When your vision isn't clear without glasses or contact lenses, but you don't want to rely on those devices for the rest of your life, surgery may be a good option. You have several different types of surgery to choose from, including PRK.
Just like LASIK, PRK involves the use of a laser to reshape your eye. But unlike LASIK, PRK doesn't rely on the use of a large surgical flap. (Learn more) There are many different types of PRK surgery your doctor might choose from to help clear your vision. (Learn more)
You might talk about PRK with your doctor if you have a high corrective prescription, thin corneas, or another medical condition that makes LASIK less than ideal. (Learn more) Complications with the surgery are possible, so you will need to discuss them with your doctor. (Learn more)
You will need to take a few steps to prepare for surgery before it begins. (Learn more) In order to make the best decision about surgery, you will need to consult closely with your doctor. (Learn more)
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What Happens During PRK?
PRK, or photorefractive keratectomy, is designed to amend the shape of your eye. When your eye is improperly shaped, images come into focus either in front of or just behind the back of your eye, and they are perceived by the brain as fuzzy or indistinct. By changing the shape of your eye, your surgeon hopes to ensure that images are focused on precisely the right part of your eye, so they are as clear as they can possibly be.
A PRK procedure typically takes about 15 minutes to complete, according to the American Academy of Ophthalmology. Your eyes will be numbed with drops, and your doctor will use a device to keep you from blinking. You'll be asked to look at a target light during the procedure and hold your eyes very still. You should not feel any pain during the procedure.
Your doctor will remove a thin layer of cells from your cornea, and a laser will then be used to reshape your eye. The reshaping will be based on measurements taken before your surgery, and they will be unique to you.
The cell-removal step makes PRK different than LASIK surgery, say researchers writing in the journal Current Opinion in Ophthalmology. In a LASIK surgical procedure, your doctor creates a flap from your cornea, and that flap is folded up to give the laser access to your eye. In most PRK procedures, no flap is created. That can make PRK a good option for people who might develop health issues, such as scarring, from the creation of a flap. It can also make PRK ideal for people with eyes that don't have enough tissue to make a flap.
If the surgery works perfectly, you should have crisp vision that allows you to avoid wearing glasses or contact lenses some or even all of the time. But your eyes will need time to heal, and you may have blurred vision while that healing process takes place.
PRK Comes in Many Forms
All PRK surgeries are designed to reshape the eye, but the basic surgery can be modified based on your eye's condition when you present for surgery. Your surgeon may also have specialized techniques they use when performing PRK in order to give patients the best chance at a smooth recovery.
The insurance company Kaiser Permanente recognizes a few types of PRK, including:
- Standard PRK, in which surface layers of the cornea are removed altogether with a brush or a solution.
- LASEK, or laser epithelial keratomileusis, which involves loosening a thin layer of corneal cells and pushing them to the side. After the laser's work is complete, the surface layer is returned.
- Epi-LASIK, in which the corneal surface layer is lifted via machine and replaced after the laser's work is done.
Each type of PRK is designed for a different type of eye and a different type of patient. As a result, comparing the results of the different types of surgery is not especially effective. Since they are not designed to address the exact same issue, comparisons may not be helpful.
Even so, researchers have performed studies that compare the types. In one, published in the journal Contact Lens and Anterior Eye, researchers found that patients who had either LASEK or epi-LASIK had the similar outcomes in terms of comfort and visual acuity after surgery. Both surgeries were considered safe and effective by researchers.
Studies like this suggest that one surgery is not necessarily better than another kind. Patients should talk with their surgeons about which type is recommended for the specific issue they are facing.
Who Might Consider PRK?
A PRK procedure is not as well-known as a LASIK procedure, and as a result, some people may not think to ask for this kind of surgery by name. But there are some people who would benefit from a PRK procedure instead of a LASIK procedure, and they may only find that out when they meet with a surgeon to ask for LASIK help.
According to Michigan Health, people with a corrective prescription of -8.00 or higher might be better suited for PRK when compared to LASIK. That's because a LASIK flap must be of a certain thickness in order to be viable. If your doctor needs to remove a great deal of tissue to amend your vision, there may not be enough left over for a flap. Since most PRK procedures involve no flap or a tiny flap, this isn't a concern, so it could be a good option.
If you have thin corneas, PRK might also be a better option for you. PRK tends to preserve an extra amount of tissue when compared to LASIK, and that can help to ensure that you have fewer problems with eye health after surgery.
Your lifestyle preferences can also play a role in your decision between PRK and LASIK. For example, the flap created by LASIK surgery is not stitched or tacked back onto the surface of your eye when surgery is complete. It will heal and adhere to the eye, but it may remain sensitive and vulnerable to dislodging if put under enough pressure. That could be a problem if you:
- Play contact sports, such as football.
- Engage in martial arts.
- Participate in the military.
- Habitually rub your eyes.
Any or all of these activities could push your surgery flap out of place, and when that happens, you might need a doctor's help to fix the problem. As a worst-case scenario, the flap could also break free of your eye, and you might need another surgery to repair the damage.
Since PRK surgeries involve no flap or a tiny flap, these risks can be significantly reduced, and that could be exceptional news for your eye health.
There is one way in which PRK and LASIK surgeries are similar: pricing. Both surgeries tend to come with price tags in the thousands. In most cases, these surgeries are considered cosmetic enhancements since they are mainly designed to eliminate contact lenses and glasses. As a result, you may be expected to pay for them out of pocket.
Complications Are Possible
While your doctor will work hard to choose the surgery type that is best for you and that lowers your risk of complications after surgery, PRK is a delicate procedure. As a result, it is possible that you could experience an issue when the surgery is complete.
