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No-Touch Laser Eye Surgery (Trans-PRK) vs LASIK vs SMILE: Pros, Cons and Recovery
No touch laser eye surgery (Trans-PRK) is a flap-free surface laser with the longest, sorest recovery but no flap risk. LASIK recovers fastest, often with a return to work the next day, but cuts a flap. SMILE is flap-free keyhole laser with faster recovery than surface laser. Results are equally good by three months. Prof. Dr. Ahmet Satıcı and Op. Dr. Aysan Bayram choose between them after measuring your corneas.
What is no touch laser eye surgery (Trans-PRK)?
No touch laser eye surgery is the patient name for transepithelial PRK, written Trans-PRK, TransPRK or tPRK. It belongs to the surface laser family with PRK and LASEK. In every surface treatment the cornea's clear skin layer (the epithelium) is removed, the tissue underneath is reshaped by an excimer laser, and the skin layer then regrows. In Trans-PRK the laser itself removes the skin layer as part of the same treatment, so no blade, no flap, no alcohol and no instrument touches the cornea. According to the Royal College of Ophthalmologists (RCOphth), this shortens recovery by 1 to 2 days compared with PRK and LASEK.
"No-touch" does not mean nothing comes near your eye. Numbing drops are used, a small spring clip holds your eyelids open, and a bandage contact lens is placed on the eye afterwards. It means the cornea itself is touched only by laser light.
The other two methods work like this:
- LASIK uses two lasers. A femtosecond laser prepares a thin protective flap, which is lifted; an excimer laser reshapes the cornea beneath; the flap is smoothed back and sticks without stitches (RCOphth).
- SMILE (also sold as SMILE Pro, CLEAR, SmartSight or SILK) uses a femtosecond laser to shape a thin lens-shaped piece of tissue inside the cornea, which the surgeon removes through a small incision. The RCOphth describes it as "like LASIK without the LASIK flap". EyeWiki, the American Academy of Ophthalmology's (AAO) clinical encyclopedia, puts the incision at 2–3 mm.
The RCOphth says the three groups of methods carry similar risks and benefits and normally produce very good results in the right patients. The difference is how the surgeon reaches the tissue, and that decides your recovery, your comfort and which corneas each method suits.
Trans-PRK vs LASIK vs SMILE at a glance
| No-touch Trans-PRK | LASIK (Femto-LASIK) | SMILE / SMILE Pro | |
|---|---|---|---|
| Family | Surface laser | Flap-based laser | Lenticule extraction |
| How the tissue is reached | Laser removes the skin layer, then reshapes the surface | Laser-made flap is lifted, then tissue reshaped beneath | Lens-shaped piece of tissue removed through a small incision |
| Flap? | No | Yes | No |
| First days | Eye normally very sore while the skin layer regrows (about a week) | Gritty or burning at first | Gritty or burning at first |
| Return to normal life | A week or longer before the driving standard | Often back at work the day after | Visual recovery slightly slower than LASIK |
| Contact sports | Sooner than LASIK | Wait at least 1 month | Sooner than LASIK |
| Dry eye | Less than after LASIK in general; better nerve recovery | The most frequent side effect of LASIK | Better than LASIK in meta-analyses |
| Special risk | Corneal haze (mostly deeper treatments) | Flap problems | Suction loss; touch-ups are harder |
| Often chosen for | Thin corneas, contact sports, flap-free preference | Fast recovery, wide range of prescriptions | Sport, dry eye, no flap with faster recovery |
Sources: RCOphth patient information (PROF/2024/499); EyeWiki (AAO); FDA. Details and numbers are in the sections below.
Which is better: no touch laser eye surgery, LASIK or SMILE?
None is better for everyone. The RCOphth states that visual results at three months are equally good for all types of laser vision correction, and that the main difference between the procedures is speed of recovery. A 2026 meta-analysis in the European Journal of Ophthalmology pooled 17 studies and 5,686 eyes and found no significant difference in efficacy or predictability between Trans-PRK and LASIK or SMILE. Its authors concluded that the choice should rest on your eyes, the available technology, the risk profile and the surgeon's experience, not on one method beating the others.
