Toutes vos questions sur la Trans PKR, opération des yeux au laser sans contact

Questions & Answers about eye surgery techniques: TransPKR, PKR, Lasik, or femtosecond laser:

How much does TransPKR cost?
From 2,200 euros with the SmartPulse option on the Amaris 1050 RS laser.

Price of pre-operative consultation: 75 euros. Not reimbursed by Social Security, but may be reimbursed by mutual insurance depending on the terms of your contract. A receipt will be provided.

Is TransPKR really a contactless technique?
Absolutely. Everything happens remotely and it is therefore a completely painless treatment; you can even avoid using the eyelid retractor for those who are put off by this prospect.
It is also the only truly contactless technique, unlike the femtosecond laser, which is sometimes wrongly referred to as “100% laser,” a terminology that could lead one to believe that the femtosecond does not involve any manipulation of the eye, which is inaccurate.

Is Femtolasik or femtosecond laser contactless?
Absolutely not: whatever the femtosecond used, it necessarily includes a phase of direct intervention in contact with the eye, namely:
– first, the placement of an eyelid retractor,
– then application of the head of the femtosecond laser directly in contact with the eye with suction-aspiration of the eye to immobilize it,
– then detachment (sometimes delicate) followed by lifting of the corneal flap with a metal cannula.
We are really far from a contactless procedure..., which does not prevent this laser from being able to present a certain interest in certain cases.

Post-Lasik ectasia:
Haze (a type of scar fog) which normally only occurs with surface treatments such as PKR and which is never seen in classic Lasik with micro-keratome.

Transient photophobia:
Rainbow glare that is believed to be due to the diffraction of light through a grid-treated interface by the femtosecond laser. Recently, images of the altered cornea of one of these patients treated at the Rothschild Foundation with Alcon's FS200 laser were able to be demonstrated using a confocal microscope.

As we can see, the list of potential complications of the femtosecond laser is long, some of which seem to us to be all the more important as they are specific to femto and do not exist with classic Lasik, such as difficulties or even impossibility of lifting the flap, complications due to gas bubbles, Haze, transient photophobia, halos - rainbow glare.
It should also be remembered that the femtosecond laser was supposed at the beginning to reduce or even prevent the risk of ectasia on keratoconic cornea, which is absolutely not the case.
We do not entirely share the optimism of some who would attribute these complications to a sort of youthful defect suggesting that latest generation femto lasers would improve things, as we see in particular with these rainbow glare cases which concern a very recently released laser and we believe that there are indeed complications specific to the femtosecond laser as indeed in any new technology and candidates must be informed of them.

If TransPKR is really so interesting, why hasn't it replaced all other techniques?
First, it is not suitable for all visual defects.
Second, it is certainly completely painless during the operation, but it is more painful afterwards (especially the first night).
Furthermore, it takes longer to recover optimal vision.
For those who want to be corrected and operational the next day, Lasik remains essential.
TransPKR is, in our experience, indisputably superior to other surface Excimer laser techniques such as classic PKR, epi-Lasik, Lasek: several studies have demonstrated this.

Is TransPKR really worthwhile for my case?
Cases where TransPKR is truly irreplaceable:
1/ All thin corneas with irregular, asymmetrical, suspicious topography, leading to fears of complications if the cornea is weakened by Lasik or femtolasik.
2/ All patients who are resistant to the prospect of any contact or manipulation on their eyes: it is the only non-contact technique where the treatment is done remotely.
3/ Patients whose profession (firefighters, military, police officers) or sporting activity (boxing, combat sports, rugby) involves frequent and violent shocks.
In any case, only a preliminary examination will allow the technique to be chosen on a case-by-case basis.

Is transPKR really risk-free?
Zero risk does not exist, it never will.
But with this technique we are very close to it:
No contact: therefore minimized risk of infection.
No cutting or corneal flap: therefore no risk of tearing or displacement of the flap if the cutting goes wrong or if we move during the operation or if we rub our eyes afterward.
It really is the safest technique par excellence.
Let us also remember that it is an improvement on PKR for which we have almost 40 years of experience.

The TransPKR Procedure is Painless, But What Happens After?

The operation is very brief—about twenty seconds per eye using the Schwind Amaris 1050 laser, which is the fastest laser in the world.

At the end of the procedure, the surgeon often (but not always) places a bandage contact lens to facilitate healing. The patient does not need to worry about this; they live and sleep with it, and it is barely noticeable. The surgeon will remove it after 3 to 4 days. If the lens falls out before that, it is not a problem, as it is mainly useful for the first night.

Immediately after leaving the clinic, the patient experiences blurry vision but can still move around and perform daily activities. However, driving is strictly prohibited, and work is discouraged for 48 hours.

