Photorefractive Keratectomy (PRK) Vision Correction Surgery

PRK, or photorefractive keratectomy, is a laser eye surgery that was approved before LASIK but is now less popular compared to the other brand name. Still, PRK is a very popular operation, helping millions of people achieve good visual acuity, with a 95 percent success rate.

PRK is a great option for some people who are not good LASIK candidates, such as those with thin corneas, chronic dry eye, or a high rate of nearsightedness.

What Is PRK?

LASIK is the most famous and trendy type of laser eye surgery to fix refractive errors, but there are many other options for this cosmetic procedure that can work well for those who might not be good candidates for LASIK. One of the most popular alternatives is photorefractive keratectomy, or PRK.

Like LASIK, PRK uses a programmed, guided laser to reshape the cornea to eliminate myopia, hyperopia, or astigmatism. However, it is a better option than LASIK for people who have thin corneas or chronic dry eye.

PRK was developed originally in 1983 and improved upon in 1987. It was approved in 1996 by the U.S. Food and Drug Administration (FDA), a few years before LASIK hit the market.

While it was a more effective and faster procedure than previous refractive surgeries, it was quickly outpaced in popularity by LASIK. However, PRK remains a very popular option to fix visual acuity.

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Who Benefits the Most From PRK?

If you are eligible for LASIK, you are also a good candidate for PRK. More people choose LASIK due to cost and name recognition.

That said, PRK is also a great option for people who may not be good candidates for LASIK. For a small subset of people, LASIK can have long-lasting side effects, especially for those with naturally thin corneas, who have had one LASIK procedure already, who have a high level of myopia (nearsightedness), or who have chronic, serious dry eye (which would get worse with LASIK).

People who are good candidates for PRK:

• Are adults who are 18 or older.
• Have a stable refractive error, which has not changed in the last year.
• Have a type of refractive error that can be treated with laser eye surgery.
• Have healthy corneas.
• Have no serious or untreated underlying health conditions.

Even though PRK is good for some people who might not benefit from LASIK, there are still certain people who are not good PRK candidates. This group includes:

• Anyone younger than 18 or older than 60.
• Those with an unstable, consistently changing refractive error.
• Those with underlying health conditions that make healing more difficult.
• Older adults with presbyopia, or age-related farsightedness.
• People with a history of scarring, especially on the eyes.
• Those with certain eye conditions like corneal abrasions, cataracts, or glaucoma.
• Those who are pregnant or nursing.

The PRK Procedure

Like LASIK, PRK requires an examination from an eye surgeon before the operation, to assess your overall eye health and ensure you are a good candidate for this procedure. This examination will include:

• Testing your visual acuity with and without corrective wear.
• Checking for other eye problems like cataracts and glaucoma.
• Mapping the surface of your cornea to program the PRK lasers.
• Measuring your pupil size.

Just before your examination, you may be asked to stop wearing contact lenses so your surgeon can more accurately map the shape of your cornea. You will also need to set up a ride to and from the procedure. Although PRK, like LASIK, is a quick and safe outpatient operation with little healing time, you will need help getting home immediately after the operation.

During the procedure:

• Your eyes will be numbed with topical anesthetic, so you are awake during the procedure.
• Special clamps will be put in place on your eyelids to keep your eyes open.
• An eyelid holder will be placed on top of your eye to assist with creating and moving a flap of epithelial tissue on top of the cornea.
• The epithelial flap will be shifted using an alcohol solution, brush, blade, or laser.
• You will be asked to look at a point of light as the laser reshapes your cornea.
• You will spend 15 minutes total in the operating room and another 15 to 30 minutes in the recovery room.

Once you arrive home, follow the aftercare instructions your ophthalmologist or surgeon gives to you. This will include resting your eyes for the remainder of the day.

Recovery From PRK

Unlike LASIK, PRK requires a little more postsurgical time to heal. Most people who receive LASIK can return to work or school the next day, but PRK requires resting for three to five days. You should also avoid strenuous activity like exercise for up to one week after the procedure, as this can shift the corneal flap and cause scar tissue, infection, or poor healing.

After the surgery, you can expect:

• Some eye pain or discomfort that should go away over two or three days.
• Haloes or glares around lights for a few days.
• Some blurry vision as your eyes heal.
• To use prescription eye drops if they are provided to you, usually for about one month.
• To go to a follow-up exam the day after PRK to ensure your eyes are healing.
• To wear sunglasses outside for several weeks regardless of the time of year or cloud cover, until your doctor tells you otherwise.
• To avoid water in pools, oceans, lakes, and hot tubs until you are cleared.
• To protect your eyes when you shower or take a bath for up to one week.

If you experience long-lasting side effects like dry eye, poor or blurry vision, itching or eye discomfort, or trouble seeing at night, let your doctor know. These side effects can last for several weeks, just like with LASIK, but they should clear up on their own. If they do not, you may need an adjustment or additional treatments.

The reported PRK success rate is around 95 percent, similar to LASIK’s outcomes. Both procedures have high patient satisfaction rates as well.

The Cost of PRK

PRK ranges in cost, depending on where you live, your surgeon’s skill, and the severity of your refractive error, among other costs. Typically, PRK costs between $1,800 and $4,000 per eye. This is similar to LASIK, although it may be easier to find LASIK clinics and surgeons in your area than PRK specialists. Like LASIK, PRK is not covered by insurance except in very rare cases, so you will need to consider how you will pay for this operation. You might be able to use a health savings plan, personal savings or credit cards, or a financing option with your eye surgeon.

References

1. What Is Photorefractive Keratectomy (PRK)? (September 2017). American Academy of Ophthalmology (AAO).

2. Photorefractive Keratectomy. (July 2021). StatPearls.

3. Photorefractive Keratectomy. (January 2022). EyeWiki, American Academy of Ophthalmology (AAO).

4. Photorefractive Keratectomy (PRK) Is Safe and Effective for Patients With Myopia and Thin Corneas. (Summer 2016). Medical Hypothesis, Discovery & Innovation Ophthalmology Journal.

5. PRK Costs and Financing. (September 2017). DocShop.