So the real question is which trade-off suits you: a faster return to normal life (LASIK), no flap with a quick recovery (SMILE), or no flap and the most corneal tissue left untouched at the price of a sorer, slower recovery (Trans-PRK). The next sections set out the pros and cons of each.
Pros and cons of no touch laser eye surgery (Trans-PRK)
Pros
- No flap. Nothing is cut in the cornea, so there is no flap that could move or be injured. The AAO says PRK "does not involve cutting a flap" and suits active people.
- Often suits thinner corneas. The AAO notes that PRK helps people whose corneas are too thin for LASIK, because more of the cornea is left untouched.
- Contact sports sooner. The RCOphth says people can return to contact sports sooner after surface laser than after LASIK, which needs at least a month.
- Less dry eye than LASIK. EyeWiki lists better corneal nerve recovery, and so less dry eye, as an advantage of surface treatment over LASIK.
- Shorter recovery than PRK and LASEK. One to two days shorter (RCOphth). A systematic review in BMC Ophthalmology (2025, 11 studies) quotes a study in which every eye had healed its skin layer by 72 hours.
- Comparable results to PRK. A 2022 meta-analysis of 12 studies and 1,711 eyes found Trans-PRK and PRK gave comparable vision, with lower pain scores and similar haze after Trans-PRK. The authors warned that only 2 of the 12 studies were randomised, so the size of the differences is uncertain.
Cons
- The slowest visual recovery. While the skin layer regrows over about a week, the eye is normally very sore (RCOphth). EyeWiki describes the discomfort as mild to moderate and usually worst on days 2 and 3, and the AAO says eye pain for 2 to 3 days is typical. The RCOphth says you may need a week or longer to reach the driving standard, and vision keeps sharpening for about three months.
- A bandage lens and a longer stay. The bandage contact lens usually comes out between day 4 and day 7 (RCOphth), so travellers plan about a week in Istanbul.
- Haze risk and months of drops. Corneal haze, a mild cloudiness, typically appears a few weeks after surface laser and peaks at one to two months. It is more likely after deeper treatments, including short sight above −6.00 D, and with more UV exposure (EyeWiki). Many surgeons use mitomycin C during surgery to reduce it, and steroid drops can continue for up to four months (EyeWiki). The AAO says sunglasses matter because sun can cause scarring.
- Weaker evidence for long sight. The 2025 BMC Ophthalmology review found the evidence for Trans-PRK in long sight limited, with more haze and regression, and lower predictability at higher corrections.
- Less pain is not guaranteed. Pooled data favour Trans-PRK over PRK, but individual studies disagree, so plan for sore days.
Pros and cons of LASIK
Pros
- The fastest visual recovery. Patients are often back at work the day after surgery (RCOphth).
- Mild early discomfort. The eye may burn, itch or feel gritty at first (FDA), and there is no skin layer to regrow.
- Well proven. An 18-year audit of 53,731 eyes, summarised by EyeWiki, found more than 99% of eyes reaching 20/40 or better unaided and over 70% reaching 20/20 since 2010. The AAO says about 9 in 10 patients end up between 20/20 and 20/40 without glasses or contacts.
- Wide range of prescriptions, including astigmatism, which SMILE can under-correct.
- Low re-treatment rate. The same audit found a re-treatment rate of 2.55%.
Cons
- A flap is created. That is why the RCOphth tells LASIK patients to wait at least a month before contact sports, and why the FDA lists flap complications (during surgery, or later through flap movement or infection) among the risks.
- Most dry eye. Dry eye is the most frequent side effect of LASIK. EyeWiki says it usually resolves over 6 to 12 months but persists in up to 20% of patients, and the FDA notes that it may be permanent.
- Ectasia. A rare weakening and bulging of the cornea. EyeWiki puts it at about 1 in 5,000 with modern screening, and names abnormal corneal topography as the biggest single risk factor, which is why scans matter.
- Not for thin or weak corneas. The AAO lists thin corneas, keratoconus and severe dry eye among the conditions that rule LASIK out.
Pros and cons of SMILE
Pros
- No flap and a small incision. About 2–3 mm (EyeWiki). EyeWiki reports that SMILE preserves the cornea's biomechanical properties better than LASIK and about as well as PRK.
