No-Touch laser (TransPRK): who is it for, and how does healing go?

The most confusing thing for someone considering surface laser is that the same procedure is described under different names: No-Touch, transPRK, single-step PRK, sometimes "contact-free laser". On this page I have written what the procedure is, in whom I perform it, how the first days go, and at which point it is more demanding than LASIK or SMILE Pro.

I wrote it so that you can ask the same questions whichever doctor you see, in Ankara or anywhere else. I almost always perform surface laser (PRK) with the No-Touch method; No-Touch and transPRK are two names for the same procedure. You will not find a promised result here. I describe the effort of healing, and the places where the literature disagrees, just as openly.

The short answer

No-Touch laser is a single-step surface laser that removes the outermost layer of the cornea (the epithelium) with the laser itself, rather than with alcohol or a brush, and corrects the prescription in the same session. Its name in the literature is transepithelial PRK (transPRK). No flap is created and no incision is made. In return, healing is slower: stinging and blurred vision are expected in the first days, and vision settles later than with LASIK and SMILE Pro. Whether you are suitable is decided less by your prescription than by your cornea (thickness, topography), your ocular surface and your work.

You may be suitable if:

• Your corneal thickness at the thinnest point is above 480 µm (the threshold I apply) and your topography (corneal map) is regular
• You do not want a flap, or you do a sport or job with a risk of blows to the eye
• Your myopia is up to −7.00 D (the upper limit is set by corneal thickness) and your astigmatism up to −3.00 D (the limits I apply)
• You are between 18 and 45 and your prescription has not changed for at least 1 year (the conditions I apply)
• You accept the discomfort of the first days and a slower recovery of vision

You are not suitable, or I postpone, if:

• Topography shows keratoconus or a suspicion of it
• The remaining corneal tissue would be insufficient
• Your prescription is still changing or is outside the range
• You have marked dry eye or an active ocular surface disease
• You are pregnant or breastfeeding

What is No-Touch laser?

A single-step surface laser in which the epithelium is also removed by the laser

The cornea is made of several layers; on the outside is a thin protective layer of cells (the epithelium), and beneath it is the tissue that gives the cornea its actual shape (the stroma). In classic PRK the epithelium is first loosened with alcohol or removed with a brush or blade, and then the excimer laser reshapes the stroma; it is a two-step procedure. In No-Touch the same laser treats first the epithelium and then the stroma in a single programme. In the literature this single-step method is also referred to as "no-touch".[1] No flap is lifted and no lenticule is removed; the surface of the cornea is reshaped and the epithelium closes again by itself within days.

There is a separate debate about alcohol: according to one review, removing the epithelium with alcohol increases the death of keratocytes (the cells in the stroma) at the time of surgery, and it has been suggested that this may be linked to the "breakthrough haze" (clouding that develops after healing) seen after PRK with mitomycin C. The same review also describes the limitations of transPRK and notes that the method is still evolving.[1] This is a hypothesis; do not read it as a proven advantage.

What "no-touch" means, and what it does not

The name "No-Touch" means that the epithelium is not removed with a brush, blade or alcohol. It does not mean that nothing touches the eye. During the procedure the lids of your eye, numbed with drops, are held open with a small instrument (a lid speculum), the light you look at keeps the eye steady, and the device's eye-tracking system follows your movement. After the procedure a protective bandage contact lens is usually placed on the cornea. So there is contact with the eye; what is removed is the mechanical and chemical intervention on the epithelium.

