TransPRK - Transepithelial PhotoRefractive Keratectomy


What is the difference between TransPRK, LASIK and Epi-LASIK?

There are many methods to correct your vision - LASIK, LASEK, Epi-LASIK, PRK and now TransPRK. All are widely recognised procedures for correcting myopia and astigmatism.

LASIK is known as the flap-and-zap method. During LASIK, a cut is made across the cornea such that a flap is created either by a metal oscillating blade or a Femtosecond laser. The flap is then lifted, and the laser correction will be applied to the underlying cornea tissue. After which, the flap is closed back without any form of stitches.

Epi-LASIK (Epi is short for epithelium), on the other hand, is a form of ablation where no cut is made to the cornea. During Epi-LASIK, the uppermost surface layer of cells - also known as the epithelium layer - is removed with a blunt oscillating blade made of metal or plastic! Laser correction is then applied to the underlying cornea. As the epithelium cells have regenerative properties, these cells will grow back on its own in 3-5 days. In this way, corneal tissue loss and nerve damage can be better preserved.

TransPRK is even better - there is no oscillating plastic or metal blade. The Excimer laser removes the epithelium by vaporisation and then continues to reshape the cornea all in a one-step, no touch, no blade treatment! This all happens under the guidance of a 7 Dimensional eye tracking system using the SCHWIND Amaris 1050RS Laser.

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How do I know if I am suitable for LASIK, TransPRK and/or Epi-LASIK?

You will need to go through an in-depth pre-surgical evaluation. Eye surgeons and optometrists will check your eyes thoroughly. Some of the factors that determine your suitability for TransPRK, LASIK or Epi-LASIK are:

  1. Corneal shape
  2. Corneal thickness
  3. Any pre-existing eye conditions such as glaucoma, cataracts, etc.

Usually, treatments below 75 degrees are rarely done but like in most refractive surgeries, the lower the power, the better the accuracy. The maximum power for safe correction is usually determined by 2 factors:

  1. Corneal thickness
  2. Pupil size in the dark.

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If I am suitable for TransPRK, LASIK and Epi-LASIK, which procedure is best for me?

You may want to opt for TransPRK over Epi-LASIK or LASIK if:

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How do I evaluate and pick a good eye surgeon?

In TransPRK, Epi-LASIK and LASIK, an experienced and capable surgeon will keep surgical complications to a minimum. TransPRK has a shorter time for surgery. The short surgical time will result in more accurate results. You may also want to check if your surgeon has a good reputation in the community, and if he is committed to his patients before, during and after the surgery.

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What happens during surgery?

TransPRK is the most recent and elegant iteration in laser refractive surgery. Your eye will be held open by a speculum and you will stare at a blinking green light straight ahead. The laser will do the rest! Nothing touches your eye and the laser does its magic. With 7th dimensional tracking, the AMARIS laser will direct, predict and recognise a thin layer of your cornea gently. Only the AMARIS family of lasers can perform TransPRK, with the 1050RS having the shortest surgical times.

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How long does the surgery take?

TransPRK is the quickest of the laser refractive surgery procedure taking no more than 2 minutes. Epi-LASIK takes approximately 5 to 6 minutes per eye while standard LASIK takes 10 to 15 minutes per eye. Epi-LASIK uses a microkeratome to scrap off the most superficial layer, the epithelium. In LASIK, a flap is cut with a blade or laser. Then, the laser treatment is applied both for Epi-LASIK and LASIK.

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Will I be put to sleep during the surgery?

No, the procedure is done completely under numbing eye drops. The eye drops are instilled just before the surgery. You will not feel any pain throughout the short procedure.

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What are the risks and complications of TransPRK, LASIK & Epi-LASIK?

Modern TransPRK, LASIK and Epi-LASIK are safe and problem-free in almost all patients. Unfortunately, there is no such thing as risk-free surgery. All surgeries will have the risk of complications such as infections, inflammation and under/over correction. However, such conditions rarely occur. Nevertheless, to ensure a problem free recovery, patients should also do their best by following the doctor's post-surgery instructions.

Because there is a cut made across the cornea, LASIK has the additional risk of flap complications. These include: flap infection, flap inflammation, risk of flap dislodgement caused by rubbing or a finger poke or sports injury. Another complication resulting from a cut flap is acute and chronic dry eye because of the thousands of tiny cornea nerve endings are being severed in the process of cutting the flap.

Epi-LASIK has the risk of cutting the substance of the cornea. This is because it "peels" away the surface layer (Epithelium) of the cornea using a blunt metal or plastic blade, and then the Excimer laser treats the exposed area.

This is why TransPRK is so elegant. It only removes tissue that is absolutely necessary without any collateral damage. Healing is therefore quicker in TransPRK.

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How many days of medical leave will I be given?

You will be given up to 7 days of medical leave, including the day of the surgery itself. Many patients are able to go back to work earlier. However it is advisable not to return to work in the first three days after the operation so as to reduce the risk of infection. You will be prescribed topical eye drops to prevent infection and promote rapid healing.

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What are some of the things I should take note of post-surgery?

Rest at home and observe good hygiene for the first week after TransPRK surgery. Avoid crowded, dirty and dusty locations. Do not rub your eyes especially for the first week as the delicate superficial layer is healing under a special (very thin) contact lens. This contact lens reduces discomfort to a minimum and promotes healing. There will be no bloodshot eyes formed in Epi-LASIK and LASIK due to the suction ring. Your vision will be a little misty and cloudy for the first few days but will become clearer every day.