- Better dry-eye profile than LASIK. A meta-analysis found no significant difference in refractive outcomes between SMILE and LASIK except corneal sensation and tear break-up time, which favoured SMILE (EyeWiki). EyeWiki lists pre-existing dry eye, higher short sight, contact sports and larger pupils among the groups for whom SMILE is preferable.
- Faster than surface laser. The RCOphth notes that visual recovery after lenticule extraction may be slightly slower than after LASIK, but that patients can return to contact sports sooner than after LASIK, and that eye-surface comfort may recover slightly faster.
- Very short laser time. With the newer SMILE Pro platform, EyeWiki gives a laser time of about 8–10 seconds.
Cons
- Slightly slower visual recovery than LASIK (RCOphth).
- Slightly more tissue removed, from slightly deeper in the cornea, than with LASIK (RCOphth).
- Not for long sight. EyeWiki notes SMILE is not approved for hyperopia, and that it tends to under-correct low to moderate astigmatism compared with LASIK.
- Touch-ups are harder. If an enhancement is needed, EyeWiki says re-treatment may require PRK.
- Specific complications. Suction can be lost during the laser step; EyeWiki reports it was managed in the same sitting in 81.8% of cases. Rare problems include incision tears and interface infection.
Recovery compared: Trans-PRK vs LASIK vs SMILE
For all three, surgery on both eyes takes about half an hour and you go home the same day (RCOphth). After that, the paths diverge.
| No-touch Trans-PRK | LASIK | SMILE | |
|---|---|---|---|
| First days | Sore, watery, light-sensitive; worst on days 2–3; blurry vision | Gritty or burning, hazy at first | Gritty or burning, hazy at first |
| Bandage lens | Yes, usually removed on day 4–7 | No | No |
| Skin layer | Regrows in about a week (EyeWiki: 3–4 days) | Kept intact | Kept intact |
| Back at work, driving | A week or longer before the driving standard | Often back at work the next day | Visual recovery slightly slower than LASIK |
| Showering and hair washing | After the bandage lens is out | From day one | From day one |
| Gym and jogging | From day one | From day one | From day one |
| Swimming | Most surgeons advise no swimming for a week | Same | Same |
| Contact sports | Sooner than LASIK | At least 1 month | Sooner than LASIK |
| Results equally good | By 3 months | By 3 months | By 3 months |
| Full stabilisation | Up to 2 years | Up to 2 years | Up to 2 years |
| Usual stay in Istanbul | About a week | {{3–5 nights}} | {{3–5 nights}} |
Sources: RCOphth (PROF/2024/499) and EyeWiki (AAO). The RCOphth says most changes after three months are very small, although it can take up to two years for the results to stabilise fully.
Whichever method you choose, expect to avoid rubbing your eyes, use lubricating drops often, and leave at least two minutes between different drops (RCOphth). For a day-by-day account, read our guide to the laser eye surgery recovery timeline.
Which method suits your eyes and lifestyle?
Your surgeon decides after measuring your corneas, but these are the usual pointers from the sources above.
| Your situation | Method often considered | Why |
|---|---|---|
| Thin corneas | No-touch Trans-PRK (or SMILE after scans) | Surface laser leaves more of the cornea untouched (AAO); thin corneas can rule LASIK out |
| Contact sports, martial arts, a job with eye knocks | Trans-PRK or SMILE | Return to contact sport sooner than after LASIK (RCOphth) |
| Need to be back at work quickly | LASIK, or SMILE | LASIK gives the fastest recovery (RCOphth) |
| Dry eyes or contact-lens dryness | SMILE or Trans-PRK | Better nerve and tear-film recovery than LASIK (EyeWiki) |
| Higher short sight | SMILE or LASIK | EyeWiki lists higher short sight among reasons to prefer SMILE; deeper surface laser raises haze risk |
| Astigmatism | LASIK or Trans-PRK | SMILE tends to under-correct low to moderate astigmatism (EyeWiki) |
| Long sight (hyperopia) | LASIK, or lens surgery | SMILE is not approved for hyperopia; Trans-PRK evidence is limited (BMC Ophthalmology, 2025) |
| Over 45 and starting to need reading glasses | Lens surgery may suit better | See the guide to refractive lens exchange vs laser |
Who can have laser at all? The RCOphth says you are most likely to be suitable if you are over 18, your prescription has changed by no more than 0.5 dioptres in the last two years, and it falls within up to −10.00 D of short sight, up to +4.00 D of long sight and up to ±6.00 D of astigmatism. Laser can work above these ranges for some people, and some people below them are better suited to lens implants. Cataract, eye-surface problems and an abnormal corneal shape such as keratoconus can rule laser out.
