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If you suffer from myopia (nearsightedness), hyperopia (farsightedness), or astigmatism ( blurry vision or difficulty focusing your eyesight), PRK, or photorefractive keratectomy, is a surgical procedure that may enable you to improve your vision. PRK was the first ever vision correction procedure in which ophthalmologists used lasers to reshape the cornea, the thin layer of tissue through which light enters the eye.
An improperly shaped cornea impairs the retina's ability to process images and distorts vision. During the procedure, a surgeon removes the outermost layer of the cornea and uses an ultraviolet excimer laser to adjust the shape of the underlying tissue so that light can refract properly.
PRK was such a revolutionary breakthrough in ophthalmological surgery that it inspired an entire wave of laser vision correction procedures, including LASIK and LASEK. Millions of patients in the United States alone have experienced the benefits of PRK, which has one of the most impressive safety profiles of any surgical procedure in the history of medicine. The procedure requires just minutes and produces results that can last a lifetime.
Only an ophthalmologist can confirm that you qualify for PRK eye surgery by conducting eye exams to test your corneal thickness, measure your refractive errors, and check for other vision problems that could prevent you from being a suitable candidate for treatment. Patients who are not good candidates for LASIK are often good candidates for PRK surgery. Since PRK does not require the creation of a corneal flap, this procedure is often preferable for patients who have a difficult time sitting still or those with inadequate corneal tissue.
To be a good candidate for PRK, you should:
- Be at least 18 years old. This ensures that the eye has matured and developed properly.
- Your vision must be stable for at least one year prior to surgery. If your eyesight is still shifting, PRK may not be as effective, or it may need to be redone once your eyesight stabilizes.
- Have no abnormalities of the cornea or external eye, as these can interfere with the success of PRK. In particular, you should not have or be at risk for keratoconus, a disease in which the cornea takes on a cone shape due to weakening ocular fibers. If your cornea is already shifting due to tissue damage, it is inadvisable to attempt to reshape it with an excimer laser.
- Not be taking medications such as Imitrex, Cordorone, Accutane, or any steroids, as these substances can interfere with the surgical and healing processes. If you want to undergo this surgery but are currently taking one of these medications, consult with your doctor and ophthalmologist about your options. You should have stopped taking these prescriptions for at least six months before your surgery date.
- Have no allergies to local anesthesia, as your ocular surgeon will need to numb your eyes with drops before beginning laser treatment.
- Be free of autoimmune disease or immunodeficiency, since these can interfere with proper healing.
- Not suffer from arthritis or diabetes, as these conditions can interfere with surgery and results.
- Be free of collagen vascular disease, which could lead to corneal ulceration, compromising your ocular health.
- Have no predisposition to keloids, the development of irregular or excessive scar tissue at the site of surgery or trauma.
- Be free from glaucoma, a disease in which patients' eyesight diminishes due to increased pressure within the eye.
- Not be pregnant or nursing at the time of surgery, as hormones cause tissue fluctuations within the eye, changing the refractive error.
- Understand the risks involved with PRK surgery. Side effects can include halos around vision, permanent mild glare, and worsened vision.
While more complex or severe corneal issues such as keratoconus may make a patient ineligible for PRK, this procedure is often an excellent option for patients with milder corneal conditions. Patients who have thin corneas or other corneal problems generally cannot undergo LASIK surgery due to an increased risk for developing corneal flap complications. However, patients that are not good candidates for LASIK may be appropriate candidates for PRK laser eye surgery.
When patients undergo any type of refractive procedure, including PRK and LASIK, they should be aware that the cornea is made even thinner during surgery. Experts believe that the ideal cornea is no thinner than 250 microns thick and thicker corneas are better than thin corneas, since the function of the cornea is to protect the eye.
During LASIK, the flap created on the cornea can be as thick as 160 microns. For patients with already thin corneas, this can greatly jeopardize corneal integrity. PRK is a great alternative laser vision correction treatment for patients with thin corneas; during the procedure, the laser ablation (tissue removal) only affects the very surface of the cornea. Therefore, PRK alters the structure of the cornea less significantly, which is especially important for patients with a thin cornea, as this procedure allows the doctor to leave the cornea intact to protect against future eye trauma.
If you have a thin cornea and you decide to undergo a laser eye surgery procedure such as PRK, your doctor will thoroughly examine your cornea before your procedure to determine if your thin cornea is the result of a disease or a natural occurrence, due to genetic proclivity or eye shape. If the eye is diseased, scarred, or warped, PRK or any other refractive procedure is not recommended.
In addition to patients with less corneal tissue, PRK is preferable to other refractive procedures such as LASIK for patients with certain corneal dystrophies (impaired or declining tissue) or scars. It can also work for patients with a condition called "recurrent corneal erosion," a disorder in which the outermost corneal cells do not properly connect to the layer of tissue beneath them, often causing pain and sensitivity.
Many patients want to correct their myopic, hyperopic, or astigmatic vision issues, but are concerned about the cost of PRK surgery. In fact, over 45 million Americans are good candidates for PRK and would like to improve their eyesight, but most choose not to use this treatment, often because they believe they cannot afford it. On average, PRK costs between $1,800 and $6,500, depending on the severity of the refractive error and the degree of customization the patient requires. Doctors often price PRK surgery per eye, although most patients will need to correct both eyes.
Fortunately, the cost of PRK is affordable for many patients. In addition, many ophthalmologists and ocular surgeons offer laser vision correction financing plans to break up the total PRK price into smaller, more manageable monthly installments. These financing plans typically require the patient to pay an interest rate on the principal amount, which is usually based on the payer's credit history.
Patients who are considering PRK should also consider this usually permanent vision correction as a long-term investment in their optometric care. For example, contact lenses cost the average American between $500 and $700 per year, according to All About Vision. Most glasses or contact-lens wearers also attend regular optometry appointments to check their vision or update their prescriptions, which results in an additional cost.
Some health insurance providers may cover a portion of PRK corrective surgery, although most do not, since it is considered an elective treatment, not a medical necessity. Some insurance companies or health networks may have partnerships with ocular surgeons who provide PRK at a lesser, fixed cost for members. Patients may also be able to deduct the cost of the procedure from their taxes, making it much more economical. Patients with a Health Spending Account or Flexible Spending Account may be able to use money from these savings vehicles on this treatment.
Prospective PRK patients should research all of their options to determine if this surgery is financially viable for them. In addition, they should be careful not to let cost be the overriding factor in their decision-making about this surgery and simply choose the least expensive option. PRK is a highly technical procedure and requires the expertise of an experienced doctor.