How it differs from classic PRK, and how it does not

Published comparisons do not show a large difference in visual outcome. In a meta-analysis of 20 studies (10,204 eyes) comparing transepithelial PRK with mechanical or alcohol-assisted PRK, no significant difference was found in efficacy (log(OR) 0; CI −0.32 to 0.33) or safety (0.04; CI −0.98 to 1.06). For predictability the pooled log(OR) was 0.48 (CI 0.16-0.81) and the confidence interval does not include zero; its direction cannot be worked out from the abstract. The authors nevertheless write in their conclusion that there was no significant difference in any of the visual outcomes. Because of this inconsistency in the abstract, I do not say "no difference" on predictability.[2] In a randomised study of 70 eyes of 35 people, with classic PRK in one eye and transPRK in the other, the mean absolute prediction error at month 3 was 0.26 D (SD 0.23) with classic PRK and 0.34 D (SD 0.32) with transPRK; the authors report that the noninferiority threshold was met.[3] In a meta-analysis of 16 studies (1,924 eyes) examining transPRK alone, the pooled probability of efficacy was 94% (CI 0.86-0.97) and of predictability 89% (CI 0.82-0.93); the analysis covers studies of a single laser platform only, and because hyperopia studies did not meet the inclusion criteria, the results apply to myopia and astigmatism.[4]

The difference is sought not in visual acuity but in the healing process, and there the data do not all point one way. I have set this out study by study in the "After the procedure" section.

Who is it for?

Thin or borderline corneas

This is the strongest argument for surface laser. Because no flap is created, the front layers of the cornea are not separated as in LASIK. A systematic review of PRK or transPRK in eyes with a mean central corneal thickness below 500 µm included 946 eyes from 10 studies; all of the studies were case series. None of the studies reported postoperative ectasia (the cornea gradually bulging forward). The authors' conclusion applies to simple or astigmatic myopia without topographic abnormality or other eye disease; they also note that the power analysis and follow-up were not sufficient to draw reliable conclusions.[5] So it is a reasonable option for a thin cornea, but the data are not enough to say "a thin cornea is not a problem".

My threshold: corneal thickness at the thinnest point must be above 480 µm; below that I do not perform No-Touch. So although "thin cornea" is an argument for surface laser in the literature, in my practice that argument applies to eyes above 480 µm in which I do not want to spend tissue on a flap or a lenticule. In the PubMed search made while preparing this page, no study was found that gives a single corneal thickness or dioptre limit for PRK or transPRK; my 480 µm and prescription limits are not literature values but my clinical rule. These numbers do not decide anything on their own; I look at all of them together with the topography.

People who do not want a flap, and jobs with contact and impact risk

Because there is no flap, there is no risk of a flap being displaced by a blow. One review lists surface laser as a suitable option for people at risk regarding flap integrity (military personnel, people who play contact sports).[6] This describes the situation after the healing period; in the first days, while the epithelium has not closed, do not return to sport or risky environments without your doctor's permission. I have written the waiting time for sport below.

The debate about a tendency to dry eye

There is a common assumption: since there is no flap, dry eye is less frequent after surface laser. One review writes that the risk of postoperative dry eye may be lower because no flap is created.[6] A study I was able to find does not support this expectation. In a retrospective analysis of 778 patients (1,598 eyes) aged 18-45, the frequency of dry eye at month 2 was 45.7% with surface lasers (PRK and transepithelial PRK together) and 39.7% with flap methods (LASIK and femtosecond LASIK) (P = 0.005); in multivariate analysis surface laser came out as an independent risk factor (OR 1.32; CI 1.08-1.61). In the same study, a preoperative tear break-up time below 10 seconds (OR 1.45; CI 1.19-1.77) and a tear meniscus height below 0.2 mm (OR 1.58; CI 1.29-1.94) were also independent risk factors.[7] Because this study groups surface lasers together it does not give a figure specific to No-Touch, and it is retrospective. I do not draw a general rule from a single study; but do not come expecting that "there is no dry eye with surface laser" either.

In my own practice I look at ocular surface measurements before surgery.

Hyperopia

In hyperopia, No-Touch is a weak area in the published data: in the transPRK meta-analysis mentioned above, the hyperopia studies did not meet the inclusion criteria.[4] I do not choose surface laser for hyperopia; as I also wrote on the SMILE Pro page, my options in this group are LASIK and SMILE Pro.

Who is it not for?

