Comparing
the approaches.
An honest comparison of the four main families of procedure. This table does not establish a ranking — it sets the characteristics side by side to inform your choice together with your surgeon.
| Criterion | transPRK Transepithelial excimer | LASIK Femtosecond + excimer | KLEx Intracorneal lenticule | ICL / IPCL Phakic implant |
|---|---|---|---|---|
| Main indications | Myopia ≤ −6 to −8 D, thin corneas, active patients | Myopia ≤ −6 to −8 D, hyperopia ≤ +3 D (beyond, case by case) | Myopia −2 to −8 D, moderate astigmatism | Myopia > −6 D, cornea unsuitable for laser |
| Return to activities | About 1 week | 24 h | 24 to 48 h | 24 to 48 h |
| Postoperative discomfort | Moderate, 48 h | Minimal | Minimal | Minimal |
| Corneal biomechanics | Little altered (surface ablation) | Strongly altered (corneal flap) | Moderately altered (corneal cap) | Intact |
| Dry eye | Uncommon | Possible, 3 to 6 months | Possible, close to LASIK | Rare |
| Reversibility | No | No | No | Yes |
What the table does not say.
transPRK has become my default approach in the young, active patient, for a simple reason: it better preserves corneal biomechanics without any stromal cut, and the available data suggest near-complete recovery of corneal nerve density at two years, more complete than after LASIK. The trade-off is well known — four to seven days of visual discomfort — but the ten-year benefit seems to me greater in the majority of profiles.
LASIK remains the most widely performed technique in the world and keeps the advantage of excellent visual results from the day after surgery, at the cost of a slightly more marked biomechanical alteration and slightly more prolonged dry eye. KLEx was initially presented as combining the advantages of PRK and LASIK. Real-world studies show that the mechanical alteration and dry eye are closer to LASIK than to PRK. Phakic implants remain the modern answer for high myopia, and lens surgery is reserved for indications of cataract or established presbyopia.
This reading reflects an individual practice. Each case requires a complete examination and a personalised discussion.
The limits no brochure shows.
Refractive ageing
No procedure freezes vision in the long term. After 45, presbyopia will appear; after 60, cataract. Today’s correction must anticipate tomorrow’s. And at each stage of this evolution, a suitable solution can be offered to you. This is the principle of Vision Correction for Life.
Dry eye
A frequent and under-discussed phenomenon. It usually eases within 3 to 6 months, but can persist. The preoperative assessment is designed precisely to identify at-risk profiles.
Halos
In the earliest laser treatments, the treatment zone was smaller the stronger the correction. This limitation has greatly diminished with modern lasers, to the point where a patient noticing a night-time halo is now rare. Conversely, the ICL and IPCL phakic implants have a central opening that is responsible for night-time halos. These are quite real, fairly common just after implantation, but fortunately tend to diminish quickly in the majority of patients.
Depending on the characteristics of your eye, the indication will be established at your first consultation.
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