Photorefractive keratectomy, or PRK, is a laser-assisted surgical procedure that corrects refractive errors like nearsightedness, farsightedness, and astigmatism. It is very similar to LASIK, although PRK was developed before LASIK was approved.
PRK does not require creating a corneal flap, which is then put back into place. Instead, a laser shaves off layers of the cornea so another laser can reach the lens and shape it to correct vision. Because this process is older and less time-consuming, PRK is typically less expensive than LASIK; however, it can still be costly because insurance is not likely to cover it. PRK, like LASIK, is an elective procedure, so your vision insurance may cover part of the cost, especially the doctors’ visits, but they are not likely to cover the cost of the actual surgery.
What Is Photorefractive Keratectomy?
Photorefractive keratectomy (PRK) is a type of laser-assisted surgery like LASIK. It involves using a laser device to sculpt the cornea and correct vision. Although LASIK is more popular, PRK was the first corrective eye surgery to use a laser rather than a scalpel or a microkeratome.
The Excimer laser, one of the most widely used types of lasers for several kinds of eye surgery, was developed in the 1970s, and it was modified for ophthalmic procedures in the 1980s. However, the U.S. Food and Drug Administration did not officially approve this laser for use in PRK procedures until 1995. Shortly after this approval, LASIK was developed and approved as a form of laser eye surgery, and PRK fell out of favor.
Like LASIK, PRK is an outpatient procedure, taking between 5 and 15 minutes per eye to reshape the cornea and correct vision. Numbing drops will be used in the eye, and you will be awake during the PRK procedure. An instrument will hold your eyelid open, and you may be asked to focus on a specific target while the laser works. A bandage contact lens will be put over your eye afterward, to help the cornea heal, and you will wear this for three to four days.
Unlike LASIK, the PRK operation mechanically removes surface cells from the cornea and then uses the Excimer laser to remove small amounts of tissue from the front of the cornea until the lens can be reached. In LASIK, a flap of tissue is made from the cornea, which is then put back into place and left to heal. This process is considered an advantage for some people because less of the cornea is touched in PRK compared to LASIK, allowing for better healing of the corneal surface.
There are other benefits of PRK over LASIK.
- Rapid recovery after PRK can promote faster recovery of the corneal nerves.
- Dryness from the surgery is minimized.
- There is less risk of trauma and scarring on the eye if trauma occurs after the procedure.
People who have unusual shapes to their corneas typically do better with PRK than LASIK because the device does not cut a flap in a specific way, but instead shaves off a few layers of cells that can grow back over time. Additionally, people who have a high degree of refractive error, like extreme nearsightedness, are often better suited for PRK because the cornea in these individuals is more likely to be very thin. Competitive athletes and others who have physically high-impact jobs may prefer PRK because there is no corneal flap to dislodge.
There are some downsides to PRK over LASIK.
- Good vision can require up to 10 days to recover rather than two days. Most patients cannot return to work, drive, or perform vision-intensive activities for three to six days after PRK, and 90 percent of vision is not likely to be restored until a month after the procedure.
- Sometimes there are overcorrections or undercorrections, necessitating a second operation. LASIK faces some of the same risk.
- You may have to use cortisone eye drops for up to four months after PRK because this minimizes the risk of developing a haze on the cornea, which otherwise may regrow cells in a disadvantageous way
The greatest benefit for many people when they are choosing between PRK and LASIK is the price and time difference. PRK is faster, less complex, and cheaper than LASIK. However, depending on where you live in the country, PRK may still be expensive.
How Much Does PRK Cost?
Since PRK is considered an elective surgery, it is not likely to be covered by insurance. Like LASIK, some of the initial scans or exams leading up to PRK may be partially covered by your vision insurance, but the cost of the surgery itself probably will not be covered. You should still speak to your insurance company to understand what aspects of PRK may be covered, however.
The surgeon’s skill level, geographic location, and practice type all affect the cost of PRK, as they do with other laser-assisted eye surgeries. If your surgeon has decades of experience and has improved the vision of tens of thousands of patients, they may charge more. If they are located in a surgery center, they may cost less.
One of the greatest factors that changes the price of PRK and other, similar elective eye surgeries is geographical location. If you are in a major city, like New York or Los Angeles, the procedure will cost more than if you are at a university surgery center in a small town in the middle of the country. This has a lot to do with the cost of living in these areas, which impacts the cost of getting equipment, the cost of renting or owning a building for an ophthalmology practice, the cost of the surgeon’s education, and more.
One ophthalmology center reported that their cost was $1,695 per eye and broke down the fees like this:
- Procedure fees: $495 per eye to the cost of the surgeon’s fee and materials they need
- Facility fee: $900 per eye to the use of the laser and other technology in the facility itself
- Preoperative and follow-up fees: $300 per eye to the initial examination before PRK, then the follow-up exams at the facility unless prior arrangements are made with a different ophthalmologist
A different ophthalmologist listed their cost as $1,500 per eye as a one-time payment, but also offered financing through the surgery center with $750 down on the day of the procedure, then payments of $75 per month for the next year. There were no additional listed costs, but preoperative and follow-up exams, prescription eye drops, and enhancements may cost more on top of the per-eye cost.
Ultimately, costs can vary greatly depending on all the specifics mentioned. Some centers charge up to $3,000 per eye for PRK whereas others may offer the lower rates mentioned above. It’s up to you to weigh the benefits of a particular surgeon against the costs.
Again, since PRK is elective, it is very rare to find discounted or free versions of this surgery. Some ophthalmologists will offer a free eye exam if you are interestedin LASIK or another refractive surgery like PRK, which comes with no obligation between you and the ophthalmologist. However, this exam is geared toward determining if you are a good candidate for the procedure and not to determine your eye health overall.
If you are interested in PRK, you can contact your vision insurance and see if the procedure may be covered, at least in part. Then, you can start saving up for the operation. Your ophthalmologist can help you determine if there are payment plans, financing, or other payment options that may work better than paying a lump sum up front.
- Photorefractive Keratectomy. (2010). EyeWiki, American Academy of Ophthalmology (AAO).
- LASIK vs. PRK: Which Vision Correction Surgery Is Right for You? (December 22, 2017). Michigan Health.
- Frequently Asked Questions About Refractive Surgery. Kellogg Eye Center, Michigan Medicine.
- Ophthalmology: Laser (Refractive) Eye Surgery: Photorefractive Keratectomy (PRK). University of Wisconsin-Madison, School of Medicine and Public Health.