Keratoconus or a suspicion of it on topography

This is the first, non-negotiable item. Surface laser also removes tissue from the cornea, and in keratoconus (a disease in which the cornea thins and becomes cone-shaped by itself) this process can accelerate. Surface laser does not eliminate the risk of ectasia: in a study examining 23 eyes that developed ectasia after laser, 1 eye was after transPRK (20 after LASIK, 1 after SBK, 1 after LASEK); this is not a frequency but an indication that ectasia has also been reported after surface laser.[8] If there is a suspicion, I do not perform laser; we clarify the suspicion first. If topography shows a suspicion of keratoconus: information on keratoconus

Insufficient remaining tissue

If the calculation shows that a safe stromal bed will not remain after ablation, or if the thinnest corneal thickness is below 480 µm, I do not perform No-Touch (my threshold). Although surface laser is an option for thin corneas, it is not unlimited: the higher the prescription, the more tissue is removed.

Prescription outside the range or still changing

I do not recommend No-Touch for myopia above −7.00 D (this upper limit may be lower depending on corneal thickness) or for astigmatism above −3.00 D (the limits I apply). In the literature transPRK has also been studied in high myopia: in a study of 101 eyes with myopia of 6.00 D or more, comparing a group treated with a modified transepithelial technique (41 eyes, mean baseline spherical equivalent −7.9 D) with alcohol-assisted PRK and LASIK, refractive outcomes and regression at month 12 did not differ between groups; mitomycin C was used in all PRK and modified-technique eyes, follow-up was limited to 12 months, and the control groups were partly retrospective.[9] This is written not to defend values beyond my limits but to show where the literature stands. In an eye whose prescription has changed in the past year, the value I correct today will fall short tomorrow; in that eye I wait.

Marked dry eye, active ocular surface disease

In the study mentioned above, the frequency of dry eye after surface laser was not lower than with flap methods; I do not assume that surface laser will reduce dry eye. In someone who already has marked dry eye, I first treat the ocular surface and repeat the measurements afterwards. I also do not operate while there is an active infection or inflammation.

Pregnancy and breastfeeding

Because hormonal changes can temporarily shift the prescription and corneal measurements, I postpone the procedure during pregnancy and breastfeeding. I wait 3 months after breastfeeding ends (my practice).

What I suggest if you are not suitable

"You are not suitable for No-Touch" does not have to mean "carry on with glasses". If your cornea is thick enough and its map is regular, in myopia SMILE Pro is assessed with the criteria on the who SMILE Pro suits page. If the prescription is very high or the cornea does not allow any laser, an implantable lens placed inside the eye (ICL) comes up in a separate assessment. ICL for those not suitable for laser: who it suits and who it does not Sometimes the right answer is to wait.

Assessment day: which measurement do I look at, and why?

Corneal topography and thickness

The map of the front and back surfaces of the cornea and the thickness at its thinnest point. What I look at is shape: is one area steeper than the others, is there a forward bulge on the back surface, do the two eyes resemble each other. This measurement carries the most weight in the decision; the thickness number is interpreted together with it.

Tear tests and the dilated examination

Because healing after surface laser depends on the ocular surface, tear measurement is especially important with this method. In the dilated examination the pupil is widened, your true prescription is measured and the retina is examined in detail; your vision will be blurred for a few hours, so do not plan to drive.

Before the appointment: contact lenses

Because lenses temporarily change the shape of the cornea, there is a period you need to spend without lenses before the measurements; the measurements must reflect the true shape of the cornea. The periods depend on the type of lens (soft, rigid, toric) and I have written them in the description of assessment day; tell us your lens type when you book.