Risks that apply to all three methods
The risks and benefits of the three families are similar (RCOphth). Know these before you choose:
- Permanent, serious loss of vision is rare. Fewer than 1 in 5,000 patients need a corneal transplant to restore vision after laser surgery (RCOphth).
- Additional surgery. Up to 1 in 10 patients need some further surgery to get the best result (RCOphth). UK clinics normally include fine-tuning laser for up to two years.
- Dry eye and fluctuating vision. Both come from a less stable tear film, improve over a few months and are usually controlled with lubricating drops (RCOphth).
- Glare, halos, starbursts and ghost images. Most noticeable at night, usually mild with modern lasers and improving within a few months; lasting problems are unusual but possible (RCOphth, NHS).
- Red blotches on the white of the eye. Harmless, and they can take up to 6 weeks to fade (RCOphth).
- Later in life. Tell any eye doctor you have had laser: it can make eye-pressure readings for glaucoma read low and affects cataract lens calculations (RCOphth).
Satisfaction is high: the RCOphth reports that over 95% of patients are satisfied with the outcome.
Do the three methods cost the same?
Prices vary by clinic and are not set by the method alone. In the UK, the RCOphth says laser vision correction is not available on the NHS and is not covered by private health insurance, so you pay in full. Published UK private prices for both eyes in 2025–26 range from about £3,000 to £5,600 for Femto-LASIK and about £4,400 to £7,600 for SMILE (typical clinic and comparison-site ranges, not quotes).
At Laser Istanbul Clinic, no-touch Trans-PRK starts from {{£ price}} for both eyes. The price includes your pre-operative examination and scans, surgery by your named surgeon, medication, follow-up checks in Istanbul, a personal interpreter, a coordinator and remote follow-up. Hotel and airport transfers are not included; they are a separate charge, arranged for you on request. Flights are not included either. Because Trans-PRK needs a longer stay than LASIK, include the extra nights in your budget.
How do Prof. Dr. Satıcı and Op. Dr. Bayram choose your method?
Choosing is a measurement decision, not a menu. Before recommending anything, the surgeon checks:
- Corneal shape and thickness (topography and tomography), to rule out keratoconus and decide how much tissue can safely be treated.
- Your prescription and its stability, including astigmatism and long sight.
- The tear film and eyelid glands, because dry eye changes the best choice.
- Pupil size and retina health, which matter for night vision and for high short sight.
- Your life: sport, work, driving needs and how many days you can spend in Istanbul.
Prof. Dr. Ahmet Satıcı (laser, lens and cataract surgery) and Op. Dr. Aysan Bayram (laser, cataract and retina; she speaks English) lead laser surgery. Because they also treat cataract and lens problems, they can tell you honestly when laser is not the right tool. If your scans show a thin, weak or irregular cornea, your case is reviewed by Doç. Dr. Muhammet Derda Özer (Doç. = Associate Professor), our cornea and keratoconus specialist, before any decision is made.
Stop wearing contact lenses before your examination so the cornea returns to its natural shape. The US Food and Drug Administration (FDA) advises 2 weeks for soft lenses, 3 weeks for toric soft or rigid gas-permeable lenses and 4 weeks for hard lenses; your coordinator confirms the timing for your lenses.
Frequently asked questions
No touch laser eye surgery is Trans-PRK (transepithelial photorefractive keratectomy), a surface laser in which the excimer laser removes the cornea's skin layer and reshapes the cornea in one step. No blade, flap, alcohol or instrument touches the cornea. It corrects short sight, long sight and astigmatism, and the skin layer regrows within days.
