TransPRK vs ReLEx SMILE

TransPRK

TransPRK (Transepithelial PhotoRefractive Keratectomy) is an Advanced Surface Ablation (ASA) procedure, meaning that there is no cutting to create a flap, allowing the laser to access and reshape the cornea. Instead the laser simply ablates (surgically removes) the outermost layer of cells on the surface of the eye.

What makes TransPRK different from other ASA procedures such as traditional PRK and Epi-LASIK, is that there is nothing actually physically touching your eye (besides an eye clamp to gently keep your eyelids open) in order to remove the surface cells.

This results in a quick surgery for the patient (5 mins per eye), and more importantly a fast and comfortable healing process as compared to other forms of ASA.

ReLEx SMILE

ReLEx SMILE (Refractive Lenticule Extraction, Small Incision Lenticule Extraction) was created with the aim of bringing over some of the benefits of LASIK, while being much less invasive. It makes use of the creation and removal of a tiny lens-shaped piece of corneal tissue within the eye, to reshape the cornea.

This tiny lens is referred to as the lenticule, and the minimally invasive 2 mm micro-incision (as compared to LASIK’s 22 mm flap cut) through which it is extracted from, contributes to a fast and comfortable healing process – patients are able to go back to work in just 2 days!

Unlike LASIK, no corneal flap is created which means that you do not get the risk of flap complications (dislodgement, wrinkles, inflammations) or dry eyes.

TransPRK

TransPRK was made possible with the introduction of the Schwind Amaris 1050RS excimer (gas) laser in 2013, and is the much improved version of traditional PRK, which was the very first laser vision correction method. PRK has been around since the early 1990s, and through the decades we have seen multiple iterations of the ASA procedures, leading up to what we have today with TransPRK.

ReLEx SMILE

ReLEx SMILE was introduced in 2011 by ZEISS, and is performed using the ZEISS VisuMax femtosecond (ultrashort pulse) laser. Because of its safe treatment and quick recovery, ReLEx SMILE was brought into Singapore in 2014. And in 2016, it was introduced into the US after passing the US Food and Drug Administration’s (FDA) notoriously strict regulations and safety standards.

TransPRK

• Hyperopia (longsightedness – difficulty seeing objects up close)
• Myopia (shortsightedness – difficulty seeing objects at long distances)
• Presbyopia (difficulty focusing on objects up close, in older age a.k.a. lao hua yan)
• Astigmatism (distorted, blurry vision at any distance)

ReLEx SMILE

• Myopia (shortsightedness – difficulty seeing objects at long distances)
• Astigmatism (distorted, blurry vision at any distance)

TransPRK

Ideally, corneal thickness should be at least 485 microns thick.

Corneal cross-linking (CXL) is advisable as an adjunct treatment if your cornea is thin, or you have high astigmatism and/or high myopia (more than -8 diopters [800 degrees]). This procedure strengthens the cornea to prevent it from changing its shape in the future.

If you have myopia, your prescription must not be more than -10 diopters (1,000 degrees).

For hyperopia, not more than -4 diopters (400 degrees).

For astigmatism, not more than -5 diopters (500 degrees).

ReLEx SMILE

Ideally, corneal thickness should be at least 550 microns thick, meaning that thinner corneas might not be eligible.

Corneal cross-linking (CXL) is not advisable as an adjunct treatment if your cornea is less than 550 microns thick. We typically recommend going for TransPRK if your cornea is too thin.

If you have myopia, your prescription should be between -2.5 to -8 diopters (250 – 800 degrees).

Hyperopia is not treatable by ReLEx SMILE.

For astigmatism, it should not more than -2.5 diopters (250 degrees).

Please note, you will not be suitable for TransPRK or ReLEx SMILE if you:

• Are pregnant or breastfeeding
• Are under the age of 18 (parental consent is required if you are under the age of 21)
• Have severe dry eye syndrome

TransPRK

For our Safe Sight TransPRK procedures at Clearvision, we use the Schwind Amaris^® 1050RS, which is able to treat 100 degrees of myopia in only 1.3 seconds. It is also equipped with features such as 7-dimensional eye tracking and zero latency tracking technology, which allows accurate treatment as it takes into consideration the tilt and roll of the eyeball. This translates into a short surgery, as well as high accuracy, consistency and comfort for our patients.

ReLEx SMILE

For our ReLEx SMILE^® procedures at Clearvision, we use the ZEISS VisuMax^® femtosecond laser, which implements femtosecond laser technology known for its precision, speed and gentle treatment technique. Its minimally invasive approach does not require the creation of a corneal flap – instead it creates a lenticule inside the cornea and a small incision, in just one single step. With a pulse frequency of 500 kHz, the ZEISS VisuMax^® enables short treatment times, making procedures easy and comfortable for our patients.

Schwind Amaris^® 1050RS

• 1050 Hz pulse rate enables a fast and comfortable procedure
• 7D eye tracking provides precision and accuracy
• SmartSurf^ACE provides safe, gentle, and touch-free treatment

ZEISS VisuMax^®

• Lenticule creation and incision are performed in just one step
• Minimally invasive flapless procedure allows for quick, comfortable healing
• Femtosecond laser provides precision, speed and stability

TransPRK

Length of surgery: about 5 minutes per eye

1. Put on your surgical gown and other protective equipment
2. Lie flat and get comfortable on the operating bed.
3. A clamp is then used to gently keep your eyelids open
4. Numbing eye drops are added so that your eye does not feel anything
5. Your eye is lined up in the optimal position for the laser
6. You stare straight at the dim green guiding light
   

   Schwind Fixation Light

7. The laser starts to ablate the surface cells (you might smell a slight burning smell)
8. The laser then starts to reshape the cornea
9. Your vision has been corrected!
10. A bandage contact lens is placed over the eye to allow the surface cells to safely heal (to be removed after 5 days by the doctor)

You will be able to see immediately after the surgery. But as the surface cells heal back in the next few days, your vision will get blurry.