The day of the procedure, step by step

The procedure is done under eye-drop anaesthesia; there are no needles and no general anaesthesia. I treat both eyes in the same session. As the laser I use the SCHWIND Amaris 1050RS excimer laser platform; some of the studies on this page were also done with the same manufacturer's platforms, so keep this in mind when applying the results to other platforms. The following happens in order:

1. Preparation. Numbing drops are put in, and the eyelids are held open with a small instrument. You will feel the urge to blink but will not be able to; it is uncomfortable but short.
2. Laser phase. The only thing I ask of you is to keep looking at the light. First the epithelium, then the stroma is treated in the same programme. No alcohol is applied and no brush is used. The eye-tracking system follows your movement. You may feel pressure and a brief change in the light.
3. Bandage lens. When the procedure is over, a protective bandage lens is usually placed on the cornea and stays in for 5 days (my practice). In the literature, too, using a bandage lens during healing is routine.[6]
4. Afterwards. After a short rest and check, you go home the same day. Have someone with you; you cannot drive that day.

After the procedure: first day, first week, first month

I am writing this section without holding anything back, because this is where the real price of surface laser lies: the epithelium has to close again. According to one review, this re-epithelialisation takes 3 to 5 days, and PRK is associated with longer visual recovery and more early discomfort than LASIK.[6]

The first day and the first 3-5 days

Stinging, watering, sensitivity to light and blurred vision are expected; in some people pain is marked. Studies disagree on whether pain is less or more with No-Touch than with classic PRK, and I do not promise "less pain":

• In a randomised, double-blind study with alcohol-assisted PRK in one eye and transPRK in the other eye of the same person (29 people, 58 eyes), epithelial healing was complete on day 3 in 62.1% of alcohol-PRK eyes and 89.7% of transPRK eyes; but pain on the first day was higher with transPRK (p = 0.0134).[10]
• In another randomised study (39 patients for transPRK versus mechanical PRK, 33 for transPRK versus alcohol-assisted PRK), mean epithelial healing time was 3.74 ± 0.82 days with transPRK and 3.59 ± 0.79 days with mechanical PRK (P = 0.21); 3.67 ± 0.92 days with transPRK and 3.67 ± 0.74 days with alcohol-assisted PRK (P = 1.00). When the initial epithelial defect area was taken into account, the healing rate was higher in the classic PRK groups (P < 0.001 in both), with no significant difference in safety, efficacy, refraction or haze (P > 0.05 in all). In their conclusion the authors state that pain and discomfort on the first day were lower with classic PRK; the abstract gives no numerical value for this.[11]
• In a randomised study of 56 patients examining bandage lens exchange (20 transPRK, 36 alcohol-assisted PRK; the comparison between techniques was not randomised and is a secondary finding), the day-1 pain score was 2.35 ± 1.2 with transPRK and 1.58 ± 1.4 with alcohol-assisted PRK (P = 0.04; the score scale is not defined in the abstract, and eyes with and without bandage lens exchange are combined).[12]
• By contrast, in a randomised study of 60 eyes, a single-step modified transepithelial technique (ASLA) had a 64% lower pain score on day 3 than alcohol-assisted PRK (P < 0.0005); 96% of eyes had no remaining epithelial defect, whereas 43% of alcohol-PRK eyes had not fully healed and had their bandage lens changed.[13] This is a modified technique; I do not apply the result to every transPRK.
• In an observational (non-randomised) study comparing 200 eyes of 100 patients, epithelial closure was faster and peak pain over the first 4 days was lower with transPRK (p < 0.0001).[14]

So on pain the studies point in both directions. Which device, which bandage lens and which pain management were used may make a difference. In my view the honest statement is this: the first days can be uncomfortable; know this from the start.

Vision settling

After surface laser vision can be blurred in the first days, so do not come expecting "clear the next day" as with LASIK or SMILE Pro. In a retrospective series of 2,093 eyes after single-step transepithelial surface laser, mean uncorrected visual acuity measured immediately after surgery or up to the next day was 20/41 ± 8, and 20/21 ± 5 at month 3; at month 3, 94% of eyes had monocular uncorrected vision of 20/25 or better. In the same series, 62% of eyes had monocular vision of 20/40 or better immediately after surgery, and the authors describe recovery as fast; so these data do not say "the first days are always blurred", they show a marked rise between the first day and month 3. The series is retrospective, belongs to a specific laser platform and pulse technology, and two of the authors are affiliated with the laser manufacturer's R&D unit; do not read these numbers as a personal expectation.[15] In the observational study comparing with classic PRK (mild to moderate myopia, single centre), on day 4, 72% of transPRK eyes had decimal uncorrected visual acuity of 0.7 or better, while none of the classic PRK eyes did; at week 6 both groups reached 1.0 or better.[14]

