Heals Faster Than PRK”

False.

Some studies report faster healing, while others find similar healing times.

“The Laser Measures My Exact Epithelium Automatically”

Not necessarily.

Many treatments use a programmed epithelial-thickness model rather than a fully individualised map.

“TransPRK Is Always Better Than Conventional PRK”

False.

Final visual outcomes are generally similar.

The best technique depends on the eye, platform and surgeon.

“TransPRK Is Always Safer Than LASIK”

False.

It avoids flap complications and may preserve more residual stromal tissue, but it has separate risks such as pain, slow healing, infection and haze.

“Thin Corneas Should Automatically Have TransPRK”

False.

A thin or suspicious cornea may be unsuitable for all tissue-removing laser surgery.

“TransPRK Cannot Cause Dry Eye”

False.

Corneal nerves and the ocular surface are disrupted.

“TransPRK Cannot Cause Ectasia”

False.

The risk appears low but is not zero.

“Mitomycin C Makes Haze Impossible”

False.

It may reduce risk but cannot eliminate haze.

“Vision Is Perfect When the Bandage Lens Is Removed”

False.

The epithelium and stroma continue healing for weeks or months.

“TransPRK Prevents Presbyopia”

False.

The natural lens continues ageing.

“Correcting Myopia Removes Retinal Risk”

False.

The eye remains anatomically myopic.

Frequently Asked Questions

Is TransPRK Better Than PRK?

Neither is universally better.

TransPRK may offer a shorter, more automated epithelial-removal process.

Conventional PRK allows direct control of epithelial removal and produces similar final outcomes.

Is TransPRK Better Than LASIK?

TransPRK may be preferable when avoiding a permanent flap is important.

LASIK may be preferable when rapid recovery and minimal early discomfort are priorities.

Is TransPRK Better Than SMILE?

The choice depends on:

Prescription
Corneal structure
Visual goals
Recovery requirements
Treatment customisation
Enhancement planning
Available technology

Is TransPRK Suitable for Thin Corneas?

It may be suitable for selected thin but otherwise normal corneas.

A thin cornea with abnormal tomography should not automatically undergo TransPRK.

How Painful Is TransPRK?

Pain varies.

Some patients experience moderate discomfort, while others find the first two days difficult.

A structured pain-control plan is important.

Will I Be Able to See During the First Few Days?

Yes, but vision is usually blurred and fluctuating.

Patients can often move around indoors but should not expect clear driving vision.

Can I Treat One Eye at a Time?

Yes.

Staged treatment may be considered when:

Bilateral discomfort is a concern
Work or caregiving responsibilities make bilateral recovery difficult
One eye requires a different plan

Does the Epithelium Grow Back?

Yes.

The surface epithelium regenerates.

The stromal reshaping beneath it remains.

Can the Bandage Lens Fall Out?

Yes, although this is uncommon.

Do not replace it yourself.

Contact the clinic.

When Will the Pain Stop?

Pain commonly improves substantially once the epithelium closes.

Persistent or worsening pain requires review.

When Will Vision Become 20/20?

Some patients achieve 20/20 within several weeks.

Others take one to three months or longer.

Not every patient reaches 20/20 without spectacles.

Will I Need Steroid Drops for Months?

Possibly.

Surface-ablation steroid courses are commonly longer than LASIK courses because they help control inflammation and haze.

Can Steroid Drops Raise Eye Pressure?

Yes.

Eye pressure should be monitored during prolonged steroid use.

Can TransPRK Be Repeated?

An enhancement may be possible when:

Refraction is stable
Corneal thickness is adequate
Tomography remains normal
Haze risk is acceptable
The expected benefit justifies the risk

Does TransPRK Cause Cataracts?

No.

It treats the cornea.

Patients may still develop age-related cataracts later.

Can TransPRK Cause Blindness?

Severe permanent visual loss is very rare.

Possible causes include:

Infection
Severe scarring
Ectasia
Uncontrolled inflammation
Another unrelated eye disease

The risk is small but not zero.

Can I Wear Contact Lenses Again?

Yes, if required.

