There are basically two laser refractive procedures to correct myopia (nearsightedness), hyperopia (farsightedness), and astigmatism
- LASIK (Laser Assisted In-situ Keratomileusis)
- PRK (Photorefractive Keratectomy)
In LASIK, a corneal flap is created and lifted to expose the inner corneal tissue which is then treated with the laser to correct refractive errors. Caucasians have an average corneal thickness of 543 microns, which is less in African Americans and even less in Asians. If the corneal tissue is too thin to create a flap without interfering with the structural integrity of the cornea, then PRK may be the better option.
Both procedures have similar success rates, but LASIK offers patients less post-operative discomfort and a quicker period of healing. The complication rates for LASIK and PRK are relatively the same, though PRK has a slightly higher risk for a haze to develop within the cornea.
FREQUENTLY ASKED QUESTIONS
How is PRK performed?
Before the procedure begins, a technician will administer anesthetic eye drops to numb your eye. An eyelid holder will be placed between the lids to prevent blinking. Then an instrument will be used to carefully brush the epithelial surface of the cornea so the tissue can be treated with the laser. This process generally takes only a few seconds and is painless. You will be asked to watch a target light during the laser treatment, which also takes only a few seconds. Once the laser has treated the cornea, a soft contact lens is placed on the eye for three to six days to act as a bandage. This allows the epithelium to heal and helps keep the cornea comfortable during this time. The surgeon will place a tiny punctal plug into your tear drainage tube to help keep your eye moist during the next few days.
Is the procedure painful?
Before the procedure, your eyes will be numbed with an anesthetic eye drop. Some patients may experience a feeling of light pressure from the lid speculum (the instrument used to hold your eyelids open). A soft contact lens is placed on the eye following surgery to act as a bandage and keep the cornea comfortable when blinking as the cornea heals. Patients generally have mild to moderate amounts of discomfort for the first few days until the surface of the cornea has healed. Frequent use of artificial tears following PRK will help prevent the feeling of dry, scratchy eyes and will also greatly aid in the eye’s healing process.
How long is the procedure?
Although the procedure itself generally lasts under 10 minutes, you should plan to be at our office for at least two hours on the day of surgery to account for pre-op preparations and post-op evaluations.
Will both eyes be done on the same day?
Generally both eyes are done on the same day.
What can I expect immediately following PRK surgery?
It is recommended that surgery patients sleep for at least four hours following their procedure to allow the eye some time to recover. A scratchy, stinging sensation following surgery is normal and will subside in a couple of hours. Vision is usually blurry for the first few days but will greatly improve within a week, though full visual results may not be seen for a few weeks following PRK. You will be instructed to use medicated eye drops for the first couple of weeks to help decrease inflammation and reduce the risk of infection. Artificial tears will also be required to aid in the healing process and comfort the eyes. Daily follow-up visits may be required for the first few days after a PRK procedure so that the epithelium may be carefully monitored during this healing time.
Will my vision be 20/20 after the procedure?
You will likely notice a significant improvement in vision a few days following the procedure, but your vision is likely to fluctuate for a few weeks as the eyes heal. Although the goal of PRK is to improve vision to the point of not being dependent on glasses or contacts, we cannot guarantee that your vision will be 20/20. You can rest assured that we will take extreme care during the measurement process and will take every precaution to ensure that your results are to your satisfaction.
Will I ever need glasses again?
We cannot guarantee 20/20 vision following any eye surgery. Some patients may still need glasses or contacts, though their prescription will be much lower than before. You should also understand that your eyes will continue to change as you age, possibly causing you to develop myopia (nearsightedness) or hyperopia (farsightedness) over a length of time, though it is rare. Most people will eventually develop presbyopia (the loss of reading vision) sometime after the age of 40 and will require the use of reading glasses. Presently, PRK cannot treat presbyopia. Additional treatments or other procedures (such as CK for presbyopia) are available to correct the above refractive errors.
What are the risks and side effects of PRK surgery?
Every surgery has risks as well as benefits. PRK has a less than 1% complication rate, and the vast majority of these complications are treatable or can be corrected with an additional procedure. Some risks and side effects of PRK include over- or under-correction, increased sensitivity to light, glare or halos around lights at night, or dry eyes. You should be aware that there is a risk of infection, which can result in irregular scarring or loss of vision if not treated correctly. Studies have shown that you have a greater chance of being injured or killed in a car accident than you have for losing vision due to an infection after PRK surgery. These and other complications will be fully discussed with you prior to your PRK procedure.
Are there certain restrictions following surgery?
Most patients are able to return to work and other normal activities two to three days after surgery. You should be prepared to use eye drops for a few weeks before and after PRK surgery to prevent infection and help the healing process. Frequent use of artificial tears will greatly improve your vision results. Your eyes may be more susceptible to traumatic eye injury after PRK, so protective eyewear is recommended for all sports where a direct blow to the eye may occur.
How long has PRK been available?
PRK was first performed in Germany in 1987 and was FDA approved for use in the United States in 1995. Dr. Cathy Schanzer, our medical director and chief surgeon, is a board-certified ophthalmologist and has been performing PRK surgery since its FDA approval. She has performed over 5,000 refractive surgeries.
Will my insurance cover PRK surgery?
Because we are medical specialists, we cannot accept vision insurance, but we do accept most medical insurance. The majority of insurance carriers has deemed PRK as an elective surgery and will not cover the cost of the procedure. You will need to check with your insurance carrier by calling their customer service phone number to determine if they will cover the cost.