The first week and the first month

Clarity can fluctuate during the day, and a feeling of dryness can be marked. Keeping to the drop schedule is important for the quality of healing in this period. The schedule I apply: artificial tears for 6 months, steroid drops for 3 months. I ask you to wait 1 week before driving; for the first 5 days water must not touch your face and eye (you can shower; protect your face and eye from the water); 2 weeks for sport. For screens, eye make-up, swimming and returning to work, we decide together at the check-up according to the condition of your eye. I do check-ups on day 5, at 1 month, 3 months and 6 months (my practice).

Steroid drops are used after surface laser to control inflammation and haze; I prescribe them for 3 months (my practice). In the literature the duration varies: one review gives 4-6 weeks or longer,[6] while a randomised study examining the duration of mitomycin C used a 4-month tapering schedule.[16] Steroid drops can raise eye pressure; that is why I check eye pressure at the check-ups. Do not stop or extend the drops on your own, and do not skip check-up days.

The most important rule in this period is not to rub the eye. Until the epithelium closes, the protective layer of the cornea is missing and there is a risk of infection; if pain increases, or there is redness or a drop in vision, call the same day without waiting for the check-up.

No-Touch, classic PRK, LASIK and SMILE Pro side by side

In a meta-analysis of 17 studies (5,686 eyes) comparing transepithelial PRK with LASIK and SMILE, against LASIK the log(OR) was 0.09 (CI −0.34 to 0.52) for efficacy and 0.08 (CI −0.28 to 0.44) for predictability, i.e. no significant difference; for safety, however, there was a significant difference in favour of LASIK, log(OR) −0.85 (CI −1.40 to −0.31); the authors see this difference in the subgroup with astigmatism and low to moderate myopia, and there was no difference in the safety index. Against SMILE, efficacy was 0.77 (CI −0.29 to 1.84), safety −0.3 (CI −2.27 to 1.67) and predictability −0.91 (CI −1.82 to 0; the upper limit is at zero, and the authors do not count it as significant). The authors conclude that there was no significant difference in efficacy and predictability in the LASIK and SMILE comparisons; they also write that haze is less frequent with LASIK, that SMILE has better biomechanical stability, and that the choice of method should be made according to patient characteristics and surgeon experience.[19]

This table does not answer "which is better"; it answers "which one in which eye". I sometimes discuss different methods even for the two eyes of the same person. Other laser methods we perform (in Turkish)

Permanence is a separate question: a prescription corrected by laser can partly come back over the years, and this likelihood varies with the method and the starting prescription. In high myopia I discuss expectations for surface laser at the outset. The closest data I have is a study of 101 eyes comparing a modified transepithelial technique with mitomycin C in myopia of 6.00 D or more with alcohol-assisted PRK and LASIK: at month 12 refractive outcomes and regression did not differ between groups; but follow-up was limited to 12 months and some of the comparison groups were retrospective.[9] I have covered this with figures in a separate article: Can the prescription come back, and is there a difference between methods?

Risks and limits

Temporary ones

Pain, sensitivity to light, blurring in the first days, dryness, and halos or glare around lights at night are the complaints I discuss most often. After surface laser, discomfort and blurred vision in the first days can last longer than after LASIK.[6] For dryness, see the figure I gave above.[7]

Haze and mitomycin C

Haze is clouding that can form on the surface of the cornea during healing; it is a risk seen more often with surface lasers (its frequency has been reported to be lower with LASIK[19]). Its degree varies; when marked, it can affect vision.