If you are not using financing to pay for PRK, the full cost of the procedure will be due up-front on or before the date of your surgery. If you have set up a financing plan or insurance reimbursement with your ophthalmologist, you will need to meet with a staff member to go over your bill and payment schedule before your procedure. Most financing plans require monthly payments on the principal amount as well as any interest accrued. Determining payment plans before your surgery allows you focus on healing and enjoying your improved vision as you recover from PRK.
Before you pay, make sure you see an itemized receipt that details the costs involved in your PRK, which often include equipment fees, local anesthesia, post-operative supplies, and the doctor's time. Having the clinic break down these costs will help you understand your costs and find any discrepancies. A detailed receipt can also be useful for patients who plan to pursue insurance reimbursement or seek tax breaks on their PRK surgery.
How to Choose a PRK Surgeon
PRK is a very exact and often permanent surgery, so it is important to find an ocular surgeon you trust. Your primary care physician, optometrist, or ophthalmologist may be able to refer you to an ocular surgeon. You should also consult friends and family members who have had laser eye surgery to get recommendations. Many ophthalmologists and surgeons also have online review websites where you can read about other patients' experiences to help you decide. In addition, you can search for surgeons by their specialty and region on the American Academy of Ophthalmology's online database at www.aao.org.
Once you have narrowed your search down to a few different clinics, there are some basic questions you should ask your prospective surgeon before you schedule your first appointment. These include:
- What is the cost of PRK at your office? As mentioned above, the average cost should be between $1,800 and $6,500. Be wary of clinics that charge less than $1,800, as this may be a sign of poor care or an inexperienced staff.
- Are you a board-certified ophthalmologist? This may seem like an obvious question, but nevertheless important. Your surgeon should be certified both to practice medicine and in ophthalmology as a surgical specialty. You can also verify this information yourself by checking the National Practitioner Data Bank, which records doctors' credentials and licenses.
- Are you a Fellow of the American College of Surgeons? While not required to perform surgery, this organization sets strict quality and ethical standards, so many patients prefer to work with surgeons who are members.
- How many PRK surgeries have you performed? PRK has been an FDA-approved laser surgery technique for almost twenty years, so it is standard practice for most ocular surgeons. A surgeon who has performed hundreds or thousands is likely more reliable than one is not very practiced in this procedure.
- Do you perform custom PRK? Custom PRK involves measuring your eyes to create a custom surgical plan that will often yield superior results to a preset laser technique.
- Do you provide post-operative care to PRK patients? Some ocular surgery clinics send patients to their regular ophthalmologists for care during recovery, but many patients prefer to work with a PRK specialist throughout the entire process. The way you use steroid drops after surgery will be an important factor in the accuracy of your vision after a full recovery, so it is important to ensure your post-operative care is top-notch.
- What recovery supplies does your office provide? Ideally, your clinic will give you the steroid, antibacterial, pain-relieving, and lubricating drops you need to apply to your eyes after surgery so that you don't have to find them yourself. You will also likely need contact lenses to cover your eyes during healing, sunglasses that fit over prescription glasses to protect them from glare, and painkillers.
- Will you or one of your associates be performing my surgery? Ocular surgeons often form teams in clinics, which means that the surgeon you initially speak to may not be the person actually operating on your eyes. If you've chosen this clinic because of one doctor's particularly outstanding reputation, make sure he or she will actually be your surgeon.
- How recently have you updated your laser and mapping equipment? Since PRK is a relatively high-tech surgery, it's important that the clinic stays up to date with the latest, most precise tools. The accuracy of laser technology has advanced markedly since PRK was first widely practiced. In general, the clinic you choose should have made some upgrades or invested in new systems within the last five years or so.
- What are the clinic's success rates, and how does this compare with national averages? Obviously, there is an inherent risk of complication involved in any laser eye surgery, but a high rate of failure can be a bad sign. The FDA recently conducted a study that found that 95 percent of PRK patients experienced at least 20/40 vision after their procedure.
- What have been the shortest and longest recovery times you have seen for PRK patients? Each person's eyes and healing time are different, but this will help you understand the range for this clinic.
- On average, how quickly after surgery do patients return to using the computer and driving? Most patients are concerned about how quickly they can return to their normal routines, so gathering this information is important.
- Do you provide touch-ups and necessary revisions to PRK as part of the surgical cost? Some patients will need small updates or tweaks to their vision after surgery. Clinics' stances on this issue will vary: some always charge for later enhancements, some will provide revisions for a set period of time, and some provide a lifetime guarantee for their PRK patients.
If your surgeon is willing to take the time to answer these questions for you, that is a good sign that he or she will respond to your questions and concerns throughout the surgical process.
While your surgeon is the most important person involved in your PRK procedure, it is also important that you feel comfortable with the nurses and front office staff, as they will be caring for you on the day of your surgery, as well.
The Initial Consultation
Once you have decided to pursue PRK surgery and chosen a surgeon you feel comfortable with, you will come in to the clinic for an initial consultation. First, your doctor will assess your eyes. There are several important tests that need to be performed before you undergo PRK laser surgery. Your doctor will perform a full eye exam and ask for your eye history to make sure that your prescription has been stable for at least one year, since this is a requirement for candidacy. The eye exam typically includes different types of tests, including:
- A dilation exam to check for ocular irregularities. Your ophthalmologist will insert eye drops that dilate your eye, stimulating it so that it opens fully. This allows him or her to determine the extent of your corneal irregularities so that he or she can plan your surgery. The eye drops used will make your vision hazy and sensitive to light for between four and six hours after use, so you will need to have someone drive you home from this appointment.
- Refractive error measurement. To correct your vision, your surgeon first needs to understand how poor it is. To that end, he or she will test your eyesight in one of two ways. Using refractometry, your ophthalmologist will apply eye drops and use a special computer to scan your eyes for corneal imperfections. He or she may also use a skiascope, a tool that shines light into your retinas to see if it refracts properly and determine the degree of the error.
- Pupil and corneal thickness measurements. This is an especially important step for patients undergoing PRK, since they often choose this surgery because they lack the corneal tissue thickness for other procedures, such as LASIK. The size of your pupil and cornea will determine the techniques your surgeon uses during your PRK procedure.
- A corneal topography map. In addition to measuring the thickness of your cornea, your ophthalmologist will need to map its curvature. To do this, he or she will take a digital photograph of your eye while you stare at a complex pattern. Using the reflection of the pattern in your cornea, he or she will create a three-dimensional map of your eye.
