Key Takeaways
- Photorefractive keratectomy (PRK) is a refractive surgery for correcting myopia, hyperopia, astigmatism, and presbyopia. It's an excellent alternative to LASIK because it doesn't require a thick cornea to create a flap. Instead, PRK removes the thin corneal epithelium to allow for laser treatment.
- Outcome studies indicate a 95% success rate among PRK patients, with 90% achieving 20/40 vision or better.9
- Although PRK is ideal for people with thin corneas, it's less popular due to its extended recovery timeline (6 months to a year).
- Before undergoing PRK, your surgeon will conduct preliminary exams to determine your eligibility.
- During recovery, you may experience side effects that wear off with time. Following your surgeon’s instructions will help you heal fast and avoid complications.
What is Photorefractive Keratectomy (PRK)?
Photorefractive keratectomy (PRK) is an FDA-approved refractive surgery for correcting:
- Myopia (nearsightedness)
- Hyperopia (farsightedness)
- Astigmatism (irregularly shaped cornea)
- Presbyopia (age-related farsightedness)
PRK improves how light focuses on the retina by reshaping the cornea.1 The cornea is the clear front part of the eye that refracts (bends light). The retina is the light-sensitive part of the eye that receives images and sends them to the brain for interpretation.
PRK is an excellent alternative to LASIK surgery. It's ideal for people who have thin corneas and don't qualify for LASIK.2
PRK is less popular than other refractive surgeries because of its long recovery period.
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PRK Procedure Overview
PRK is a quick outpatient procedure, meaning you'll be able to go home after surgery. You can expect the following before, during, and after the surgery.
Before Surgery
Before the surgery, your doctor will conduct eye examinations to determine the extent of your refractive error, pupil size, corneal thickness, and your eye's general health.
If you're eligible for PRK, your surgeon will schedule you for the surgery and provide preparation instructions. They will instruct you to stop wearing contact lenses at least 1 week before surgery.
Tell your surgeon about any medication(s) you're taking. On the day of surgery, remember to organize reliable transportation, as you will not be able to drive home.
During Surgery
During surgery, you will sit on a reclining chair, and your surgeon will prepare your eyes by administering local anesthesia. This will numb your eyes and help you relax.
They'll use an eyelid holder to keep your eyelids open during surgery. With a blade, laser, and alcohol solution, your surgeon will remove the epithelium (outer layer of the cornea) and expose the inner tissues.
They will then use an excimer laser device to reshape your cornea.
After laser treatment, your surgeon will administer anti-inflammatory eye drops, antibiotic drops, and steroid drops to prevent swelling, infection, and irritation.
Lastly, they'll place a clear contact bandage on your cornea to protect the open wound and allow the epithelium to grow back.
The PRK procedure takes about 15 to 20 minutes for both eyes.
After Surgery
After surgery, your surgeon will provide you with post-operative care instructions. They will also prescribe antibiotics, anti-inflammatory eye drops, and pain relievers to ease discomfort and prevent infection.
Remember to book a follow-up appointment 24 to 48 hours after surgery so your surgeon can monitor healing.
PRK Recovery Timeline: What to Expect
A PRK recovery timeline is longer than recovery from LASIK and other refractive surgeries because of the invasive nature of the procedure.
During PRK, the surgeon removes the corneal epithelium entirely and does not reposition it after reshaping the tissue underneath. The new epithelium takes some time to grow back.
Days 1-2
The first day after surgery will likely be smooth with mild pain or discomfort that should go away by the second day. You can take medicated eye drops and over-the-counter (OTC) pain relievers to ease pain and promote healing.
Report any pain that persists beyond the second day. Persistent pain may signal potential complications. Your surgeon will address the cause of pain during your first follow-up appointment.
Days 2 to 4
After the second day, you may still feel mild discomfort, which is usually not cause for concern. Keep applying the prescribed eye drops, take pain relievers, and observe the post-op care guidelines your surgeon provided.
Do not remove the protective bandage covering your cornea even if your vision improves. To be safe, leave that job to your surgeon on your next visit. They'll be able to assess the healing process and give appropriate advice if necessary.
