What Is PRK Eye Surgery?   

Welcome to our in-depth guide on PRK Eye Surgery, also known as Photorefractive Keratectomy. This advanced laser vision correction procedure has helped millions of people reduce their reliance on glasses and contact lenses, offering a powerful alternative for improving vision. As an online resource dedicated to connecting consumers with highly qualified eye surgeons, Trusted LASIK Surgeons® is committed to providing you with comprehensive, accurate information to help you make informed decisions about your eye care.  

What Is PRK?

Photorefractive Keratectomy (PRK) is a type of refractive surgery that utilizes an excimer laser to reshape the cornea. The cornea, the clear front surface of the eye, plays a vital role in focusing light onto the retina. By precisely altering the cornea's curvature, PRK corrects how light enters the eye, thereby improving blurry vision caused by refractive errors.

Unlike LASIK, which involves creating a thin flap of corneal tissue, the PRK procedure is performed by gently removing the outermost layer of the cornea, the epithelium. The excimer laser is then applied directly to the underlying corneal tissue (stroma). This technique makes PRK a "surface ablation" procedure. PRK was a pioneering laser vision correction technique, first approved by the FDA in 1996.

What Vision Problems Can PRK Eye Surgery Correct?  

PRK has been approved by the FDA to correct  Nearsightedness (difficulty seeing distant objects clearly.),  Farsightedness (difficulty seeing near objects clearly),  Astigmatism (blurred vision due to an irregularly shaped cornea,  Presbyopia (Age-related loss of near focusing ability, sometimes addressed with Monovision PRK in select cases). 

Monovision is also an option with PRK for either nearsighted, farsighted or astigmatic eyes as well as with Presbyopia. Although Monovision PRK is an Off-Label Use of the lasers since it is not FDA-approved, a highly qualified LASIK expert can best advise you on whether you are a good candidate for Monovision PRK and perform this procedure if this is a viable option for you.

Please click the "play" button below to view a video on "How the PRK procedure is performed." Scroll down to learn more about PRK, how it compares to LASIK, who is a good candidate for LASIK and more.  

Who Is a Good Candidate for PRK?

Determining candidacy for PRK Eye Surgery is a critical step performed during a comprehensive eye examination by a qualified refractive surgeon. Ideal candidates typically meet specific health and vision criteria to ensure the best possible outcome and a safe recovery. Key factors considered include:

• Age: Candidates are generally 18 years or older, with many surgeons preferring patients to be at least 21 to ensure vision stability.
• Stable Prescription: Your eyeglass or contact lens prescription should not have changed significantly for at least one year prior to the evaluation.
• Refractive Error: Your degree of nearsightedness, farsightedness, or astigmatism must fall within the range treatable by PRK with a high probability of success.
• Corneal Thickness and Health: While PRK can be suitable for individuals with thinner corneas compared to LASIK candidates, adequate corneal thickness and overall corneal health are still essential for the procedure.
• Overall Eye Health: You should be free from eye diseases that could affect healing or the outcome, such as advanced glaucoma, cataracts impacting vision, uncontrolled dry eye syndrome, or corneal infections.
• General Health: Certain systemic health conditions may affect wound healing and should be discussed with your surgeon.
• Realistic Expectations: Understanding that while PRK significantly improves vision, the goal is typically to reduce reliance on corrective lenses, not necessarily guarantee perfect 20/20 vision for every individual.

PRK is often an excellent alternative for individuals who may not be ideal candidates for LASIK, particularly those with thinner corneas, certain types of corneal irregularities, or those whose professions or hobbies put them at a higher risk of eye trauma.  

