What is PRK?
Photorefractive keratectomy (PRK) is a type of laser eye surgery. According to studies, PRK has a 95 percent overall success rate, with 70 percent of people achieving 20/20 vision or better.1
PRK involves reshaping the cornea, the clear front part of your eyes. Together with the eye lens, the cornea helps focus light on the retina.
An abnormally shaped cornea can affect your ability to see. Reshaping it through the PRK procedure can restore proper vision.
Why is PRK Performed?
PRK is a refractive surgery. It’s FDA-approved to treat the following refractive errors:
- Myopia (nearsightedness). This causes blurry vision when looking at distant objects.
- Hyperopia (farsightedness). This makes up-close objects appear blurry.
- Astigmatism. This is an irregular curvature of the eye that causes blurred vision up close and far away.
- Presbyopia. This is farsightedness that begins after age 40.
PRK Surgery vs. LASIK
Both PRK and LASIK surgery have similar outcomes of 20/40 vision or better. Although both involve reshaping the cornea, their procedures and recovery timelines differ.2
- PRK surgical procedure. The eye surgeon removes the outer layer of corneal tissue (epithelium). This exposes the inner tissue for treatment with an excimer laser.
- LASIK surgical procedure. The surgeon cuts a small flap in the corneal tissue. They fold back the flap for laser treatment.
The absence of a corneal flap makes PRK a better choice for people with thinner corneas.
Recovery Differences
- PRK has a longer recovery time. Outcome studies show that PRK can take 5 days to a month for the initial recovery. Most people who get LASIK recover within 24 hours.3
- PRK can be more painful. PRK is associated with pain and discomfort, whereas LASIK is considered painless.
Who is a Candidate for PRK Surgery?
You'll qualify for PRK if you:
- Are 18 years or older
- Have good eye health and overall health
- Have a refractive error (myopia, hyperopia, or astigmatism)
- Have a stable eye prescription lasting at least a year
- Have a thin cornea, making you a poor LASIK candidate
- Want to achieve better vision and eliminate dependence on contacts or eyeglasses
- Understand the risks and benefits of the procedure
- Have realistic expectations
- Can follow post-surgery care instructions
Who is Not a Good Candidate for PRK Surgery?
Health conditions that may prevent you from getting PRK surgery include:
- Pregnancy or breastfeeding
- Uncontrolled diabetes
- Rheumatoid arthritis
- Glaucoma
- Cataracts
- Eye infection
- Eye injury
- Refractive instability
- Corneal scars, injuries, or diseases
These conditions can increase the risk of complications during or after refractive surgery.
PRK Procedure: What to Expect
Once your doctor determines your suitability for PRK surgery, they’ll schedule your procedure. Like any other surgery, preparation is important.
Before Surgery
Before surgery, you and your doctor will discuss what to expect before, during, and after the procedure. This will vary depending on unique factors, like your vision and lifestyle needs.
Your doctor will review your medical history and perform an eye exam. This may include:
- Measuring your pupil size
- Testing your vision to determine your refractive error
- Checking for other eye problems that might affect the surgery outcome
- Measuring your corneal thickness and mapping your corneal surface to guide the laser during surgery
People who wear rigid gas-permeable contact lenses should stop wearing them at least 3 weeks before their screening visit. If you wear other contact lenses, stop at least 3 days before the evaluation.
Day of Surgery
PRK surgery is an outpatient procedure that usually takes 15 to 20 minutes for both eyes. Here’s what to expect:
- You will receive anesthetic drops to numb your eyes.
- Your eye surgeon will position an eyelid holder on your eye to prevent blinking.
- Your surgeon will remove the epithelial layer of your cornea. They use a laser, blade, brush, or an alcohol solution to do this.
- You will have to stare at a target light to keep your eyes from moving. Then, your ophthalmologist uses a laser to reshape your cornea. The laser is programmed with the measurements they took from your eye. You’ll hear a clicking sound as the laser pulses.
- Your surgeon will place a bandage contact lens over your eye while it heals.
- You will need someone to drive you home after surgery. Plan to relax for the rest of the day.
Aftercare
After surgery, you may feel some pain and discomfort. You can relieve these using prescription or over-the-counter (OTC) pain medications.
Your ophthalmologist will prescribe antibiotic eye drops, lubricating eye drops, and steroid drops to apply to the healing eye as necessary. You’ll also need to do the following:
- Wear protective sunglasses when you go outside to avoid excessive sun exposure
- Take medications as prescribed
- Take a few days off from work if your doctor suggests it
- Avoid strenuous physical activities for up to a week or as long as advised
- Stop contact sports, such as football, until your doctor advises otherwise
- Avoid rubbing your eyes
- Avoid contact with dirty water from pools, rivers, etc.
Attend your first follow-up appointment at least 24 hours after surgery to closely monitor the healing process. Regular follow-up visits are recommended to ensure a successful recovery.
PRK Surgery Side Effects and Risks
Studies show that PRK is a safe, efficient, and stable procedure.8
However, like any surgical procedure, there are side effects and risks, including:
- Mild eye pain or discomfort
- Halos and starbursts, especially at night
- Clouding of the cornea (corneal haze)
- Corneal scarring
- Blurred vision
- Possible overcorrection/undercorrection
- Light sensitivity (photophobia)
- Eye infections
If PRK surgery overcorrects or undercorrects your vision, you may need to wear glasses or contact lenses. Some people opt for an additional laser vision correction surgery.
Most complications of PRK are treatable without threatening your vision. Rare risks include:
- Having worse vision than you did before surgery
- Vision loss
Contact your doctor if you experience sudden vision changes, severe pain, or bleeding.
PRK Surgery Recovery Time
The initial recovery for PRK may take about a week to a month, with vision improving daily. It may take 3 to 6 months to fully recover.
How Much is PRK Surgery?
PRK surgery costs about $1,750 to $3,000 per eye. The cost may vary by location, available facilities, and your surgeon’s experience.
Talk to your doctor for accurate pricing information before making your decision. Some surgeons may offer financing options. Your health savings account (HSA) or flexible spending account (FSA) may also cover some costs.
PRK Surgery Pros and Cons
Like all laser eye surgery procedures, PRK has its advantages and disadvantages. Discuss both with your eye doctor before deciding to have laser surgery.
Pros of PRK
Advantages of PRK include:
- Reduced risk of eye trauma and corneal flap complications compared to LASIK
- Less risk of postsurgical dry eye syndrome than LASIK
- Safe for people with thinner corneas
- Faster recovery of corneal nerves
Cons of PRK
Potential drawbacks of PRK include:
- Lengthy recovery time that can take 3 to 6 months after surgery
- Clear vision can take up to 10 days to return
- Higher risk of eye infection than LASIK
Summary
- Photorefractive keratectomy (PRK) is an FDA-approved laser eye surgery.
- PRK corrects refractive errors, including nearsightedness, farsightedness, and astigmatism.
- Like LASIK, PRK involves reshaping the cornea with laser technology to achieve better vision.
- PRK is a great alternative to LASIK for people with thin corneas.
- An ideal PRK candidate is at least 18 years old, in good general health, and has a refractive error.
- PRK is generally safe and effective, with a success rate of 95 percent.
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