During days 2 to 4, you may experience the following side effects:3
- Excessive tearing
- Sensitivity to light
- Itching
- A burning sensation
- Blurry vision (corneal haze)
- Dry eyes
- Halos and glares around bright lights4
- Feeling like something is in your eye
Call your surgeon if you notice:
- Bleeding
- Swelling
- Fever
- Pus
- Dislodged contact lens
During this time, avoid activities that may cause water, dust, or debris to get in your eyes, all of which can cause serious complications.
Days 5 to 7
Most people are ready to remove the bandage contact lens by day 5. To avoid accidental injuries, only your ophthalmologist should do this.
The cornea will heal from the periphery (edges) towards the center.5 You will notice a significant improvement in your vision when the contact lens bandage is removed. However, the extent of clear vision will depend on the severity of your previous refractive error.
Most people realize at least 20/50 vision by this time. Although you may not see clearly, you'll be able to resume your normal routines such as work, driving, and reading. However, do these in moderation to avoid straining your eyes.
Weeks 1 to 4
By the end of week one, you should be healed enough to resume your normal life without much worry. You may experience side effects, such as:
- Glares
- Halos
- Starbursts
You may also have mild problems with night vision. If you notice any severe side effects, call your doctor.
Avoid things like face makeup, facial creams, or any facial products that may cause irritation or introduce bacteria into your healing eye. Also, avoid contact sports or activities that may expose you to trauma.
Weeks 4 to 12
By the end of the first month, your vision should significantly improve with minimal to no side effects. Continue to take your prescription eye drops, as prescribed, to prevent corneal haze, a common side effect that appears several weeks after surgery.
Corneal haze can reduce your visual acuity.6 If the haze persists, irregular astigmatism may result.
This will affect the outcome of PRK. With modern laser devices and treatments such as intraoperative application of mitomycin-C (MMC), ophthalmologists can now minimize the chances of corneal haze and other complications.7
Months 3 to 6
During this time, your vision will be fully improved. Most people who undergo PRK achieve 20/40 vision or better within 6 months.
Months 6 to 12
You will notice the full benefits of surgery 6 months to 1 year after surgery. You'll be able to get rid of your eyeglasses and contact lenses because your vision will be clear. However, this is not the time to neglect your eyes.
You'll still need to protect them from UV rays from the sun, dust, smoke, and other irritants. You may also need a pair of anti-glare sunglasses to protect them from bright lights and vehicle headlights.
1+ Years
After a year of PRK recovery, you may still need to protect your eyes from harmful rays from the sun and bright lights that may cause strain.
Remain in contact with your surgeon for close monitoring and professional advice. Let your ophthalmologist know if you experience any vision changes.
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7 Tips to Help Your Eyes Heal After PRK
- Ask for help. A family member or trusted friend can help you with important tasks such as driving, cooking, caring for pets, and anything else that could damage your healing eyes.
- Get enough rest. Your eyes will have time to heal when you rest. Take off from work and avoid strenuous activities for at least a few days.
- Wear an eyeshield. An eyeshield will protect your eyes from dust, debris, or accidental rubbing, especially during sleep.
- Apply your eye drops as prescribed. Follow your doctor's medication directions and do not miss any doses.
- Buy a pair of sunglasses. Choose sunglasses that block UVA and UVB rays that can damage to your eyes.8
- Use lubricating eye drops. Sometimes you may experience dry eyes. Use lubricating eye drops to ease discomfort and avoid irritation.
- Attend follow-up visits with your surgeon. Even if you don’t experience any side effects, it's still good to schedule frequent visits with your surgeon for close monitoring.
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What NOT to Do After PRK Surgery
After PRK surgery, avoid:
- Rubbing your eyes, which can irritate them or cause infection
- Contact with pool water, as it may contain infection-causing bacteria
- Face makeup such as mascara and eyeliners
- Facial lotions and creams
- Contact sports such as football, rugby, and basketball
- Strenuous activities such as heavy lifting that may strain your eyes
What is the Success Rate of PRK?
Research shows that PRK's overall success rate is over 95%.9
Nearly 90% of people achieve 20/20 vision, while 95% achieve at least 20/40 or better.
PRK, like LASIK, is a permanent solution to refractive errors. Both procedures have similar outcomes, but LASIK has a faster recovery timeline.
Although LASIK is more popular, PRK serves as a great alternative for people with thin corneas. Most people who undergo PRK realize an improvement in their visual acuity.
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