Mitomycin C is a drug applied briefly to the cornea immediately after ablation to reduce haze. A meta-analysis of mitomycin C use in PRK (11 randomised trials, 5 cohort studies and 1 case-control study; 3,536 eyes) reports that mitomycin C reduces both early and late haze, with no difference in endothelial cell density.[17] In another meta-analysis, haze formation was markedly lower in the mitomycin C group (RR 0.29; CI 0.19-0.45), with no significant increase in complications.[18] These studies look at PRK in general; I do not give a separate figure specific to No-Touch.

My practice: I use mitomycin C in all eyes; the application time is at least 30 seconds, and 60 seconds in high myopia (my practice). In the literature the duration and protocol are not uniform. In a randomised study comparing 15-, 30- and 60-second applications in PRK (mean baseline spherical equivalent −5.98 D, 4-month tapering steroid schedule), no eye developed more than trace haze; haze scores between mitomycin C and control eyes differed at months 1 and 3 and were the same at months 6 and 12, and the authors wrote that with this schedule mitomycin C may not be needed in modern PRK.[16] In 100 eyes of 50 patients (−3.00 to −6.00 D), there was no significant difference in haze between 15- and 30-second applications.[20] In a series of 120 eyes treated with transPRK (one subgroup without mitomycin C; 30-50 seconds in the mitomycin C groups), haze was clearly prevented in 119 of 120 eyes, with no significant change in endothelial cell density or count.[21] A review also notes that mitomycin C protocols are heterogeneous.[22] So my times are longer than the short 15-second application examined in the studies above; this is my own clinical preference, and there are also studies showing that shorter times give a similar haze outcome.

An example of a haze comparison between methods: in a retrospective study following 59 transPRK and 59 alcohol-PRK eyes in high myopia (spherical equivalent more myopic than −6.00 D) for 12 months, haze was similar; at month 12 two transPRK eyes had +1 haze and no alcohol-PRK eyes did (p = 0.154). The abstract states mitomycin C use for the alcohol-PRK group; whether it was used in the transPRK group cannot be determined from the abstract.[23]

Undercorrection, regression and enhancement

The target is not hit exactly in every eye. If an enhancement is needed, I first wait for the prescription to settle and measure the remaining corneal tissue again; if the tissue allows it, I do the enhancement again with No-Touch (my practice); if the tissue does not allow it, I do not.

Rare but serious ones

Ectasia. Thinning and forward bulging of the cornea months or years after the procedure. That it has not been reported in thin-cornea series[5] does not mean the risk is zero; there is a reported case of ectasia after transPRK.[8] In a systematic review collecting published cases, the frequency of ectasia in eyes without identifiable risk factors was calculated as 20 per 100,000 eyes for PRK, 90 for LASIK and 11 for SMILE;[24] because this calculation is based only on published cases, it may underestimate the true frequency. Most of this risk is managed not on the operating table but on assessment day.

Infection. Rare, but it can affect vision permanently. Because the cornea has no protective layer until the epithelium closes, keeping to the drop schedule and check-up days is important.

What laser does not change

Laser corrects your current prescription; it does not stop the eye from ageing. In your 40s near vision becomes harder (presbyopia), and someone who sees far without glasses will also need reading glasses. The development of cataract in later life, and the need for regular retinal check-ups in high myopia, are also not changed by laser.

Frequently asked questions

References

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3. Ang RET. "Transepithelial Versus Conventional PRK: A Randomized Controlled Study." Ophthalmology and Therapy, 2025. PMID 40445504
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11. Hashemi H, Alvani A, Aghamirsalim M, Miraftab M, Asgari S. "Comparison of transepithelial and conventional photorefractive keratectomy in myopic and myopic astigmatism patients: a randomized contralateral trial." BMC Ophthalmology, 2022. PMID 35148689
12. AlDahash F, AlAmeer A, Hussain OB et al. "Effect of Bandage Contact Lens Exchange on Pain and Healing After Photorefractive Keratectomy-A Randomized Control Trial." Eye & Contact Lens, 2021. PMID 33492010
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