How Is PRK Eye Surgery Performed? (Step by Step)

The PRK Eye Surgery procedure is a quick outpatient surgery, typically taking about 10-15 minutes per eye. While the prospect of eye surgery can be daunting, understanding the steps involved can help alleviate anxiety. The general process includes:

1. Preparation and Anesthesia: Upon arrival at the surgical suite, you will be made comfortable. Anesthetic eye drops will be administered to completely numb your eye, ensuring a pain-free experience during the procedure. An instrument called a lid speculum will be used to gently hold your eyelids open, preventing blinking.
2. Epithelial Removal: The surgeon will carefully remove the thin outer layer of the cornea (the epithelium). This can be done using various techniques, including the application of a diluted alcohol solution to soften the epithelium before removal, using a specialized brush, or employing a laser (in advanced techniques like TransPRK where the laser removes the epithelium).
3. Laser Reshaping (Ablation): You will be asked to focus on a blinking target light. Using a highly calibrated excimer laser, the surgeon will reshape the underlying corneal tissue based on the precise measurements taken during your preoperative evaluation. The laser delivers cool pulses of ultraviolet light, removing microscopic amounts of tissue to correct the refractive error. This part of the procedure is very fast, usually lasting less than a minute per eye.
4. Bandage Contact Lens Placement: Once the laser reshaping is complete, a soft, clear contact lens (known as a bandage contact lens) is placed on the treated eye. This lens acts as a protective covering and helps the new epithelial cells grow back comfortably over the next few days.
5. Post-Procedure Care: The bandage contact lens will remain in place until your surgeon removes it at a follow-up appointment, typically 3-7 days after the surgery. You will be given specific instructions on using eye drops and protecting your eyes during the crucial healing period. 

PRK Eye Surgery Recovery: What to Expect

The recovery period after PRK Eye Surgery is a key difference when compared to LASIK. Because the epithelial layer is removed and needs to regenerate, the initial recovery takes longer and may involve more discomfort. Understanding the typical recovery timeline will help you prepare:

• First Few Days (Days 1-3): You will likely experience moderate discomfort, including a burning or gritty sensation, light sensitivity (photophobia), and watery eyes. Vision will be significantly blurry. Pain medication and frequent use of lubricating and prescribed eye drops are crucial during this phase. Resting with your eyes closed can provide significant relief.
• Epithelial Healing Progress (Days 3-7): The new epithelial cells begin to cover the treated area under the bandage contact lens. Discomfort typically starts to subside, but vision will remain blurry and may fluctuate throughout the day.
• Bandage Lens Removal and Initial Vision Improvement (Day 5-7): Your surgeon will remove the bandage contact lens once the epithelium has sufficiently healed. Vision will start to clear more noticeably after the lens is removed, but it will not be sharp immediately.
• Gradual Visual Acuity Improvement (Weeks 1-4): Over the next few weeks, your vision will continue to improve steadily. Blurriness and fluctuations will decrease, and you will likely notice a significant improvement in clarity.
• Stabilization of Vision (Months 1-6): Full and stable vision typically takes 3 to 6 months to achieve after PRK. This is a gradual process, and patience is key. Regular follow-up appointments are necessary to monitor your healing progress and visual outcome.

Essential Post-Operative Care:

• Use all prescribed antibiotic, anti-inflammatory, and lubricating eye drops exactly as directed.
• Avoid rubbing or touching your eyes.
• Wear sunglasses outdoors to protect your eyes from UV light and reduce light sensitivity.
• Avoid swimming, hot tubs, saunas, and dusty or smoky environments during the initial healing period.
• Refrain from using eye makeup for at least two weeks, or as advised by your surgeon.
• Attend all scheduled follow-up appointments.

 How Is PRK Different from LASIK?

PRK is essentially LASIK without the creation of a LASIK flap. PRK Eye Surgery generally produces similar results to LASIK but the patient usually experiences more discomfort and has a slower recovery of vision than in LASIK as it takes several days for the epithelium to grow back. 

Please click the play button below to view a video showing the differences between PRK v LASIK.

View Video

Benefits of PRK Eye Surgery

While the recovery period for PRK Eye Surgery is longer than for LASIK, PRK offers several significant benefits that make it a valuable and often preferred vision correction option for many individuals:

• Flapless Procedure: The most notable advantage is the absence of a corneal flap. This eliminates the potential for flap-related complications such as displacement, wrinkles, or epithelial ingrowth, which, though rare, are specific risks associated with LASIK.
• Ideal for Certain Candidates: PRK is particularly well-suited for individuals who may not be good candidates for LASIK, including those with thinner corneas, certain pre-existing corneal conditions, or those involved in activities where eye trauma is a concern.
• Comparable Long-Term Outcomes: Numerous studies have shown that the long-term visual acuity and stability achieved with PRK are comparable to those of LASIK [¹]. Patients can expect excellent vision correction results over time.
• Potentially Lower Risk of Long-Term Dry Eye: Some research suggests that PRK may be associated with a lower incidence of persistent severe dry eye symptoms in the long term compared to LASIK, although temporary dry eye is common after both procedures [²].
• More Residual Corneal Tissue: Because no flap is created, PRK leaves slightly more untouched corneal tissue in the central load-bearing area compared to LASIK, which may be advantageous for corneal stability in certain cases.

