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The Complete 2024 Guide to PRK Laser Eye Surgery: What You Need to Know

Introduction to PRK Laser Eye Surgery

Over the years, photorefractive keratectomy has evolved into a highly precise procedure with excellent safety and efficacy outcomes. It remains a top choice for certain patients today.

What is PRK Laser Eye Surgery?

Photorefractive keratectomy PRK improves vision by reshaping the cornea with an excimer laser. Unlike LASIK, no corneal flap is created. Instead, your surgeon creates an opening in the surface cornea epithelial cells, which are gently removed to expose the underlying tissue, known as the stroma.

Alternative names include LASEK, epiLASIK and advanced surface ablation (ASA).

The excimer laser then painlessly sculpts the stroma, altering the eye’s focus. The laser pulses remove tiny amounts of tissue to either flatten or steepen areas of the cornea, correcting nearsightedness, farsightedness, and astigmatism.

Once the laser treatment is complete, a soft bandage contact lens is placed on the eye as a bandage until the epithelial cells regenerate over the next few days. The lens will speed visual recovery and relieve pain. Lubricating drops aid healing and replace moisture on the surface of the cornea.

Millions of Americans have safely undergone PRK to gain freedom from glasses and contacts through LASIK-quality visual outcomes without the flap.

Here’s a comparison of PRK eye surgery and LASIK:

PRK

LASIK

Surface cells removed

Flap created

More discomfort in recovery

Faster recovery

No flap complications

Risk of flap issues

Better for thin corneas

Requires thicker cornea

Enhance by repeat PRK

Easy to enhance

Who is a Candidate for PRK?

To determine if you are eligible for photorefractive keratectomy, your ophthalmologist will evaluate the following:

  • Your refractive error (nearsighted, farsighted, or astigmatism)

  • Your corneal shape, contours, and thickness

  • The health of your retina and optic nerve

  • Your medical history and any medications you take

  • The stability of your vision prescription

In general, good PRK candidates include those who:

  • Are 18+ years old with stable vision

  • Have no eye diseases or uncontrolled medical conditions

  • Do not take medications that could impact healing

  • Have enough corneal thickness

PRK may be preferred over LASIK for people with thin corneas, certain occupations, or high involvement in contact sports.

 A PRK procedure is an outpatient surgery where the doctor uses a laser to reshape the cornea and improve your vision. After receiving numbing drops, the doctor removes the outer layer of cells from the surface of your eye to access the cornea underneath.

The laser is then used to sculpt and reshape it, correcting any refractive errors that may be present.

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Preparing for PRK Surgery

Taking these steps can help optimize your PRK surgical experience and recovery:

  • Stop wearing contact lenses, usually for 1-4 weeks before your evaluation. You should wear glasses during this time.

  • Have a comprehensive eye exam to determine your candidacy

  • Follow your surgeon’s guidance on stopping certain medications before surgery

  • Make arrangements for transportation on the day of surgery

  • Ensure you can take 4-5 days away from work or school to rest your eyes after PRK

  • Mentally prepare for mild postoperative discomfort and light sensitivity

  • Don’t wear eye makeup on the treatment day

Thorough physical and mental preparation helps PRK go smoothly.

The PRK Procedure: A Step-by-Step Guide

Here is how the PRK surgical procedure is performed:

1. Pre-Op Assessment

Your eye doctor will re-evaluate your overall health, eyes, and eye health with tests including corneal mapping and pupil dilation. He or she will recheck your refractive error (your glasses’ eye prescription) once again before surgery. This will confirm your best vision with glasses.

The goal is not perfect vision but to match your best vision with glasses or contact lenses. Rarely, the treatment may result in slightly worse vision.

2. Epithelial Skin Removal

Numbing drops are applied to ensure you feel no eye pain, and an eyelid holder is placed. The outer layer of corneal epithelial cells is gently removed with an alcohol solution to expose the cornea’s surface.