It will take 5 days for the cells to fully heal and for the blur to go away, after which you can resume your day to day activities and go back to work.

You will be given 5 days of medical leave.

ReLEx SMILE

Length of surgery: about 10 minutes per eye

1. Put on your surgical gown and other protective equipment
2. Lie flat and get comfortable on the operating bed.
3. A clamp is then used to gently keep your eyelids open
4. Numbing eye drops are added so that your eye does not feel anything
5. Your eye is lined up with the contact glass, which uses low suction pressure keep your eye in position
6. You stare straight at the dim green guiding light
   

   ZEISS Fixation light

7. The laser creates a lenticule (small lens shaped piece of corneal tissue)
8. The laser then seamlessly makes a small micro-incision of 2 mm
9. The lenticule is removed through this small incision, changing the shape of the cornea
10. Your vision has been corrected!

Your vision will be blurry immediately after the surgery. But your vision will clear up the next day, and continue to get less blurry in the next few days.

It will take just 2 days for your eye to heal and for the blur to go away, after which you can resume your day to day activities and go back to work.

You will be given 3 days of medical leave.

TransPRK

Full visual recovery, where your vision has totally stabilised and your eyes are consistently seeing very clearly, takes up to 3 months (patients with high myopia may take even longer).

Patients are required to follow a strict routine of eye drops application. TransPRK requires 4 types of eye drops to be applied multiple times a day for at least the first week, after which number and frequency of eye drops will decrease (eye drops application can continue for up to 3 months or longer), depending on how the patient’s eyes heal.

Protective sunglasses must be worn whenever outdoors for 1 month, to prevent UV exposure which can be harmful to the healing process. (UV blocking sunglasses are provided to Clearvision patients).

After surgery, you will need to have your eyes checked up at these specific times post-surgery:

• 1 day
• 5 days
• 2 weeks
• 1 month
• 2 months
• 3 – 6 months (especially if you had high myopia)

More follow-ups may be required, subject to the individual’s healing progress.

ReLEx SMILE

Full visual recovery, where your vision has totally stabilised and your eyes are consistently seeing very clearly, takes 1 – 2 months (patients with high myopia may take up to 3 months)

Patients are required to follow a strict routine of eye drops application. SMILE requires 2 types of eye drops to be applied multiple times a day for at least the first week, after which number and frequency of eye drops will decrease (eye drops application can continue for up to 1 month or longer), depending on how the patient’s eyes heal.

Protective sunglasses must be worn whenever outdoors for 1 month, to prevent UV exposure which can be harmful to the healing process. (UV blocking sunglasses are provided to Clearvision patients).

After surgery, you will need to have your eyes checked up at these specific times post-surgery:

• 1 day
• 1 week
• 1 month
• 2 months

More follow-ups may be required, subject to the individual’s healing progress.

Post-TransPRK, you will be allowed to resume these activities after a specific period of time:

Long sessions of reading books, screens and watching TV: 5 days

Driving: 1 week

Applying eye makeup : 1 week

Showering without having to make sure that no water enters the eyes: 1 week

Swimming and other water-related activities: 2 weeks

Light sports: 5 days

Contact sports: 2 weeks

Post-ReLEx SMILE, you will be allowed to resume these activities after a specific period of time:

Long sessions of reading books, screens and watching TV: 48 hours

Driving: 48 hours

Applying eye makeup : 48 hours

Showering without having to make sure that no water enters the eyes: 48 hours

Swimming and other water-related activities: 2 weeks

Light sports: 5 days

Contact sports: 6 weeks

TransPRK

• No flap-related complications
• Low risk of dry eyes
• Ability to participate in contact sports
• No surgical instruments touching the cornea
• Wide range of suitability criteria (high myopia, thin corneas etc.)
• Length of surgery is short (5 mins per eye)

ReLEx SMILE

• No flap-related complications
• Low risk of dry eyes
• Ability to participate in contact sports
• Little to no discomfort during recovery
• Quick initial recovery, with just 2 days of downtime. Quick full visual recovery, with most patients expected to achieve a stabilised visual clarity after 1 month (patients with higher myopia may take longer, up to 3 months)
• Less follow up reviews and medications required

TransPRK

• Some discomfort early on during the healing process (mild itchiness or soreness on the surface of the eye)
• Slower initial recovery of surface cells, resulting in 5 days of downtime. Slower full visual recovery, with patients expected to achieve a stabilised visual clarity in 2 – 3 months (patients with higher myopia may take longer)
• More follow up reviews and medications required

ReLEx SMILE

• 2% risk of lenticule-related complications, requiring the patient to switch to TransPRK (most common being – suction loss due to the patient squeezing or moving their eye too much; less common – unsuccessful lenticule extraction, lenticule tear)
• More narrow range of suitability criteria (hyperopia, high myopia or thin corneas not eligible)
• ReLEx SMILE can only be performed once, meaning that any future enhancements or corrections will have to be done using TransPRK

TransPRK

S$3,988 for both eyes, inclusive of GST

ReLEx SMILE

S$5,200 for both eyes, inclusive of GST