Potential Risks and Complications of PRK

As with any surgical procedure, PRK Eye Surgery carries potential risks and complications. While modern techniques and technologies have made PRK very safe, it is crucial to be aware of and discuss these possibilities with your surgeon during your consultation. Potential risks include:

• Postoperative Discomfort and Pain: The initial recovery period is typically more uncomfortable than with LASIK due to the epithelial healing process.
• Slower Visual Recovery: It takes a longer period to achieve clear and stable vision compared to the rapid visual improvement often seen after LASIK.
• Corneal Haze: This is a potential complication where the cornea becomes slightly cloudy during healing, especially with higher corrections. While often temporary and treatable with medication, it can occasionally persist and affect vision in rare cases.
• Infection: A rare but serious risk is infection of the cornea after surgery. Strict adherence to post-operative eye drop regimens is essential to minimize this risk.
• Dry Eye: While potentially less common in the long term than with LASIK for some individuals, temporary dry eye is a frequent side effect during the PRK healing process.
• Regression: The eye's natural healing response can sometimes lead to a partial return of the original refractive error over time, requiring an enhancement procedure or corrective lenses.
• Halos, Glare, and Starbursts: Some patients may experience visual side effects, particularly in low light conditions, which usually diminish over time but can occasionally be bothersome.
• Under- or Over-Correction: Achieving the exact desired refractive correction is not always possible, which may necessitate an enhancement procedure or the use of glasses or contact lenses for some tasks.
• Delayed Epithelial Healing: In some cases, the epithelial layer may take longer than average to regenerate.

Serious complications from laser vision correction procedures like PRK are considered rare, occurring in less than 1% of cases [³]. Your surgeon will discuss your individual risk factors based on your eye health and overall medical history.

Why Choose a Trusted LASIK Surgeons® Expert for Your PRK?

Choosing the right surgeon is arguably the most critical factor in the success and safety of your PRK Eye Surgery. At Trusted LASIK Surgeons®, we understand this, which is why the surgeons listed in our directory undergo a stringent screening process. This process is designed to identify surgeons who are not only board-certified but also possess significant experience in performing PRK and other refractive procedures, have a history of excellent patient outcomes, and are recognized by their peers for their professional contributions.

When you choose a Trusted LASIK Surgeons® expert for your PRK, you are selecting a surgeon who has demonstrated:

• Extensive Experience: A high volume of experience performing PRK and other complex vision correction surgeries.
• Professional Recognition: Often hold academic appointments, are involved in research, lecture to peers, or hold leadership positions in professional ophthalmology organizations.
• Commitment to Patient Care: Prioritize thorough patient evaluation, education, and personalized treatment planning.
• Proven Outcomes: A track record of achieving excellent results for their patients.
• Expertise in Managing Complications: Experience in identifying and managing potential complications, should they arise.

Our screening process ensures that you are connected with surgeons who are truly at the forefront of refractive surgery, giving you the best possible chance for a safe procedure and optimal visual results with PRK.

To find a laser vision correction expert who has qualified to be listed in the Trusted LASIK Surgeons® directory, please visit: 

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Learn more about the high standards and rigorous screening process we use to qualify the surgeons featured on our site:

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PRK Eye Surgery: Frequently Asked Questions (FAQs)

To further assist your understanding of PRK Eye Surgery, here are answers to some of the most frequently asked questions:

Q: How long does the PRK procedure itself take? A: The laser application time is usually less than a minute per eye. The entire procedure, from preparation to completion, typically takes about 10-15 minutes per eye.

Q: Will I feel pain during PRK surgery? A: No, your eyes will be completely numbed with anesthetic eye drops before the procedure begins, so you should not feel any pain during the surgery itself.