Contact lenses may be used for:

Residual refractive error
Irregular astigmatism
Ectasia
Special visual tasks

Does TransPRK Change Eye Colour?

No.

The iris is not treated.

Can TransPRK Treat Lazy Eye?

No.

It corrects refractive error but does not reverse childhood amblyopia.

Can I Have Cataract Surgery Later?

Yes.

The cataract surgeon should use post-refractive intraocular-lens calculation methods.

When to Seek Urgent Eye Care

Seek urgent assessment for:

Increasing pain
Increasing redness
Rapidly worsening vision
Thick discharge
A white corneal spot
Marked light sensitivity
Bandage-lens loss with significant discomfort
Symptoms worsening after initial improvement
Eye trauma
New flashes or floaters
A curtain or shadow

Severe or increasing pain should not automatically be assumed to be normal healing.

A TransPRK Assessment Checklist

Visual Goals to Discuss

Distance vision
Near vision
Computer use
Night driving
Sports
Occupation
Spectacle independence
Monovision
Tolerance of glare and halos

Medical Information to Report

Diabetes
Autoimmune disease
Thyroid disease
Pregnancy or breastfeeding
Medication
Allergies
Abnormal scarring
Healing problems
Migraine or chronic pain

Eye History to Report

Dry eye
Contact-lens intolerance
Recurrent corneal erosion
Eye rubbing
Keratoconus in the family
Herpetic eye disease
Glaucoma
Retinal tears
Eye trauma
Previous laser surgery

Tests That May Be Used

Unaided and corrected vision
Manifest refraction
Cycloplegic refraction
Corneal topography
Corneal tomography
Pachymetry
Epithelial thickness mapping
Wavefront aberrometry
Biomechanical assessment
Tear-film testing
Pupil and centration assessment
Eye-pressure measurement
Dilated retinal examination

Questions to Ask the Surgeon

Am I genuinely suitable for TransPRK?
Is my corneal tomography normal?
Why is TransPRK recommended instead of PRK, LASIK or SMILE?
Is my prescription stable?
Does the laser use a fixed or individualised epithelial profile?
How much stromal tissue will remain?
What optical-zone size will be used?
Will mitomycin C be applied?
What is my haze risk?
What pain-control plan will be used?
How long will the bandage lens remain?
When can I realistically return to work?
What is my risk of dry eye?
What is my risk of ectasia?
How would residual prescription be treated?
What symptoms require urgent review?

The Bottom Line

TransPRK is a surface laser vision-correction procedure.

During TransPRK:

The excimer laser removes the corneal epithelium.
The laser reshapes the underlying stroma.
A bandage contact lens protects the surface.
The epithelium grows back over several days.

TransPRK may treat:

Myopia
Astigmatism
Hyperopia on selected platforms
Presbyopia through monovision in selected patients

Potential advantages include:

No permanent LASIK flap
No alcohol-assisted or mechanical epithelial removal
No risk of traumatic flap displacement
Preservation of more residual stromal tissue than equivalent LASIK
Suitability for selected relatively thin corneas
Suitability for some contact-sport or trauma-risk occupations
Availability of customised surface treatments

Possible disadvantages include:

Pain during the first several days
Slower visual recovery than LASIK
A bandage contact lens
Longer steroid treatment
Risk of corneal haze
Greater early visual fluctuation

Possible complications include:

Slow epithelial healing
Infection
Corneal haze
Scarring
Dry eye
Glare and halos
Residual refractive error
Regression
Corneal ectasia
Rare loss of corrected vision

TransPRK and conventional PRK generally provide similar final refractive outcomes.

The relative difference in pain and healing is not consistent across every study or laser platform.

LASIK may offer faster recovery and less early discomfort.

SMILE may offer a flap-free procedure without a large epithelial defect.

ICL may be more appropriate for high prescriptions or corneas unsuitable for tissue-removing laser surgery.

The most important message is:

TransPRK is not simply a painless or automatically safer version of PRK. It remains a surface-ablation procedure requiring careful corneal screening, realistic expectations, several days of epithelial healing and appropriate monitoring for infection, haze, dry eye and refractive stability.

References

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