Refractive surgery · Comparison
LASIK or PKR: which technique should you choose?
LASIK and PKR correct the same vision defects with excellent results. LASIK offers faster recovery; PKR, a surface laser without a flap, preserves more of the cornea and is better suited to thin corneas and contact sports. The preoperative assessment is what settles the choice.
LASIK vs PKR comparison table
Both techniques are performed at the Clinique Laser Victor Hugo (Paris 16) with a latest-generation excimer laser. The fundamental difference lies in the corneal step: LASIK creates a flap, while PKR works on the surface. The table below summarises the clinically relevant differences.
| Criterion | LASIK | PKR / Trans-PKR |
|---|---|---|
| Principle | Corneal flap (femtosecond) + deep reshaping (excimer) | Surface laser: removal of the epithelium + reshaping (excimer) |
| Corneal flap | Yes (~100-120 µm) | No (no deep cut) |
| Thin cornea / dryness / borderline topography | Less suitable | Preferred indication |
| Defects corrected | Myopia, hyperopia, astigmatism, presbyopia | Myopia, astigmatism, hyperopia (mild to moderate) |
| Visual recovery | Fast: functional vision ≈ 24 h | Gradual: 1 to 4 weeks |
| Post-operative comfort | Nearly painless | Discomfort 3-5 days (bandage contact lens) |
| Contact sport / high-exposure occupations | Waiting period recommended (flap can be displaced) | Particularly suitable (no flap) |
| Specific risk | Flap-related (rare) | Corneal haze, rare, prevented with mitomycin C |
| Published results | 95.4% of patients satisfied (global review, Solomon 2009) | Trans-PKR 94.2-95.1% ≥ 20/25 (Curcă 2025) |
| Price (both eyes, all-inclusive) | ~3,000 € | 2,500 € |
These two indicators do not measure the same thing (overall satisfaction for LASIK, visual acuity for Trans-PKR) and therefore cannot be compared like for like: they illustrate that each technique achieves excellent results for mild to moderate myopia. Figures drawn from published studies, cited below.
Ideal LASIK profile vs ideal PKR profile
Ideal LASIK profile
LASIK is suitable for patients whose cornea is thick enough and whose topography is regular, and who prioritise fast recovery: vision is often functional from the next day (≈ 24 h), return to screen work within 48-72 h, with minimal discomfort. It covers a wide range of corrections, including hyperopia and presbyopia (PresbyLASIK).
It is also the technique with the longest clinical track record (more than twenty-five years) and whose enhancement is the simplest, by lifting the existing flap. The assessment confirms that the corneal thickness safely allows the flap to be created.
Ideal PKR profile
PKR is preferred when the cornea is thin, when topography shows a feature to monitor, or in the case of pre-existing dry eye. By working on the surface, without a flap, it preserves more corneal tissue and, above all, does not sever the deep corneal nerves: cutting a LASIK flap interrupts stromal innervation over a wide circumference, whereas PKR acts only on the surface.
This preservation of the deep nerves partly explains why PKR carries a lower risk of lasting dry eye than LASIK.
It is also the technique of choice for contact-sport athletes (boxing, rugby, martial arts) and occupations exposed to trauma (police, military, firefighters): with no flap, there is no risk of traumatic displacement. The trade-off is a more gradual recovery and discomfort during the first days.
The 3 differences that really matter
1. Surface vs flap: two ways of reaching the cornea
This is the fundamental difference from which all the others follow. In LASIK, the surgeon creates a thin corneal flap with the femtosecond laser (about 100 to 120 microns), lifts it, then reshapes the deep tissue with the excimer laser before repositioning the flap, which adheres without sutures.
In PKR, there is no flap: the epithelium (the thin superficial layer, which regenerates naturally) is removed, then the excimer laser sculpts the surface directly. In Trans-PKR, the epithelial removal is also performed with the laser, without contact. Since no deep cut is made, PKR preserves more corneal tissue — a decisive advantage when the cornea is thin.
2. Thin cornea and biomechanics: PKR’s strength
Corneal thickness is a major safety criterion in refractive surgery. Creating a flap in LASIK uses up part of the available thickness; when the cornea is too thin, or when the topography (measured with the Pentacam) shows a fragility, LASIK becomes inadvisable. PKR, by working on the surface, does not deprive the stroma of a flap and preserves better biomechanical resistance — hence its preference in these situations. This greater tolerance for thin corneas explains why PKR remains essential even in the era of flap-based techniques.
3. Recovery and comfort: LASIK’s strength
This is where LASIK takes the advantage. Because the flap is repositioned immediately, vision is functional from the next day (≈ 24 h) and discomfort remains minimal. In PKR, the epithelium must regrow: a bandage contact lens is placed for 3 to 5 days, a period during which discomfort, watering and photophobia are common.
Vision then sharpens gradually over one to four weeks, with final stability reached in one to three months. In the long term, for mild to moderate myopia, the results of the two techniques converge; the choice therefore comes down mainly to corneal anatomy and lifestyle, not to final visual quality.
The essential common ground: the assessment decides
Neither LASIK nor PKR is universally superior. For mild to moderate myopia, both techniques reach comparable final results. The question “LASIK or PKR?” has no general answer: it depends on the thickness and regularity of the cornea, the dryness profile, lifestyle (sport, occupation) and the precise refraction. A thin cornea or a borderline topography will point towards PKR; a comfortably thick cornea in a patient eager to recover will point towards LASIK.
The preoperative assessment — corneal topography (Pentacam), pachymetry, tear measurement, macular OCT, refraction under cycloplegia — is the only step that determines the appropriate technique, or whether another option (SMILE to preserve biomechanics without the surface convalescence, ICL implant for very high myopia) is preferable. This assessment is carried out at the Cachan (94) office.
Important note: Refractive surgery (LASIK, PKR, SMILE, ICL) is performed exclusively at the Clinique Laser Victor Hugo (Paris 16). Consultations and preoperative assessments take place at the Cachan (94) office. No refractive surgery is performed in Paris 13.
To explore each technique: LASIK in detail — PKR (surface) in detail — SMILE — ICL implant — Preoperative assessment — Pricing — Contact and office.
Frequently asked questions — LASIK or PKR
Preoperative assessment: LASIK or PKR is decided in consultation
A complete assessment (topography, pachymetry, OCT, refraction) at the Cachan office determines the technique suited to your corneal thickness and your lifestyle.
Scientific references
- Solomon KD, Fernández de Castro LE, Sandoval HP, et al. LASIK world literature review: quality of life and patient satisfaction. Ophthalmology. 2009;116(4):691-701. PMID 19344821.
- Curcă PF, et al. Outcomes of transepithelial photorefractive keratectomy (Trans-PKR). Diagnostics / J. 2025.
- Susanna BN, Mohan N, Santhiago MR, Randleman JB. Laser in Situ Keratomileusis Outcomes and Complications: 2016 to 2023. J Refract Surg. 2025;41(4):e391-e403. PMID 40197080.
This page is for informational purposes only and is not a substitute for a medical consultation. Results vary according to individual characteristics. Any surgical decision is made after a complete preoperative assessment by Dr Tourabaly.