- Tear function analysis. Proper ocular moisture is key to recovering from PRK and having proper eyesight, so your surgeon will perform a test to measure your tear function. Typically, he or she will do so using Schirmer's test method, in which a small piece of paper sits inside your lower eyelid for about five minutes. The amount of moisture on the paper indicates how well your tear ducts are working. Your doctor may also be able to measure tear function analysis by testing for enzymes or using flourescein dye. If you are diagnosed with dry eye, this condition should be managed before your surgery.
In addition to performing these tests, your surgeon will also discuss your medical history, lifestyle, and expectations for the surgery. This helps the surgeon confirm that you are eligible for PRK and prepare you for the procedure.
During your initial consultation, an ophthalmological nurse may give you instructions to follow before your surgery and a member of the front office staff may discuss billing with you, especially if you are opting for financing provided through the clinic.
Types of PRK
There are numerous techniques your surgeon may use when performing PRK to suit your unique needs. As such, there are four basic types of PRK surgeons perform, which are all differentiated by the method he or she uses to remove the epithelial (surface) layer of the cornea:
- Traditional PRK. During this procedure, the surgeon removes uses an Amoils brush to gently remove the outermost layer of tissue before modifying the stromal tissue with a laser.
- Alcohol-assisted PRK. This technique is similar to traditional PRK, but the surgeon applies an alcohol solution to the eyes to assist with removal of the epithelial layer.
- Microkeratome PRK. Some ophthalmologists use a thin, precise, oscillating blade to remove the outermost layer of your cornea and prepare it for modification.
- Transepithelial PRK. Also called bladeless PRK, this technique involves using the excimer laser to remove the epithelium of the cornea before reshaping the underlying tissue.
The primary goal of these four strategies is to make the cornea's surface as smooth as possible before beginning the laser ablation (reshaping and modification) process. Different surgeons have varying opinions on which instruments provide better results. Some ophthalmologists combine techniques; for example, your surgeon may apply alcohol to begin dissolving the epithelium and use a laser to complete the process.
Another type of PRK is custom PRK. During conventional laser eye surgery, the ophthalmologist uses pre-set patterns to improve your eyesight by inputting basic information about your eyes collected from your initial eye exam. With custom PRK, the surgeon performs more sophisticated tests to take more nuanced measurements and create a highly personalized surgical plan based on that data.
Primarily, this involves the use of wavefront technology, a relatively recent ophthalmological invention that sends waves of light to your eye and measures their refraction. A person with perfect vision will send straight, consistent waves back to the machine, while patients with errors will refract back distorted shapes. Since this process is computerized, your surgeon can use the information collected and send it directly to the computer-controlled excimer laser. Wavefront technology is non-invasive and generates a 3D map of your eye.
The custom PRK procedure not only corrects lower order visual aberrations (nearsightedness, farsightedness, and astigmatism), but also treats higher order aberrations that affect the quality and clarity of vision. Higher order aberrations include glare, halos, blurring, starburst patterns, double vision, and difficulty seeing at night. Typically, patients who undergo custom PRK experience fewer complications or side effects.
Most types of PRK cannot correct for presbyopia, ocular degeneration due to aging that makes focusing on close-up objects more difficult. Modifying the shape of the corneas does not prevent them from shifting or degrading over time. However, monovision PRK can either prevent or repair presbyopia.
Naturally, both eyes can focus on nearby and distant images, and they must work together to zoom in and out, or "accommodate" to adjust eyesight for different situations, from watching a play from the balcony to reading the fine print on a receipt. However, as people age, their eyes can no longer accommodate as well. In their 40s or 50s, most people notice that they suddenly need reading glasses, and by the time most patients reach 70, their eyes cannot "zoom in" at all.
To preempt or correct this condition, your surgeon can perform monovision PRK, during which he or she will correct one eye for close-up vision and one eye for distance, allowing you to retain both forms of eyesight. While this procedure provides a unique advantage for aging patients, monovision PRK surgery often requires a longer recovery time because patients must learn to see with their new "bifocal" eyes. Most patients can adjust, but up to 15 percent are unable to, resulting in headaches, eyestrain, or dizziness. In addition, some people may lose some of their depth perception and intermediate vision. Some monovision PRK patients still use reading glasses for extremely up-close objects.
The most important piece of technology in PRK is the laser used to modify the corneal shape and, in some cases, remove the epithelial layer. To work on such a small and delicate organ as the eye, the excimer laser must be extremely precise. The most recent lasers remove one quarter of a micron at a time, less than the thickness of a single human hair. These lasers also send out their pulses of light on the order of femtoseconds, which are incredibly small units of time, less than one billionth of one second. The accuracy and shortness of the laser pulses reduce the heat from the laser to improve patient comfort during PRK and lessen recovery time afterward. The wavefront scans used to create a 3D model of the eyes for custom PRK also use advanced technology compatible with this sophisticated laser. Of course, ophthalmologists are still working to discover new technologies to make refractive error correction even more successful and efficient.
Visual Errors PRK Can Address
PRK corrects the three major refractive errors people suffer from:
- Myopia, which is nearsightedness, can result from an increase in the axial length of the eye, creating more space between the cornea and the retina. Exaggerated ocular curvature can also cause nearsightedness, magnifying closer images while blurring distant ones.
- Hyperopia, farsightedness, has the exact opposite causes from myopia. If the axial length is too short or the cornea's curvature is too flat, a person may become farsighted. This means that they will be able to see faraway images more clearly than those nearer to the eyes. Hyperopia may also stem from weakened ciliary muscles, which help to focus and converge visual input from both eyes to see at a distance.
- Astigmatism is a condition in which the patient has difficulty focusing his or her eyes, causing vision to become blurry. This is caused by an asymmetrical cornea, which could be "with-the-rule," taller than it is wide, "against-the-rule," wider than it is tall, oblique, somewhere in between, or irregular, having no perpendicular patterns.
PRK may not be suitable for patients who have extreme myopia, hyperopia, or astigmatism, since the results for more severe refractive errors are less stable. Most types of PRK cannot correct presbyopia, progressive farsightedness usually brought on by aging in patients over age 40. Only monovision PRK can address this condition, and this procedure is successful for just about 85 percent of patients.
Before PRK Surgery
It is important to come to your surgical appointment fully prepared so that your PRK procedure can be as effective as possible and there are no delays in treatment.
Your surgeon or ophthalmological nurse will give you his or her pre-operative instructions, which may include:
- If you wear soft contact lenses, you should not wear them for one week prior to your surgery. This will ensure that your refractive error is measured properly and your corneas are stable during the procedure.
- If you wear hard- or gas-permeable lenses, you should not wear them for one week prior to your surgery.
- Wash your face just prior to and do not wear make-up to your surgery.