Pain typically starts 1 to 2 hours after the procedure and lasts for one night, accompanied by light sensitivity (photophobia), which usually disappears within 24 to 36 hours. The discomfort is greater for those with higher refractive errors, while it is minimal for patients with mild myopia.

Significant vision improvement begins around 48 to 72 hours after the procedure. To achieve perfect vision, it may take one to two weeks.

Many patients opt to have the procedure on a Thursday evening after a normal workday (without wearing contact lenses). A long recovery weekend is recommended, and most patients who undergo surgery on Thursday evening can return to work by Monday. However, those with visually demanding professions—such as professional vehicle operators or aviation personnel—may need a longer recovery period.

For such cases, and for those who are concerned about potential work impairment on Monday (especially individuals with high myopia or visually demanding jobs), a staggered treatment approach can be used:

In this scenario, the second eye is treated one or two weeks later, further minimizing professional downtime.

I Plan to Have Another Pregnancy, Will My Vision Change After?

No more than any other myopic person, even after multiple pregnancies, whether or not they have undergone LASIK.

This is a persistent myth.

When myopia is stabilized (a notion that must be carefully evaluated during the preliminary examination), there is no reason why the future mother's vision should regress or change more than that of the future father!

Like any misconception, there is always some truth behind it: prudence dictates that we do not operate on pregnant women. Refractive surgery is an elective procedure and is not performed on pregnant women, but it is routinely and safely performed on women who may later become pregnant.

That being said, the few pregnant women we have unknowingly operated on (either because they "forgot" to inform us or because the early stage of pregnancy was only discovered after LASIK) did not experience any different outcomes compared to others—neither for the baby nor for the visual result of the LASIK procedure.

Is TransPKR Just a Reworked Version of 90s PTK-PKR Surgery?

It is true that TransPKR is an improvement of PKR, which was the first laser eye surgery using an Excimer laser. This is actually reassuring, as we now have almost 30 years of data showing no harmful, undesirable, or degenerative effects in the millions of people who have undergone this procedure worldwide.

How Does TransPKR Improve Over Classic PKR?

First, the new generation lasers we use lead to fewer healing delays, thanks to advanced algorithms and larger treatment zones with smooth transitions.

The fact that this procedure is done in a single step, rather than two as in PKR combined with PTK, reduces corneal dryness, which can cause treatment imprecision.

The single-step process of TransPKR ensures that the corneal epithelial removal zone is limited to the strict minimum and perfectly matches the myopia treatment area. This speeds up visual recovery and minimizes post-operative pain.

Unlike classic PKR, there is no manual epithelial removal, meaning no mechanical or alcohol-induced aggression.

Further Advantages Over PTK + PKR:

Consideration of different ablation rates between the epithelium and stroma.
Accounting for variations in epithelial thickness between the center and periphery, preventing refractive shifts.
Modern corneal imaging allows extremely precise epithelial thickness mapping, eliminating result fluctuations based on epithelial thickness. Our corneal imaging module is FDA-approved with a precision of 5 microns.
Compensates for possible corneal irregularities hidden by the epithelium.
For personalized treatments, ensures a 100% customized correction based on measured data.

TransPKR is undeniably a true scientific advancement, validated by numerous studies. However, it remains a surface treatment—yet the most refined and optimized surface treatment available.

Can Trans-PKR be performed on machines other than those used at the Paris Ouest Ophthalmological Center?
True transPKR as we practice it is currently only possible on lasers offered by the German brand Schwind, inventor of TransPKR.
And this is from the Amaris 500 model (and also on the Amaris 750) which are models equipped in other French or foreign clinics.
We have the most recent and most powerful Schwind laser: the Amaris 1050 RS which is the first to have been installed in France. It is already in service in other countries: Japan, Hong Kong, Canada, Germany, Australia, Iran, Oman, Guatemala, Brazil, Colombia, Mexico, Sweden, Korea, Singapore, and France.
The Amaris 1050 is, as its name suggests, twice as fast as the 500.

Do you still practice other surface techniques (PRK, epilasik)?
Yes, because in some cases transPKR is not recommended, such as in cases of irregularity or ineligibility of the surface epithelium: this is relatively rare but sometimes happens.
All this is part of the preliminary examination for any refractive surgery.
It is only at the end of this preliminary examination that we can confirm the candidate's eligibility and the choice of the appropriate technique.
It should be noted that we also and still very frequently perform interventions such as Lasik with a microkeratome or Lasik with a femtosecond laser, which retain their indications and their indisputable effectiveness.

Can transPKR correct presbyopia?
Yes, myopia, hyperopia, astigmatism, and presbyopia can benefit.