Neither is better for everyone. LASIK recovers fastest, with many patients back at work the next day, while Trans-PRK avoids a flap, leaves more of the cornea untouched and allows an earlier return to contact sports. A 2026 meta-analysis of 17 studies found no significant difference in efficacy or predictability between Trans-PRK and LASIK or SMILE. Your surgeon recommends one after measuring your corneas.
They give similar vision. SMILE avoids a flap and tends to cause less dry eye and better corneal sensation in meta-analyses, while LASIK recovers slightly faster and is used for astigmatism and long sight more readily. The RCOphth says results at three months are equally good for all types.
LASIK: patients are often back at work the next day (RCOphth). SMILE is slightly slower, and surface laser including Trans-PRK is the slowest, needing a week or longer to reach the driving standard. By three months, results are equally good.
The treatment itself is not painful because numbing drops are used. The first 2 to 3 days afterwards are usually sore, gritty and light-sensitive while the skin layer heals, and drops and painkillers help. Pooled research suggests less pain than after conventional PRK, but individual studies differ, so plan for a few uncomfortable days.
Surface laser such as no-touch Trans-PRK is usually considered first, because no flap is cut and more of the cornea stays untouched. It is not suitable for every thin cornea: if scans suggest keratoconus or weakness, laser may be ruled out. Doç. Dr. Özer reviews borderline corneas.
SMILE and surface laser tend to cause less dry eye than LASIK because they spare more corneal nerves. Severe dry eye can rule laser out, and milder dry eye is usually treated before surgery. The RCOphth adds that many contact-lens wearers are wrongly told they have dry eyes and are in fact suitable for laser.
The RCOphth says the risks and benefits of the three types are similar. The 2026 meta-analysis found LASIK had a safety advantage over Trans-PRK in the astigmatism and low to moderate short sight subgroups, while the overall safety index showed no difference. The safest method is the one that fits your corneas, chosen by an experienced surgeon.
For Trans-PRK, most patients plan about a week, because the bandage lenses usually come out between day 4 and day 7. For LASIK and SMILE a shorter stay of {{3–5 nights}} is usual. Your surgeon confirms the number of nights, and when you are fit to fly, after reviewing your case.
The reshaping of the cornea is permanent, but your eyes can still change with age, and prescriptions can drift. The RCOphth says most changes after three months are very small, although stabilisation can take up to two years. Reading glasses in your 40s or 50s come from the natural lens ageing, not from the laser wearing off.
Sources for the facts on this page
- American Academy of Ophthalmology, LASIK — Laser Eye Surgery: how LASIK works; candidacy (18+, ideally over 21); conditions that rule it out (thin corneas, keratoconus, severe dry eye and others); about 9 in 10 reach 20/20–20/40 unaided; dry eye and fluctuating vision common. https://www.aao.org/eye-health/treatments/lasik
- American Academy of Ophthalmology, What Is Photorefractive Keratectomy (PRK)?: no flap, suits thin corneas and active people; bandage lens; eye pain 2–3 days; vision improves over 3–5 days, best vision may take a month or longer; sun protection because of scarring risk; haze. https://www.aao.org/eye-health/treatments/photorefractive-keratectomy-prk
- EyeWiki (AAO), Photorefractive Keratectomy: TransPRK as epithelial removal by laser ablation; epithelium regrows in 3–4 days; bandage lens out by day 4–5; discomfort mild to moderate, worst on days 2–3; steroid drops up to 4 months; stable by 3–6 months; advantages over LASIK (more tissue preserved, better nerve recovery, less dry eye); disadvantages (slower initial recovery, haze, longer return to work). https://eyewiki.org/Photorefractive_Keratectomy