- Stop smoking cigarettes in the days leading up to the procedure. This helps to ensure that your procedure and recovery go smoothly.
- Do not consume alcohol in the 24 hours prior to surgery.
- Do not eat or drink anything for eight hours before the procedure, especially if you plan to take an oral sedative for it.
- Stop taking aspirin, NSAIDs (Non-Steroidal Anti-Inflammatory Drugs, like ibuprofen or aspiring), and certain vitamins or herbs, as these may interfere with the surgical process or your corneas' ability to heal properly.
- Use oral or eye drop antibiotics to sterilize your eyes before surgery.
- If you suffer from dry eyes, you will need to use punctual plugs, clyclosporine drops, artificial tears, or ointments to increase your tear production before and after PRK.
- Arrange for someone to drive you to and from the appointment, since you will not be fit to drive the day of your PRK surgery, nor for several days afterward.
Your ophthalmologist will give you specific instructions tailored to your unique needs and circumstances.
While not required for pre-operative care, you may also want to follow some of these recommendations prior to surgery:
- Stay well hydrated in the days leading up to surgery to help your eyes naturally produce more moisture.
- Get adequate sleep and nutrition to prepare your body for healing.
- Take vitamin C, to improve your immune system for recovery, and omega-3 oils to help your epithelial tissue regenerate after surgery.
- Buy an eye mask to wear after your surgery, since most patients are extremely sensitive to light in the days following the procedure.
- Cover the windows in your home, which will also help with light sensitivity.
- Purchase new music or audio-books. You will likely not be able to read or watch television directly following your surgery, so these will help keep you entertained while you recover.
- Determine if you have any additional questions about the surgery. You'll have already received information about the procedure during your initial consultation, but the time before your operation is your last chance to get any further clarification.
- If your clinic does not provide painkillers or drops, you should purchase these before the surgery so that you do not have to make an additional stop after your procedure.
By following your surgeon's instructions and making common-sense preparations, you can feel relaxed and ready on the day of your PRK.
The Surgical Procedure
PRK is almost exactly like LASIK eye surgery, except for the fact that the surgeon does not create a corneal flap, instead removing the outermost corneal layer (which regrows after surgery) so that he or she can more directly access the stromal tissue.
Before your procedure, your surgeon will complete one final eye exam to ensure you are prepared for surgery. While not necessary, most ophthalmologists give you the option of taking an oral sedative to relax you before your procedure.
To prepare you for the procedure, your ophthalmologist will anesthetize your eyes with eye drops
To prepare you for the procedure, your ophthalmologist will anesthetize your eyes with eye drops. Then, he or she will likely place a speculum in your eyes, which is a device used to hold them open for the surgery. You will likely lay flat underneath the laser system during your surgery, where you will need to remain as still as possible, although most modern PRK lasers have tracking mechanisms built in.
To begin surgery, your doctor will remove the outermost layer of the cornea, the epithelium using a brush, alcohol, a microkeratome blade, or a laser. Then, the surgeon will use a powerful, precise femtosecond excimer laser to reshape the cornea, so you will stare at the light coming from the machine. You will likely not feel anything during this process, given the numbing eye drops and the accuracy of the laser. With conventional PRK, your ophthalmologist will use a surgical plan based on information collected from your eye exams, but with custom PRK, he or she will use a 3D computerized map of your eye, generated by wavefront technology.
After your cornea has been sufficiently modified to properly refract light, your surgeon will use contact lenses to "bandage" your eyes, protecting them from harm while your corneal epithelium regenerates. He or she will also apply lubricating eye drops or ointment to moisturize your corneas. It typically only takes about five days for your cornea to fully grow back.
The actual PRK procedure takes less than 15 minutes, but preoperative preparation may extend your surgery time to one hour. Both eyes can be done at the same time, but some surgeons prefer to do each eye separately. Most refractive surgeons perform this type of laser vision correction as an outpatient procedure, meaning you should be able to return home the same day (although you will not be able to drive or work that day).
After PRK Surgery
Immediately after PRK surgery, your vision will be extremely clear for several minutes. As the anesthesia wears off and your eye begins to respond to the procedure, you will most likely need to return home to rest, since your eyes will be very sensitive to light. Most patients wear a mask or thick sunglasses over their eyes to protect them right after PRK.
Your surgeon will provide instructions as to how often you should use your various types of eye-drops, which help your corneas heal properly. Note that overuse of anesthetic or steroid drops can actually lengthen the healing process, so only use as many drops as your surgeon prescribes. Make sure to only use eye drops that do not have preservatives, as these may inhibit your recovery. Most patients experience only mild discomfort and blurry vision after PRK, but your surgeon will likely prescribe a painkiller to help you remain comfortable.
Post-Operative Eye Care
Many patients are able to resume daily activities several days after PRK and often notice improved vision immediately. In general, you should follow some basic eye care rules to help you heal quickly and comfortably:
- You should avoid rubbing your eyes, as this may irritate them or prevent proper epithelium regeneration.
- Some ophthalmologists provide protective masks or goggles to wear while sleeping. If so, make sure you wear these for naps and throughout the night.
- Engage in only moderate exercise, since sweat could harm your eyes' healing.
- If your eyes are feeling irritated, you can keep your eye drops in the refrigerator or take walks in cold weather, as this may be soothing. Some may even recommend a treatment called a Durrie "popsicle," which is a frozen, sterile sponge applied to the affected eye.
- Many ophthalmologists will recommend using artificial tears to help your eyes remain moist.
- Avoid getting soap, dust, smoke, dirt, or any other particulate matter in your eyes.
- You should not spend time in a hot tub or sauna, but you should be able to shower normally.
- Your surgeon will typically recommend that you do not go swimming for at least three weeks after PRK.
- Sometimes, after PRK, patients can develop a mild eyelash infection, causing crusting. To remedy this, gently wash your eyelashes in the morning and evening, taking special care not to disturb your eyes.
- Take vitamin C to enhance your immune system while you recover. Omega 3 supplements may also help your body regenerate.
- Avoid any strenuous activity or extreme weather conditions for several months after surgery.
Contact your ocular surgeon or ophthalmologist if:
- You experience worsening pain or light sensitivity beyond four days after your surgery.
- The "bandage" contact lens comes out of your eye or seems to fit improperly.
- You have prolonged symptoms such as irritation or yellow pus, as these may be signs of an eye infection.
- You plan to do any unusual activities that you are concerned may interfere with your healing. He or she should be able to tell you if you will be putting your eyes at risk or not.