Q: How long does it take to recover from PRK? A: Initial healing takes about 3-7 days with the bandage contact lens in place. Functional vision returns gradually over the following weeks, with full visual stability often achieved within 3 to 6 months.

Q: What is the main difference between PRK and LASIK? A: The primary difference is that LASIK involves creating a corneal flap, whereas PRK does not. In PRK, the surface layer of the cornea is removed before laser reshaping.

Q: Is PRK a safe procedure? A: Yes, PRK is considered a very safe procedure with a long track record. While potential risks exist, serious complications are rare, especially when performed by an experienced surgeon.

Q: Can PRK correct my specific vision problem (nearsightedness, farsightedness, astigmatism)? A: PRK is FDA-approved and effective for treating a range of myopia, hyperopia, and astigmatism. Your surgeon will determine if your specific prescription is suitable for PRK during your consultation.

Q: When can I see clearly after PRK? A: Vision will be blurry immediately after the procedure. You will experience gradual improvement over weeks and months, with most patients achieving good functional vision within the first month, and full clarity at 3-6 months.

Q: How long do the results of PRK last? A: The changes made to the cornea during PRK are permanent. However, PRK does not prevent natural age-related vision changes like presbyopia (which typically requires reading glasses after age 40) or the development of cataracts.

Q: Is PRK better than LASIK? A: Neither procedure is universally "better." The best procedure depends on your individual eye health, corneal anatomy, lifestyle, and visual needs. PRK is often preferred for those with thin corneas or high-risk lifestyles.

Q: What is the cost of PRK Eye Surgery? A: The cost of PRK is generally comparable to LASIK, but it can vary based on the surgeon's practice, location, and the technology used. A consultation will provide you with an accurate cost estimate.

Q: Can I have PRK if I have dry eyes? A: While temporary dry eye can occur after PRK, it may be a more suitable option than LASIK for individuals with pre-existing dry eye issues, as it may be less likely to worsen the condition long-term for some patients. Your surgeon will evaluate your dry eye severity.

Q: What is Monovision PRK? A: Monovision PRK is a technique used to address presbyopia where one eye is corrected for distance vision and the other is intentionally left slightly nearsighted for reading vision. This is an "off-label" use and is not suitable for everyone; a trial with contact lenses is often recommended.

Additional Resources

• U.S. Food and Drug Administration (FDA): 
  • LASIK and Other Laser Eye Surgery Procedures - FDA Discussion
  • For a list of FDA-approved lasers please visit: List of FDA-Approved Lasers for LASIK
• National Library of Medicine Article: This publication, titled “The 25th Anniversary of Laser Vision Correction in the United States,” offers valuable insights into the evolution, outcomes, and safety profile of laser vision correction procedures, including PRK eye surgery, over the past quarter-century. It provides an excellent overview of advancements and historical context relevant to understanding modern PRK. To access, please click on: The 25th Anniversary of Laser Vision Correction in the United States.
• American Academy of Ophthalmology (AAO): AAO Discussion: What is PRK?  
• Journal of Cataract & Refractive Surgery: Publishes peer-reviewed studies on outcomes and advancements in refractive surgery procedures like PRK. Visit: The Journal of Cataract & Refractive Surgery® (JCRS).

Conclusion

PRK Eye Surgery stands as a proven and effective laser vision correction procedure, offering a valuable alternative to LASIK, particularly for individuals with specific corneal characteristics or lifestyle considerations. By reshaping the cornea using an excimer laser after gentle removal of the epithelial layer, PRK can significantly improve nearsightedness, farsightedness, and astigmatism. While the recovery period is longer than LASIK, the flapless nature of PRK eliminates certain risks, and the long-term visual outcomes are comparable and often excellent. Choosing a highly experienced and peer-recognized surgeon, like those listed in the Trusted LASIK Surgeons® directory, is paramount for maximizing the safety and success of your PRK procedure. By understanding the procedure, recovery, benefits, and potential risks, you are well-equipped to have an informed discussion with a qualified surgeon and take a confident step towards clearer vision. 

Thank you for visiting Trusted LASIK Surgeons®. We are dedicated to providing you with trusted information and connecting you with expert surgeons.

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