Quelles sont les complications de la transPKR ?
On en connait beaucoup moins qu’avec les autres techniques.
La principale complication est le « Haze », sorte de réaction inflammatoire qui retarde la cicatrisation et la récupération visuelle
Le haze est plus fréquent dans les fortes myopies (a partir de 5 dioptries), les collyres cortisonés qui sont prescrits en post-op vont le réduire.
La transPKR donne bien moins de réaction inflammatoire que les autres techniques type PKR : cela est attesté par de nombreuses études scientifiques internationales (lire en français l’étude publiée par le service du Professeur Burillon des hôpitaux civils de Lyon lors du principal congrès des ophtalmologistes français en 2011 et publié par la SFO (Société Française d’Ophtalmologie).

I suffer from dry eye, can I have surgery?
The true "dry eye syndrome" as found in certain autoimmune diseases such as Gougerot Sjogren's disease is a contraindication.
The banal dryness as found in many contact lens wearers who have overused them is generally not a real contraindication.
This point should nevertheless be reported to the Ophthalmologist during the preliminary visit (as well as any history of taking anti-acne medication such as Roaccutane).
The preliminary examination will confirm the possibility of surgery, often requiring the use of moisturizing eye drops such as artificial tears for a few weeks.
The existence of dry eye can be an additional argument tipping the balance towards surface techniques such as transPKR without Lasik cutting, but not always.

This remains to be clarified during the pre-operative examination.

I Plan to Have Another Pregnancy, Will My Vision Change After?

No more than any other myopic person, even after multiple pregnancies, whether or not they have undergone LASIK.

This is a persistent myth.

What about breastfeeding?
This should be mentioned at the preliminary visit because pre- and post-operative medications will be adapted to breastfeeding. Furthermore, the hormonal effects of breastfeeding could alter the outcome.

Should Surgery Be Avoided in Summer Due to the Sun?

All serious candidates who have thoroughly researched before taking the plunge ask us this question, fearing they will have to spend the entire summer in the shade of dark glasses. In fact, this has even become a test for me: when, at the end of the preliminary visit, they hesitantly ask, "Summer is coming, maybe it's better to wait until autumn?", I immediately think to myself, "Good, this person is conscientious and cautious—they will follow the pre- and post-operative instructions to the letter," which is one of the keys to success.

It is true that in the Paris region, the problem is less significant than in the Antilles or Réunion, where our colleagues operate year-round with complete confidence. However, a patient may undergo surgery in Paris and then immediately leave for a month in the tropics.

This question, which worries many LASIK candidates, seems somewhat overestimated by many ophthalmologists, yet it still requires clear answers:

Yes, surgery can be performed in any season.

Yes, tinted filtering lenses (class 3 should be sufficient in our latitudes) should be worn. There are also class 3 photochromic lenses that turn into class 4 in sunlight.

The brown tint is often preferred by myopic patients but is not mandatory.

No, they do not need to be worn all day, only during strong sun exposure (for about three months for a PRK or TransPRK, slightly less for LASIK). That said, today, tinted lenses are recommended for everyone, even without laser surgery, as they help prevent many sun-related toxicity issues, particularly macular damage.

Are Google Glass Incompatible with LASIK?> >What Are Google Glass?>

Difficult to define due to their innovative nature, Wikipedia describes them as a pair of glasses equipped with an integrated camera, a microphone, a touchpad on one of the arms, mini-screens, internet access via Wi-Fi or Bluetooth, and, since version 2, an earphone connected to the right arm via a mini-USB port.

They provide access to most Google features, including:

Google Glass come in different models, and Google has recently announced a partnership with Luxottica, the world's largest eyewear manufacturer.

Google’s LASIK Warning

Interestingly, Google strongly warns about the potential dangers of using Google Glass for individuals who have undergone LASIK surgery.

They explain that the LASIK flap (a corneal flap created during surgery) never fully heals, and in the event of trauma, Google Glass could damage the cornea—even years after the procedure.

Google advises LASIK patients to consult their ophthalmologist regarding potential incompatibility. However, given the novelty of this technology, most medical opinions are likely to be cautious by default.

The Future of Glasses and LASIK

Today, the public is divided between two trends:

A growing desire to eliminate the need for glasses or contact lenses, fueled by the success and increasing normalization of LASIK.
A continued strong interest in glasses as accessories—such as blue-light-blocking glasses for computer use, sunglasses, tinted lenses, and photochromic lenses.

This paradox could be summed up as:

“No to glasses as a prosthetic” for major vision correction.
“Yes to glasses as an accessory” for fashion, sports, computers, or comfort.

What will Google Glass become in 10 or 15 years? A failed project, or a groundbreaking communication tool that revolutionizes daily life—just as mobile phones and the internet did years ago? Time will tell.

And what about LASIK patients? Will they be left behind? The most likely scenario is that, with sufficient hindsight, we will determine that LASIK and Google Glass are not incompatible.

In the meantime, this concern could further strengthen interest in contact-free, flap-free procedures such as transPRK, which eliminates the risks associated with a LASIK flap.

15 Questions / Answers about Trans PRK

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