PRK Laser Eye Surgery
A comprehensive guidEOver 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 softens 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 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.
Over a million Americans have safely undergone PRK to gain freedom from glasses and contacts through LASIK-quality visual outcomes without the flap.
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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How Does PRK Work?
By reshaping the cornea, PRK helps focus light rays correctly on the retina for sharp vision. It treats all common vision disorders. Rather than fixing refractive errors with lenses like glasses or contacts, PRK permanently corrects vision by changing the anatomy of the cornea.
PRK Surgery Steps
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01. Pre-Op Assessment
Your eye doctor will assess your eyes with tests including corneal mapping and pupil dilation. They will recheck your refractive error (your glasses prescription) before surgery to ensure the best result.
02. 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.
03. Laser Treatment
Like LASIK, the PRK procedure needs an ultraviolet excimer laser to precisely shape the cornea, altering the eye’s focusing ability.
A laser pulse removes just 200 microns of tissue.
04. Bandage Contact Lenses
A soft bandage contact lens is placed over the eye to facilitate epithelial regrowth and keep your eye more comfortable after surgery.
05. Post-Op Care
Antibiotic drops prevent infection during recovery. Anaesthetic pain relieving drops can be used.
The outpatient treatment takes 5-7 minutes per eye.
The skin layer needs several days to regrow. Patients can usually return to their normal routines within a 4-7days. Patients are counselled not to expect perfect vision. However, most patients achieve eyesight that matches or exceeds what they could see with their glasses or contact lenses.
Benefits of PRK Surgery
PRK is a popular vision correction option, second only to LASIK. PRK is the original type of laser eye surgery that corrects problems with vision. It can fix nearsightedness, farsightedness, and astigmatism. This procedure is good for patients with thin corneas when LASIK is unsuitable.
The surgery benefits from its precision and safety, utilising state-of-the-art laser technology. Patients often achieve 20/20 vision or better and see lasting improvements in vision quality. PRK patients report better vision and improved quality of life a high success rate.
PRK is a good choice for those who want to stop wearing glasses, especially active sports people. It works well and is safe, giving long-term improvements in eyesight.
PRK Success Rates and Patient Outcomes
Numerous clinical studies validate PRK as a safe, effective procedure when performed on appropriately selected patients:
Over 93% 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.
Have a question about PRK? Get in touch today
Alternatives to PRK
There are several alternative treatments to PRK. I will describe each below with a comparison table for easy reference.
Each procedure has its specific place. Your ophthalmologist can advise which alternative option is best for you and your eyes.
The most common alternatives to PRK are the other laser treatments: LASEK, LASIK and SMILE eye surgery. Each has unique differences, and your own eye anatomy, situation, and preferences will play a role in deciding which is best for you. You may also be suitable for a lens-based procedure, such as RLE or ICL.
LASIK
The most popular laser eye treatment. LASIK has a fast recovery time and very little discomfort afterwards. Not suitable for very thin corneas.
LASEK
LASEK is an almost identical procedure to PRK, but the epithelial layer is returned rather than removed. The recovery and final vision are the same as PRK.
SMILE
Small incision lenticule extraction is a laser eye treatment for short-sight, aka SMILE, CLEAR, and SILK. These are all lenticule extraction procedures.
ICLs (Implantable Collamer Lenses)
A special contact lens implant is placed behind the iris to correct vision without reshaping the cornea.
RLE (Refractive Lens Exchange)
Exchanging the eye’s natural lens with a premium intraocular lens implant to restore vision. Suitable for ages 50+.
Glasses or contact lenses
The final option is to continue with glasses or contact lenses. The risk of vision loss is higher with contacts than with PRK.
PRK vs LASIK
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 | 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 |
PRK vs LASEK
Another similar procedure is LASEK. This procedure is almost identical to PRK, but where the epithelium is replaced instead of removed. PRK and LASEK improve vision to the same degree (both require a contact lens), and the epithelium heals at the same rate.
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 | LASEK |
4-7 days | 4-7 days | |
Same as LASEK | Same as PRK | |
Up to -12D (dioptres) | Up to -12D (dioptres) | |
Yes | Yes | |
1 in 7,000 | 1 in 7,000 |
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
Implantable contact lenses are done in an operating theatre because of the increased need for a sterile environment.
If you are out of range for PRK surgery, ICLs might be an excellent alternative.
FEATURES | ICL | PRK |
Up to -18D (dioptres) | Up to -12D (dioptres) | |
Stable, no regression | Can regress | |
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.
Have a question about PRK? Get in touch today
How to Prepare for PRK Surgery
Proper physical and mental preparation helps everything go according to plan before, during and after your LASIK treatment. Taking the following steps helps set the stage for the smoothest LASIK experience and recovery:
Learn If You Are Suitable
Have a comprehensive eye exam to determine if LASIK is appropriate and meets the criteria set by your eye surgeon.
Contact Lenses
If you are a contact lens wearer, you must discontinue wearing contact lenses for 1 to 4 weeks before your treatment, depending on the lens type.
Dry Eyes
Follow your ophthalmologist’s instructions on treating eye dryness before surgery.
Getting Home After
Make arrangements for transportation on the day of surgery, as you cannot drive immediately after.
Rest Your Eyes
Limit your screen time and get good sleep in the days leading up to surgery to rest your eyes.
No Products!
Avoid wearing cosmetic products like eyeliner, mascara and perfume around your eyes before the procedure.
Preparing for PRK Surgery
Taking these steps can help optimize your PRK surgical experience and recovery:
Recovery and Aftercare from PRK Surgery
With proper aftercare, most patients see well within a week and feel fully recovered within a month post-op.
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
Have a question about PRK? Get in touch today
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 extremely low risk with antibiotic drops
Visual loss – remote chance of severe vision impairment
Your ophthalmologist takes every precaution possible to mitigate risks and ensure satisfactory visual outcomes.
Choosing the Right Surgeon and Clinic for PRK
Selecting the best laser eye surgeon and facility is the most important factor for your PRK’s success.
Also, click here to learn more about finding the best laser eye surgery in London or elsewhere.
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.
The future looks bright for enhancing PRK outcomes through scientific innovations. While already proven over decades, PRK continues advancing.
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
Frequently Asked Questions About PRK
Mild pain and light sensitivity are expected during recovery. Pain is managed with medication and improves within days.
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).
No driving is allowed until your surgeon confirms your vision is stable, generally within one week.
Yes, PRK is highly effective at reducing or eliminating astigmatism.
PRK can treat thin corneas that might be ineligible for LASIK. Enough corneal thickness must remain post-surgery.
Most insurance plans consider PRK an elective surgery and do not cover it. Check your specific policy.
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!