With conscientious post-operative care, you should be able to quickly and easily return to your daily activities with better vision. You will be able to drive as early as the day after PRK if your vision is clear and meets the vision requirements for driving in your state (for example, in California, it is 20/40). You may also resume watching television, working at the computer, or reading as soon as your eyesight permits.
During your recovery process, you will most likely come in for regular appointments with your ocular surgeon or ophthalmologist. Typically, patients return the day after surgery for a check up, and then once a week for the next several weeks, before transitioning into monthly visits for several months. This allows your surgeon to monitor the progress of your corneal healing.
In addition, your eyesight may take some time to stabilize completely, especially since many surgeons slightly overcorrect during PRK to improve results. You may continue to experience worsened night vision or blurry vision after eye activity for the next several months. In many patients, one eye heals faster than the other, making it more difficult to focus while one cornea catches up with the other over a period of a few weeks. Most patients make a complete recovery with stable, corrected vision within six months to a year from the procedure. Remember to have realistic expectations for your end results. You may not have perfect vision after your surgery, but it will usually be much better than your original eyesight.
After PRK, your eye will need some time to adjust to its new corneal shape and grow its epithelium. Each person's eyes and body function differently, so patients may have varying healing and stabilization times. The general timeline is as follows:
- One to three days after your procedure, you may experience mild discomfort or irritation, as well as light sensitivity. Most surgeons recommend taking these days off of work to rest in low lighting.
- Three to five days after surgery, your ophthalmologist or surgeon will remove your contact lens, since your epithelium will have mostly grown back. During this period, your vision may temporarily blur or worsen as the edges of your cornea heal. Most patients can resume regular activities at this point in time.
- One to three months after PRK, your vision should become even sharper as your epithelial layer grows enough cells to smoothen out.
- Three to six months after surgery, your vision should stabilize and you should be able to experience all the benefits of corrected eyesight.
After PRK, most patients experience better vision for the rest of their lives. However, patients should note that only monovision PRK addresses presbyopia, which is farsightedness related to aging and ocular degeneration.
PRK success stories have been documented for over 15 years. More tan 300,000 patients in roughly 47 countries have undergone PRK, and in a recent survey, 95 percent of these patients said they were happy with their PRK results and would undergo the procedure again.
98 percent of these patients enjoy PRK success with vision of 20/40 or better within one year
While PRK success statistics are slightly better for patients who need less correction, and slightly lower for PRK patients with higher refractive errors, the vast majority of patients say that their final vision is similar to what their vision used to be with glasses or contact lenses. In fact, 82 percent of myopic (nearsighted) patients enjoy vision of 20/25 or better, while 98 percent of these patients enjoy PRK success with vision of 20/40 or better within one year.
Patients that have the highest PRK success rates undergo custom PRK surgery. This advanced form of vision correction surgery offers more accurate technology, which gives ophthalmologists the ability to correct both lower and higher order vision aberrations.
While it is unlikely, you may need to have a "touch-up" or "enhancement" procedure to fully correct your vision after PRK. This is more likely to be the case when you opt for conventional PRK over the custom type, since wavefront analysis allows the surgeon to develop a more precise surgical plan for lasting results.
Three months after surgery, you should begin to consider if PRK has given you your desired results, keeping in mind that your expectations should be realistic. A 70-year-old post-operative PRK patient should not expect to experience the same results as a 20-year old. Your vision does not need to be perfect for the surgery to be considered a success-as long as it is significantly improved and makes your daily activities easier, you should not be concerned. However, if your prescription for glasses or contacts has not changed dramatically or you have developed additional eyesight problems after PRK, enhancement may be the right option for you. Some patients also notice changes years after their initial procedure due to regression and decide to pursue enhancement to restore their original results.
There are a few reasons PRK surgery may not go exactly as planned, thus requiring a touch-up:
- Mechanical failures or glitches could cause the excimer laser to be less effective in reshaping the cornea. If the laser's tracking device is not operating properly, this could distort the ablation involved in PRK.
- Your ophthalmologist or ocular surgeon may have improperly measured your initial refractive error, causing the correction to be inappropriate for your eyesight.
- Your body may not have healed as expected, distorting your vision.
- After an initially successful PRK, your body may begin to grow corneal tissue back in its original, non-optimal shape, which is known as regression.
Determining the cause of the imperfection in your surgery can help your ophthalmologist decide how to best repair it.
There are several ways to enhance PRK. These include:
- An additional PRK surgery, which will carry the same risks and benefits as the initial surgery, although removing your epithelial layer an additional time may make the healing process more difficult.
- LASIK enhancement designed to create a thinner flap. Patients with a thin epithelium may not be eligible for this procedure.
- LASEK surgery, which involves creating and replacing a larger flap of epithelial tissue that the ocular surgeon then replaces after surgery.
- In very rare cases, your ophthalmologist may eschew laser eye surgery entirely and recommend implanting an intraocular lens, a synthetic lens that replaces your natural lens for lasting, better vision.
Up to 99 percent of patients are happy with their results and require no enhancements, but many surgeons provide touch-ups at a reduced rate or even for free to demonstrate their confidence in their expertise. If you are considering a touch-up to your PRK, you should speak with your ocular surgeon or ophthalmologist, who can tell you if your concerns warrant the risks of an additional surgery.
PRK offers patients excellent results and the surgery has a high documented success rate. Some of the many benefits of PRK include:
- PRK can be performed on an outpatient basis and requires very little recovery time. In fact, many PRK patients are able to return to work the next day after their procedure.
- With PRK, it takes only about one minute to correct a patient's vision for a lifetime.
- Because PRK does not involve the creation of a corneal flap, this procedure is better for patients with already thin or damaged corneas. With PRK, there are no risks of flap complications or flap infection, as seen with LASIK.
- PRK offers patients clear, natural vision, so they no longer have to deal with the hassle of glasses or contact lenses. This also means that with PRK, side effects of contact lens use such as warpage, infection, and inflammation of the eyes are eliminated.
- With nearly perfect natural vision, patients see increased self-confidence and expanded recreational and employment opportunities. For example, patients with favorable PRK results are able to pursue careers in law enforcement, aviation, and the military that are unavailable to people who need corrective lenses.
- PRK is easier than LASIK to perform because it does not involve the creation of a corneal flap. This is preferable for young patients or other patients who may have trouble remaining still for the duration of the procedure.
- Custom PRK offers further improved results by using sophisticated wavefront 3D mapping technology.
- Some studies indicate that PRK patients suffer less severe dry eye after surgery than those who undergo other laser eye procedures.
- PRK uses extremely precise, "cool" femtosecond lasers to accurately reshape the cornea.
- This procedure is less invasive than other refractive error correction surgeries since the laser does not need to penetrate very deep within the cornea, which could weaken the overall structure of the eye.