3. Laser Treatment

Similar to LASIK, the PRK procedure needs an excimer laser that uses ultraviolet light to precisely sculpt the corneal stroma, altering the eye’s focusing ability. A pulsing beam removes 200 microns of tissue each time the laser hits the cornea.

4. Bandage Contact Lenses

A soft bandage contact lens is placed over the eye to facilitate epithelial regrowth.

5. Post-Op Care

Antibiotic eye drops prevent infection during recovery as your surface cells regenerate. Anaesthetic eye drop pain relievers can be used. The treatment takes 5-7 minutes per eye. PRK is an outpatient procedure with minimal discomfort.

Recovery and Aftercare from PRK Surgery

Recovery from photorefractive keratectomy PRK involves:

  • Keeping all follow-up appointments with your surgeon

  • Using prescribed antibiotic and anti-inflammatory eye drops

  • Wearing sunglasses outdoors due to light sensitivity, especially in bright sunlight

  • Taking oral pain medication as needed for discomfort

  • Avoiding rubbing or touching the eyes for 4-6 weeks

  • Refraining from driving until vision is stable

  • Limiting screen time and activities requiring visual focus

  • No swimming or dirty/dusty environments which increase infection risk

With proper aftercare, most patients see well within a week and feel fully recovered within a month post-op.

Risks and Complications of PRK Surgery

All surgery carries risks, but major complications from PRK are very rare. Potential side effects include:

  • Regression – some loss of effect and blurry vision requiring an enhancement

  • Scarring – haziness causing glare or reduced night vision (uncommon with modern lasers)

  • Infection – can cause corneal scars but is an extremely low risk with antibiotic drops

    (1 in 7,000 procedures).
  • Visual loss – remote chance of severe vision impairment

Your ophthalmologist takes every precaution possible to mitigate risks and ensure satisfactory visual outcomes.

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PRK Success Rates and Patient Outcomes

Numerous clinical studies validate PRK as a safe, effective procedure when performed on appropriately selected patients:

  • Over 99% achieve 20/40 or better (functional vision)

  • More than 95% attain 20/20 or better

  • Over 90% report satisfaction with their results post-surgery

  • Most see improvement within days, with vision continuing to sharpen over three months

  • For many, the visual improvements from PRK are long-lasting when applied to suitable candidates

Of course, your individual results depend on your starting prescription and ocular anatomy. Your surgeon can guide realistic expectations.

Alternatives to PRK laser eye surgery

The main alternative procedure to PRK is LASIK eye surgery. However, LASIK involves cutting the corneal tissue to create a flap, typically using a femtosecond laser.

A major benefit of a LASIK flap is that the eyes heal quicker, lessening the chance of an eye infection. PRK has a slightly higher risk of infection because the surface layer (epithelial layer) needs to heal, which takes several days. Also, the patients experience improved vision within 24 hours with LASIK, compared to several days for PRK eye surgery.

However, a LASIK flap is less suitable for those with a very active lifestyle with some risk of eye injury. The slower healing process may be a worthwhile trade for peace of mind against trauma, as PRK does not involve cutting.

PRK vs LASEK

Another similar procedure is LASEK. This is an almost identical procedure to PRK, but where the epithelium is replaced instead of being removed. Both PRK and LASEK improve vision to the same degree (both require a contact lens), and the epithelium heals at the same rate.

   

PRK

LASEK


Can treat all prescriptions

Speed of recovery

4-7 days

4-7 days

Final vision

Same as LASEK

Same as PRK

Prescription range *

Up to -12D (dioptres)

Up to -12D (dioptres)

Thin corneas

Fix astigmatism

Fast recovery


Post-op pain

Yes

Yes

Needs operating theatre

Infection rate

1 in 7,000

1 in 7,000

The initial benefit of LASEK was to prevent corneal haze. However, the advent of mitomycin C (MMC) as a drug that prevents corneal haze has removed the rationale for performing LASEK.