According to research highlighted in Ophthalmology Times, dry eye symptoms are some of the most common issues experienced after eye surgery. Between 69 percent and 85 percent of those who have LASIK have dry eye symptoms, sometimes lasting for 1.5 years.
The authors of this article point out that PRK surgery is designed to reduce the risk of post-operative dry eye symptoms when compared to LASIK. But more research must be done to prove that PRK is better at keeping eyes moist after surgery. That means it is possible that you will have dry, gritty eyes when surgery is complete. Your doctor can give you drops that can help, but the discomfort may persist.
PRK surgeries involve scraping the surface of the eye, and there are many nerve endings that sit in that space. As a result, it is not uncommon for people to feel a great deal of pain after surgery, and according to experts writing for Review of Ophthalmology, that pain cannot be eliminated. If you have surgery, you are likely to feel pain.
This can come as a surprise to patients who have friends or family members that went through LASIK surgery. These patients may feel little to no pain at all, and patients who go through PRK may be surprised that they are not having the same experience. Going into surgery with realistic expectations can keep that shock from hampering your recovery.
Your doctor may provide you with eye drops to keep your eyes moist and comfortable. You may also have oral pain medications to ease your discomfort as your body heals.
In rare cases, your vision may not clear as quickly or completely as you expected. During your surgery follow-up appointments, your doctor will monitor your progress and offer advice and suggestions if your eyes are not healing properly. If you experience complications that impede your vision, your doctor may need to perform another procedure to fix the issue.
At one point, PRK surgeries were associated with a halo or haze that covered vision. That was caused by scar tissue building up on the surface of the eye as it healed. As an article in Cataract and Refractive Surgery Today points out, new medications and new surgical techniques are reducing the risk of haze after surgery. Some people do not experience this issue at all, but it could be a problem for you if your healing process does not go as planned. Following your doctor's advice after surgery is critical to keep this from happening to you.
Finally, you may still need to wear glasses or contacts from time to time. PRK is designed to deal with issues involving the shape of your eye, but as you age, the muscles that control the movement of the lens of your eye tend to weaken, and the lens tends to stiffen. That can lead to an inability to focus the eye on items held close to your face. This issue cannot be corrected with PRK, and as a result, you may find that you always need reading glasses to see things up close.
Preparing for Surgery
The PRK procedure takes just minutes to complete, but you will need to prepare for the work. For example, your doctor may ask you to stop wearing hard contact lenses in the weeks leading up to your procedure. These devices can change the shape of your eye and make your surgery less effective. Steering clear of them for a few weeks can allow your eye to return to a natural state before surgery begins.
You will need someone to drive you to your surgery appointment and back home again. The medications used during surgery can make you feel sleepy and woozy, which can make driving or riding public transportation unsafe. Setting that up in advance can ensure you are ready when surgery day arrives.
Your vision will remain cloudy for several days after surgery, and that may mean that you will need to step away from work until your eyes heal up a bit. Your doctor can help you understand how long you should stay away based on the work you do each day. You should plan on staying away for at least a day, if not a week or more.
On the day of your surgery, you will need to avoid the use of all creams, lotions, and makeup on your eye. Your doctor will need a clean surface to work on, and you can make that possible with your planning and care.
How Can You Decide on Surgery?
Reading through articles like this one can help you understand how surgery works and why one procedure might be better for you than another. But the final decision about the surgery you have should be made in consultation with a doctor.
As an article published in Eye World makes clear, doctors take decisions about surgery type very clearly. A surgeon quoted here reports that he talks at length with his patients about their health, their eyes, their lifestyle, and more before he offers an opinion on the surgery type that is best. Some would do well with LASIK, he reports, and others might benefit from PRK. He makes the decision on an individual basis.
During your conversation with your doctor, you can ask about the equipment that will be used during your procedure. The U.S. Food and Drug Administration regulates the machines used in these surgical procedures, and there is a list of machines that the FDA has approved for refractive surgeries like PRK. You will want to ensure that your doctor is using a machine that has been approved for the type of surgery you need to have.
In addition, you will need to ask your surgeon about their experience in performing this type of surgery. The equipment used plays a big role in how well your surgery will go, but the person who is wielding the machine will have the expertise and knowledge to use the machine properly. You will want a surgical partner that performs these procedures often and who has an exceptional success rate with this special kind of surgery. Most doctors are happy to tell you about their experience and credentials.
What Is Photorefractive Keratectomy (PRK)? (September 2017). American Academy of Ophthalmology.
LASEK (Laser Subepithelial Keratomileusis). (August 2002). Current Opinion in Ophthalmology.
PRK, LASEK, and Epi-LASIK for Nearsightedness: Surgery Overview. (January 2018). Kaiser Permanente.
Long-Term Results of Epi-LASIK and LASEK for Myopia. (June 2014). Contact Lens and Anterior Eye.
LASIK vs. PRK: Which Vision Correction Surgery is Right for You? (December 2017). Michigan Health.
When Is PRK a Better Choice Than LASIK? (January 2014). Practice Update.
Dry Eye: PRK or LASIK? (September 2012). Ophthalmology Times.
Mastering LASIK and PRK. (December 2017). Review of Ophthalmology.
Old Complications of ‘New’ PRK. (May 2003). Cataract and Refractive Surgery Today.
PRK vs. LASIK Updated. (March 2014). Eye World.
FDA-Approved Lasers for PRK and Other Refractive Surgeries. (March 2018). U.S. Food and Drug Administration.