To learn more about the benefits of PRK as compared with other ocular surgery options, discuss this procedure and your unique circumstances with your ophthalmologist.
As with any surgical procedure, PRK carries some risks for patients. Of course, these are often dependent on the skill of your surgeon, the severity of your refractive error, and your body's particular ability to heal after the procedure. Risks may include:
- Under- or overcorrection. Your surgeon will make detailed examinations and, in the case of custom PRK, use wavefront technology to prepare your surgery, but it may not be perfect. Most ocular surgeons tend to slightly overcorrect your vision for improved results, but your vision may be more or less clear than your desired result. If your results vary significantly from your expectations, you may decide to pursue enhancement.
- Loss of clarity from best corrected vision. On of the benefits of PRK is that it improves your natural vision by changing the shape of your cornea. However, a reshaped cornea may still not see with quite the clarity you have with glasses or contacts. Of course, you may choose to wear contacts or glasses to further improve your vision after PRK.
- Clouded vision. Also called haze, you may experience slightly clouded vision after PRK when your cornea has not fully grown back or adjusted to the surgical changes. This typically occurs between four and 14 months after your procedure. To reduce your risk of haze, most surgeons recommend staying out of the sun, wearing sunglasses, and taking vitamin C, which boosts your eye's ability to heal, in the months following PRK. The compound Mitomycin C may also help relieve these symptoms.
- Potential need for enhancement or touch-up. In very rare cases, you may need to undergo an additional surgical procedure to achieve your desired results, either due to equipment failure, inadequate healing, human error, or improper ocular examination before surgery. Your ophthalmologist will work with you to determine if you should consider a touch-up and some doctors provide these enhancements free of charge.
- Continued need for glasses or contact lenses. Although their vision is much improved, about five percent of patients choose to continue wearing glasses or contacts, typically at a much milder prescription.
- Ecstasia. While rare, PRK does carry a risk of ectasia, a condition in which the cornea weakens and becomes misshapen. Unfortunately, this condition can only be treated with special contact lenses or further surgery. To reduce your risk of ectasia, discuss the strength of your corneal tissue with your surgeon before PRK.
- Regression. In most cases, patients' eyes adapt well to corneal modification. However, as your cornea recovers, it may regenerate cells that reverse the corrective modifications of the laser, leading to regression in vision. This may worsen your vision up to two years after your PRK surgery. Some doctors prescribe certain medications, like Mitomycin C, that may reduce your risk for regression.
- Corneal ulcers. An extremely uncommon but serious risk from PRK is the development of corneal sores, pockets of bacteria on the eye. Typically, your ocular surgeon will give you antibiotic treatments or medications to take before surgery to inhibit bacterial growth, but resistant strains may still create sores. LASIK patients are more vulnerable to this condition than PRK patients, since the corneal flap can create a breeding ground for harmful bacteria. Of course, if you see any pockets or sores on your eyes, contact your ocular surgeon immediately.
- Increased intraocular pressure. In some patients, modifying the cornea causes a build-up of pressure within the eye, which may develop into glaucoma and require additional treatment.
- Astigmatism. If your surgeon modifies your corneas unevenly or your eyes heal improperly, you could develop astigmatism, even if you were never diagnosed with this condition prior to PRK.
- Presbyopia. While PRK does not cause presbyopia (progressive farsightedness due to the degeneration of ocular tissue, often correlated with aging), patients should be aware that most types of PRK do not prevent this condition. People who are particularly concerned about presbyopia may pursue monovision PRK.
Your eye health, medical history, and optometric prescription will determine your particular risks when undergoing PRK. Working with a highly skilled, respected ocular surgeon can also help ensure the effectiveness and safety of your procedure.
Most PRK patients choose to pursue this surgery to correct long-term refractive errors, but it can also be used as a secondary procedure in combination with other eye surgeries. Since laser eye surgery is minimally invasive and relatively quick to perform, many patients who are already undergoing surgery for a different condition appreciate the added bonus of correcting refractive errors at the same time.
Ocular surgeons often perform PRK on patients who are treating cataracts because cataract surgery is typically performed with a femtosecond laser. Cataracts result from excess protein buildup in the lens, creating clouds of material that make it difficult for patients to see. During cataract surgery, the ophthalmologist uses the laser to incise the capsule around the lens, fragment it into very small pieces, and aspirate it (gently draw it out) with a tiny instrument. Then, he or she replaces the natural lens with an artificial intraocular lens, or IOL.
After placing the IOL, the ocular surgeon can use the same laser to remove the epithelium and reshape the cornea for better eyesight. Secondary PRK corrects myopia, hyperopia, and astigmatism in cataract patients. While lens clouding is not related to refractive error, many patients have both issues, so they can benefit from combining procedures. This can also save the patient and doctor time and money in pre- and post-operative care.
For Glaucoma Patients
Glaucoma is an accumulation of pressure within the eye that can cause loss of vision and many uncomfortable symptoms. It is often linked to hereditary conditions, aging, and diabetes. Intraocular pressure typically builds up due to improper circulation of ocular fluids like the aqueous humor. To control glaucoma, ophthalmologists sometimes use powerful lasers to open up the pathways for fluid. Similar to cataract surgery, PRK can be performed in conjunction with this glaucoma treatment, although this is less common than PRK as a secondary treatment during cataract surgery.
Ophthalmologists are divided on the safety and effectiveness of combining glaucoma treatment with PRK. Many ocular surgeons recommend PRK as a secondary procedure for patients with early stages or high risk for glaucoma, but some don't believe that PRK is appropriate for patients with more advanced stages of the condition, given that PRK surgery can increase intraocular pressure in some cases. In addition, glaucoma can work to destabilize a patient's vision, so ophthalmologists must ensure that it is consistent for at least one year prior to surgery. Intraocular pressure can also affect measurements of corneal thickness, so ocular surgeons should be sure that their pre-operative examinations are accurate.
Temporary Side Effects
PRK changes the fundamental structure of your cornea, so you may experience some temporary side effects from the procedure. These can include:
- Discomfort during and after surgery. Your ocular surgeon will apply anesthetic drops and use a precise excimer laser to complete your correction within minutes, but you may still experience some sensation during your surgery. Once you return home for recovery, your eyes may feel sore or irritated for several days. Using painkillers and eye drops will help to alleviate this discomfort. If your pain increases after four to five days, contact your clinic for assistance. Some surgeons may also offer oral sedatives that you may take to help relax you before and during surgery.
- Temporary blurriness. Many patients experience temporarily blurred vision about three to five days after surgery, while their epithelial layer grows back and reattaches at the edges of the cornea.