- EyeWiki (AAO), Mitomycin C for Haze Prophylaxis: haze emerges a few weeks after PRK, peaks at 1–2 months; risk rises with ablation depth, myopia above 6 D and UV exposure; mitomycin C lowers early and late haze. https://eyewiki.org/Mitomycin_C_for_Haze_Prophylaxis
- EyeWiki (AAO), Small Incision Lenticule Extraction (SMILE): 2–3 mm incision; meta-analysis showing no significant difference vs LASIK except corneal sensation and tear break-up time favouring SMILE; biomechanics superior to LASIK and comparable to PRK; not approved for hyperopia; re-treatment may require PRK; suction loss managed in 81.8%; preferred for pre-existing dry eye, higher myopia, contact sports, larger pupils; SMILE Pro laser time about 8–10 seconds. https://eyewiki.org/Small_Incision_Lenticule_Extraction_(SMILE)
- EyeWiki (AAO), LASIK for Myopia and Astigmatism: Safety and Efficacy: 18-year audit of 53,731 eyes (more than 99% UCVA 20/40 or better, over 70% 20/20 since 2010; re-treatment 2.55%); dry eye usually resolves over 6–12 months, persists in up to 20%; ectasia about 1 in 5,000 with modern screening, abnormal topography the main risk factor; SMILE tends to under-correct astigmatism and has better dry-eye outcomes. https://eyewiki.org/LASIK_for_Myopia_and_Astigmatism:_Safety_and_Efficacy
- US FDA, What should I expect before, during, and after surgery?: contact-lens breaks (2 weeks soft; 3 weeks toric soft / rigid gas-permeable; 4 weeks hard); eye may burn, itch or feel as if something is in it after LASIK. https://www.fda.gov/medical-devices/lasik/what-should-i-expect-during-and-after-surgery
- US FDA, What are the risks and how can I find the right doctor for me?: flap complications, glare/halos, under- or over-treatment, dry eye that may be permanent, loss of lines of vision. https://www.fda.gov/medical-devices/lasik/what-are-risks-and-how-can-i-find-right-doctor-me
- NHS, Laser eye surgery and lens surgery: usually available only privately; glare, halos, starbursts and ghost images typically improve within months. https://www.nhs.uk/tests-and-treatments/laser-eye-surgery-and-lens-surgery/
- Serfözö A, Abu Dail Y, Munteanu C, Hoxha Z, Seitz B, Daas L. The efficacy, safety and predictability in transepithelial photorefractive keratectomy versus LASIK/SMILE: A meta-analysis. European Journal of Ophthalmology, 2026 (17 studies, 5,686 eyes; no significant difference in efficacy or predictability; LASIK safety advantage in the astigmatism and low-to-moderate myopia subgroups, no difference in the safety index; selection should rest on patient characteristics, technology, risk profile and surgeon experience). Abstract read via Europe PMC; PubMed ID 41734035. https://pubmed.ncbi.nlm.nih.gov/41734035/
- Alasbali T. et al. Transepithelial Photorefractive Keratectomy Compared to Conventional Photorefractive Keratectomy: A Meta-Analysis. Journal of Ophthalmology, 2022 (12 studies, 1,711 eyes; comparable efficacy; lower pain with TPRK, mean difference −0.80; comparable haze; only 2 of 12 studies randomised). https://pmc.ncbi.nlm.nih.gov/articles/PMC9427238/
- Akram S, Moazzum W, Abid K. Efficacy of single-step transepithelial photorefractive keratectomy in myopia, hyperopia and astigmatism: a systematic review. BMC Ophthalmology, 2025 (11 studies; re-epithelialisation in 100% of eyes by 72 hours in one quoted study; evidence in hyperopia limited, with more haze and regression and lower predictability at higher corrections). https://pmc.ncbi.nlm.nih.gov/articles/PMC11863916/
Find out which laser suits your eyes, free
Send us your glasses prescription and any eye reports. Prof. Dr. Satıcı or Op. Dr. Bayram will tell you whether no-touch Trans-PRK, LASIK or SMILE Pro suits your eyes, or whether another option is better, and confirm your price in writing. Hotel and airport transfers are arranged separately on request. More from the guides: Laser eye surgery guides · Laser eye surgery in Turkey / Istanbul
3 eye surgeons
Your case is reviewed by a named surgeon, not a salesperson. Reply within {{response time}}.
Prof. Dr. Ahmet Satıcı
Doç. Dr. Muhammet Derda Özer
Op. Dr. Aysan Bayram