Other types of refractive surgery include implantable contact lenses (ICLs) or refractive lens exchange (RLE). Your consultant ophthalmic surgeon can advise which may be the right choice for you.

Photorefractive keratectomy is better when there is less corneal tissue, e.g. patients with naturally thinner corneas.

PRK vs ICL Implants

Implantable contact lenses can be a better option for very high or extreme prescriptions. The main benefits are:

  • Faster recovery
  • Less pain post-op
  • No regression over the years
  • Reversible

    FEATURES

ICL

PRK

Extreme prescriptions

Prescription range

Up to -18D (dioptres)

Up to -12D (dioptres)

Can regress and return to needing glasses

Stable, no regression

Can regress

Thin corneas

Maintains ability to read

Fast recovery

Reversible

Operating theatre

Infection rate

1 in 3,000

1 in 7,000

PRK Costs and Insurance Considerations

As an elective procedure, PRK is not covered by insurance plans. However, some financing options are available. The typical cost per eye is:

  • £1,800-£2,200 for conventional PRK

  • £2,000-£2,600 for custom wavefront PRK

To save money on PRK:

  • Ask about low-interest payment plans

  • Look for discounts and special offers

  • Have surgery at an ambulatory surgery centre rather than a hospital

  • Get treated in both eyes simultaneously

The price is well worth the investment for many patients, considering the benefits of freedom from glasses and contacts.

Prices comparison LASIK PRK SMILE

Frequently Asked Questions About PRK

Here are answers to some common PRK questions:

Is PRK painful? Mild pain and light sensitivity are expected during recovery. Pain is managed with medication and improves within days.

Is PRK safer than LASIK? PRK poses no risk of cornea flap complications. However, LASIK involves less discomfort after surgery. The overall risks are the same. PRK patients are at slightly higher risk of infection (1 in 7000 for PRK vs 1 in 21,000 for LASIK).

When can I drive after PRK? No driving is allowed until your surgeon confirms your vision is stable, generally within one week.

Does PRK fix astigmatism? Yes, PRK is highly effective at reducing or eliminating astigmatism.

Can I have PRK if I have thin corneas? PRK can treat thin corneas that might be ineligible for LASIK. Enough corneal thickness must remain post-surgery.

Does insurance cover PRK? Most insurance plans consider PRK an elective surgery and do not cover it. Check your specific policy.

Choosing the Right Surgeon and Clinic for PRK

Selecting a top-quality eye surgeon and facility is the most important factor for PRK’s success. Seek a surgeon who:

  • Has extensive experience performing PRK, specifically

  • Uses the latest laser technologies and custom techniques

  • Has published research and helps train other surgeons

  • Specializes in laser vision correction procedures

  • Takes time to listen to your concerns and questions

  • Performs PRK safely and with excellent visual outcomes

  • Provides personalized, attentive follow-up care post-op

The Future of PRK Surgery

PRK technology advancements aim to improve precision, results, and recovery time. This includes:

  • Faster, more accurate diagnostic devices to plan treatment

  • Lasers that measure and apply pulses in the trillionths of a second

  • Lasers are customised based on the unique irregularities in one’s eye

  • Collagen cross-linking to strengthen the cornea after laser reshaping

  • Newer corneal shield enzymes that facilitate epithelial regrowth

The future looks bright for enhancing PRK outcomes through scientific innovations. While already proven over decades, PRK continues advancing.

Conclusion: Is PRK Right for You?

PRK offers a tested alternative to LASIK for laser vision correction, with unique advantages for certain patients. If you are dealing with glasses or contacts, meet with a specialist to see if PRK might provide the visual freedom you seek.

With an experienced surgeon, thorough prep, and proper aftercare, PRK can safely help you achieve excellent, long-lasting results.

Take the Next Step: Book Your PRK Consultation

Don’t put up with poor vision any longer – call today to schedule an initial appointment with Dave Allamby, MD. Take control of your vision and change your life for the better!

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