- Eye infection. Removing the entire epithelium offers many benefits for patients, but it also makes you more vulnerable to eye infection. Working with a clinic that practices proper hygiene and uses sterile instruments can decrease your risk of eye infection. In addition, antibacterial eye drops should help you fight any bacteria that develop. If you experience symptoms of infection, like yellow pus from your eye, call your ocular surgeon for advice.
- Dry eye. PRK can lead to dry eye in the weeks and months after your surgery. In fact, if your vision blurs or your eyes feel tired after reading or watching television in the ensuing months, it is likely because they are too dry, even if they feel moist to you. If your eyes become irritated from dryness, do not rub or scratch them; instead, apply lubricating eye drops or artificial tears (only brands without preservatives). Fortunately, PRK patients typically experience less dry eye than LASIK patients after surgery. To proactively mitigate the effects of dry eye, make sure you treat any preexisting dry eye before your operation and stay hydrated after surgery.
- Adverse effects of anesthesia. While uncommon, some patients will feel a stinging sensation upon placement of numbing eye drops, either due to sensitivity or allergy. If you know you are allergic to certain topical anesthetics, discuss this with your surgeon before PRK. In addition, be careful not too use too many numbing drops during your post-operative care. While these may relieve your discomfort, overuse can actually hinder your eye's ability to recover from surgery and grow tissue.
- Sensitivity to light. Most patients experience moderate to severe light sensitivity directly following surgery, and this may last for several days. Make sure you can rest in a dark environment to reduce discomfort.
- Halos or excessive glare during the night. As your epithelial layer and underlying stroma grow and adapt to the modifications the excimer laser has made, your cornea may not be perfectly shaped, causing rings of light or excessive glare. This is usually temporary, but may be longer-lasting, depending on how your body recovers from PRK.
- Diplopia. Also called double vision or "ghost vision," you may have difficulty focusing on an image or see two overlapping images of the same object. This side effect is typically temporary, as a result of your cornea adapting to its new refraction.
Most PRK patients find that the discomfort of dealing with these temporary side effects is worth the benefits of corrected vision in the long-term.
As a short, minimally invasive outpatient procedure, PRK is a very safe surgery. Following your surgeon's instructions about eye drop and painkiller dosage will help reduce your risks of complication or extended healing time.
Pain management medications and oral sedatives may cause nausea, rash, upset stomach, allergic reaction, and, in rare cases, liver damage, kidney disease, ulcers, and increased risk of stroke or heart attack, especially if taken for extended periods. PRK patients younger than 20 years old should not take aspirin as a pain reliever.
Steroid eye drops can help to keep your eyes healthy, but they also carry certain risks, such as itching, redness, swelling, and irritation. Uncommon but severe side effects can include glaucoma from increased intraocular pressure, optic nerve damage, and cataracts (cloudiness in the lens).
Your vision may be foggy for up to a week after the surgery and your depth perception may be in flux for up to ten days after PRK, so take extra precautionary measures when driving or operating machinery.
PRK has excellent statistics. Understanding the numbers involved can help you decide if this surgery is right for you.
- 5 percent: the number of laser eye surgery patients that choose PRK. While most patients choose LASIK or LASEK, PRK offers unique advantages to patients who require more predictable eyesight, have a thinner cornea, want to avoid flap complications, or have another condition that would make them ineligible for LASIK or LASEK.
- Up to 95 percent: the average proportion of patients for whom PRK results in at least 20/40 vision.
- 70 percent: the number of patients that achieve perfect 20/20 vision after this procedure.
- 1 to 2 percent: the small number of PRK patients that require touch-ups or enhancement after their PRK procedure.
- 5 percent: the number of PRK patients who still wear glasses after their procedure, which is relatively small, especially considering that (non-monovision) PRK does not protect patients against the effects of aging and may not fully correct severe refractive issues.
- 97 percent: the number of patients whose eyesight is as good or better than their clarity of vision was with glasses or contacts before surgery.
- 15 percent: the approximate proportion of Americans who are eligible for PRK surgery and could benefit from improved eyesight.
Of course, your specific results will depend on the severity of your refractive error and your body's response to PRK.
Alternatives to PRK
As one of the earliest laser eye surgeries, PRK has served as the basis for many alternative treatments. In addition, refractive errors are one of the most common ocular problems among patients, so ophthalmologists have developed many surgical options.
This procedure, used to treat nearsightedness and astigmatism, was invented over a century ago in 1898 and updated during the 1960s. During a radial keratotomy, or "RK," the ophthalmologist uses a thin blade to make tiny incisions in the cornea that reduce its outward curve. This procedure takes one to two hours and requires a longer recovery time than many laser corrective options. It is particularly effective only for mild conditions, and patients with hyperopia are not eligible for this procedure.
Automated Lamellar Keratoplasty
Building off of RK, ophthalmologists created ALK, the Automated Lamellar Keratoplasty. Instead of making incisions to flatten the cornea, the surgeon uses a small microkeratome, an oscillating blade, to incise a flap of tissue, which can be lifted for stromal modification. This procedure can correct both myopia and hyperopia, but with often unpredictable success.
Based on the success of PRK, ophthalmologists developed LASIK, which stands for laser assisted in-situ keratomileusis. This process is virtually identical to PRK, except for the fact that the ophthalmologist uses a laser or microkeratome blade to make a flap from the epithelium, which is lifted during surgery and replaced afterwards. LASIK and PRK have very similar success rates, but patients often recover more quickly from LASIK and experience less discomfort, since they do not have to regenerate their epithelial tissue. However, complications can arise from the creation of the flap and patients with certain corneal conditions are not candidates for LASIK. This procedure is the most popular refractive error surgery, with only one out of every 20 patients choosing an alternative. LASIK is generally slightly more expensive than PRK.
LASEK is an intermediary between LASIK and PRK, using techniques from both procedures. During LASEK surgery, the doctor creates a circular incision and remotes the epithelium, creating a thinner flap than that in LASIK. However, unlike in PRK, once he or she modifies the underlying tissue of the stroma, the ocular surgeon places the removed outer layer back onto the eye. LASEK has a longer healing time than LASIK, but can be used for patients with insufficient corneal tissue for LASIK. Patients who want a shorter healing time than PRK but who are not eligible for LASIK may find a happy medium in LASEK.
Intraocular Lenses (IOLs)
Surgically modifying the cornea for a more optimal shape can provide effective, natural results, but it may also cause complications or have unpredictable results. The corneal tissue may occasionally heal or grow back improperly, requiring touch-ups or enhancements. While more invasive, some patients and surgeons prefer to use intraocular lenses to correct myopia, hyperopia or astigmatism.
