When most people think about laser eye surgery, the first procedure that comes to mind is LASIK. It’s quick, comfortable, and has been the most popular choice for decades. But recently, I’ve noticed more and more patients asking about another option: Trans PRK (transepithelial photorefractive keratectomy).
What’s interesting is that PRK was actually the first type of laser eye surgery, developed back in the late 1980s. For a while, it was overshadowed by LASIK, which offered faster recovery. But thanks to new technology, PRK — and especially Trans PRK — is making a real comeback.
Let’s explore why.
What Is PRK?
PRK, or photorefractive keratectomy, was the pioneering form of laser vision correction. Instead of creating a flap (as in LASIK), PRK works directly on the surface of the cornea.
Here’s how it works:
- The thin outer layer of the cornea (the epithelium) is removed.
- The laser reshapes the underlying corneal tissue to correct your prescription.
- A special bandage contact lens is placed to protect the eye while the epithelium grows back.
It’s a simple, effective procedure — but because the surface cells need time to heal, recovery is longer than with LASIK. Patients often feel some discomfort for the first few days and can take a week or more before their vision stabilises.
How PRK Changed the Game
When it was first introduced, PRK revolutionised eye care. For the first time, surgeons could permanently correct vision problems like short-sightedness, long-sightedness, and astigmatism without glasses or contact lenses.
Millions of patients worldwide benefitted from PRK, and it laid the foundation for all modern laser eye surgery techniques.
But when LASIK arrived in the 1990s, PRK became less common. LASIK’s flap-based approach offered quicker recovery and less discomfort, which made it the go-to option for many patients.
That didn’t mean PRK disappeared entirely. It remained an important option for patients with thinner corneas, irregular shapes, or certain lifestyles where a flap might not be the safest choice.
The Problem With Traditional PRK
The main issue with the original PRK technique was how the epithelium — that surface layer of cells — was removed. In early procedures, it was done with alcohol or by manually scraping the surface. While effective, it wasn’t the most comfortable part of the treatment, and healing could be a bit rough.
This led many patients and surgeons to prefer LASIK, which avoided that surface removal altogether.
Enter Trans PRK: A Modern Upgrade
This is where Trans PRK comes in. Trans PRK (short for transepithelial PRK) is a modern, all-laser version of PRK. Instead of alcohol or scraping, the laser itself gently removes the epithelium before reshaping the cornea.
That means:
- No alcohol → less irritation to surrounding tissue.
- No scraping → a smoother surface, more comfortable healing.
- One seamless step → the epithelium is removed and the cornea reshaped in a single laser-guided process.
In other words, Trans PRK takes the safety benefits of PRK and combines them with the comfort and precision of modern laser technology.
Why Trans PRK Is Making a Comeback
So why are more surgeons — and more patients — choosing Trans PRK today? There are a few key reasons:
1. It’s Gentle on the Eye
Because it’s an all-laser technique, Trans PRK is less invasive than traditional PRK. The epithelium is removed more smoothly, which reduces inflammation and promotes faster, more comfortable healing.
2. No Flap, No Flap Risks
One of the reasons PRK never went away completely is that it doesn’t involve a corneal flap. For patients with thin corneas, irregular shapes, or those at risk of eye trauma (like athletes or military personnel), this is a big safety advantage.
3. Improved Recovery
Thanks to modern technology, Trans PRK patients often experience quicker recovery and clearer vision sooner than those who had older PRK techniques. While it’s still not as instant as LASIK, the difference is much smaller now.
4. Wider Suitability
Because there’s no flap involved, Trans PRK opens up laser eye surgery to people who might not have been suitable candidates for LASIK. This includes patients with thinner corneas or certain corneal irregularities.
5. Better Outcomes
With customised treatment profiles, modern lasers like the Schwind Amaris 750S can deliver highly personalised vision correction during Trans PRK. This means sharper vision, fewer side effects, and results that rival — or even surpass — LASIK in the long term.
Who Is Trans PRK Best For?
Trans PRK is a great option for patients who:
- Have thinner corneas not suitable for LASIK.
- Play contact sports or have jobs with higher risk of eye trauma (because there’s no flap).
- Want an all-laser, minimally invasive treatment.
- Don’t mind a slightly longer recovery in exchange for the safety and precision of flap-free surgery.
It’s also a good choice for people who simply want the peace of mind that comes from avoiding a corneal flap altogether.
Click here to read more about Trans PRK treatments
Recovery After Trans PRK
While recovery is still longer than LASIK, it’s much more manageable than it used to be.
Most patients experience some discomfort for the first few days as the epithelium heals, but this is usually well-controlled with drops and medication. Vision is functional within a week or so, and continues to sharpen over the next few weeks.
By three months, results are comparable to LASIK, and long-term vision is excellent.
Why Surgeons Still Value PRK and Trans PRK
As a surgeon, I find it reassuring that PRK — in its modern form — is still such a valuable option. It shows that sometimes the “older” techniques, when updated with modern technology, can stand the test of time.
Trans PRK gives us the ability to treat patients who might otherwise have been turned away from laser eye surgery. It offers the safety of a flap-free procedure, combined with the precision of today’s advanced lasers.
Final Thoughts: A Classic, Reinvented
So, why is Trans PRK making a comeback? Because it combines the proven safety of PRK with the comfort and accuracy of modern laser technology. It’s gentle, precise, and suitable for a wide range of patients — especially those who may not be ideal candidates for LASIK.
At The Harley Street Eye Centre, we’re proud to offer Trans PRK using the Schwind Amaris 750S laser, one of the most advanced systems available today. It allows us to deliver safe, customised treatments with excellent long-term results.
If you’ve been told you might not be suitable for LASIK, or if you’re curious about flap-free options, Trans PRK could be the solution you’ve been waiting for. Sometimes, the best innovations come not from inventing something entirely new — but from taking a trusted classic and making it better than ever.