During this procedure, the ocular surgeon makes a tiny incision into the eye and places an artificial lens. For myopia, the surgeon inserts a phakic IOL through the iris over the natural lens to help the patient see at a distance. Patients with hyperopia must have their natural lenses fragmented and removed before the surgeon inserts IOL. For astigmatism, the ophthalmologist can place a toric IOL.
IOLs are typically a more costly option than other refractive error surgeries, especially since the lenses come in various levels of quality. For example, the least expensive IOLs are monofocal, meaning that the patient may still need glasses for close or distant vision. Multifocal (having different focal points) and accommodating (shifting between distances) lenses are available for patients who want to be able to focus between distances, but these come at an additional cost. However, IOL surgery does provide some distinct benefits. It can correct even severe myopia, hyperopia, astigmatism, and presbyopia (using a similar technique as monovision PRK, in which the surgeon involve one IOL for close sight and another for distant sight). Since ocular tissue does not have to grow back, the patient's eyesight stabilizes much more quickly with an IOL than with PRK. Most patients are fully adapted to their artificial lens within one week.
Like PRK, IOL results are permanent, although some patients choose to undergo laser eye surgery as a touch-up or enhancement. IOL placement can typically be performed in about 15 minutes, but is almost always done one eye at a time. Most patients require only local anesthesia. IOLs carry some of the same risks as PRK, including increased intraocular pressure, infection, halos, glare, and blurry vision, as well as ptosis (eyelid drooping), intraocular bleeding, dislocation of the lens, and, in extreme cases, retinal detachment.
Frequently Asked Questions
Especially since the eye is such a complicated organ and there are so many corrective surgery options, many patients have questions about PRK. Some of the most common questions and their answers are below.
Is PRK as effective as LASIK/LASEK?
Yes. PRK, LASIK, and LASEK all have very similar success rates. Each offers unique benefits and disadvantages, so your ophthalmologist will help you decide which surgery is right for you based on your distinct prescription, medical history, desired results, and lifestyle. For example, a patient with thick corneal tissue who needs a shorter recover time might choose LASIK, while someone who is particularly athletic or has a thin epithelium might opt for PRK.
Will it hurt?
Each step of the PRK process has different risks for discomfort, but none of them are particularly severe. For some patients, the anesthetic eye drops may sting slightly. Most patients feel only slight sensation during the actual surgery since their eyes are numb and the laser works very quickly. Patients usually experience mild to moderate discomfort for three days following the surgery, due to irritation and light sensitivity. After about one to two weeks, most patients return to most of their normal activities with little to no discomfort. Generally, if you are experiencing extreme pain after PRK, this is due to a surgical error, infection, or complication, most of which can be efficiently resolved.
How does the laser work if it's "just light"?
While the femtosecond excimer laser is technically "just light," it uses extremely powerful bursts of light, which carry enough energy to sculpt your ocular tissue. While it is often more comfortable than a blade, a laser is just as or more effective at modifying the structure of the eye.
When can I start wearing makeup again?
Typically, patients are able to begin wearing makeup again about one week after their surgery. However, most surgeons recommend throwing out old makeup, which may be contaminated with bacteria that could be harmful to your vulnerable cornea while it heals. Use fresh makeup to reduce your risk of infection.
What if my vision isn't improving after surgery?
First of all, remember to have realistic expectations for your surgical results and recognize that each patient's recovery time will differ. Usually, your vision should have improved markedly by the third month. If it hasn't, you can speak with your ophthalmologist or ocular surgeon about enhancements, which can be performed as early as six months after your initial PRK. In addition, some patients experience regression, in which their vision improves but then begins to degrade after some time, since their corneas grow back to their original shapes. You may also have a touch-up for regression, although your surgeon may recommend an entirely different procedure such as IOL (intraocular lens) placement.
I've had a previous eye surgery. Am I eligible for PRK?
Generally, yes. Patients who have had every type of surgery from RK (radial keratotomy) to LASIK can be candidates for PRK, if they meet the other requirements for eligibility. In fact, many people who have previously had LASIK turn to PRK for enhancement because LASIK surgery has reduced their corneal thickness such that they no longer qualify for that procedure. Of course, speak to your ophthalmologist about your eligibility for PRK based on your particular history and concerns.
Why do surgeons overcorrect vision during PRK?
As discussed above, some patients experience regression after PRK. Overcorrecting vision helps counterbalance the eye's efforts to grow back tissue in its initial form. In addition, most patients would prefer to have slightly sharper vision after surgery rather than still having to use glasses or contacts to see properly.
Is it better to have PRK on one eye at a time or both at once?
Both options have pros and cons. In general, the FDA considers operating on one eye at once safer and more predictable, but this will lengthen your healing time and potential cost. If you are one of the few patients who loses best corrected vision or suffers from poor epithelial regeneration, having PRK on only one eye can allow you to retain more of your vision and make an informed decision about how to treat your second eye. However, many doctors prefer to perform PRK on both eyes at once because this is more convenient and efficient. With advancing technology and safety protocols, most surgeons consider performing dual PRK appropriately safe.
Do LASIK and PRK use the same laser?
The laser used during your procedure will depend less on the type of surgery you choose and more on the clinic. There are many different femtosecond lasers on the market, but they can all be used for both PRK and LASIK (as well as for many other procedures). Given the high cost and advanced technology involved in the laser, it is improbable a clinic would use different types for different surgeries. In all likelihood, your surgeon will use the same laser for PRK and LASIK patients.
Can I see my general practitioner or ophthalmologist for follow-up care rather than the surgeon?
Typically, you can see your regular physician or ophthalmologist for post-operative care. In fact, some clinics do not even provide follow-up care, so patients must go to their other doctors for check-ups. However, it is generally ideal to see your surgeon for follow-up care, since he or she knows the particulars of your procedure and has the specialized knowledge required to answer more detailed questions or handle complications.
If needed, can I wear contact lenses after PRK?
Fortunately, 95 percent of patients will not need contact lenses or glasses after PRK. However, if you need to wear them, you will most likely be able to. Some patients have difficulty wearing rigid contact lenses or finding lenses that fit their new corneal shape properly, so you should speak to your ophthalmologist or optometrist about your concerns.
Which complications are most common?
Almost all patients experience blurred vision and dry eye as temporary, immediate side effects. However, the most common long-term complications are undercorrection or overcorrection, which can be adjusted in an enhancement. Even though these complications are the most prevalent, only up to two percent of patients opt for touch-ups to their PRK. This attests to the success rates of PRK.
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