LASIK vs. PRK Surgery: What’s the Difference?

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PRK, or photorefractive keratectomy, is an alternative to LASIK (laser-assisted in-situ keratomileusis) for correcting vision problems like nearsightedness, farsightedness and astigmatism. Both use lasers to reshape the cornea so that when light reaches the retina it is refracted, or bent, in a way that produces a clearer image.

If you’re considering laser vision correction, how does PRK stack up against LASIK? Is PRK better for some people and LASIK for others? Here’s information about PRK vs. LASIK you can discuss with your eye doctor to help you decide which might be better for you.

PRK was the first laser eye surgery approved by the U.S. Food and Drug Administration (FDA) to treat certain vision problems, but both have been used for decades. LASIK and PRK now use the same kind of ultraviolet laser, called an excimer laser, but the surgical approach is different.

PRK

When you have PRK surgery:

  • Surgeons remove the cornea’s outer cellular layer, the epithelium, and then reshape the inner cornea, the stroma. The nearby epithelium rapidly covers the operative site. 

  • You may have some discomfort for several days to a few weeks following the PRK procedure while the cellular surface of the cornea recovers. 

  • Most people are advised to wait a week before driving and to avoid strong sunlight for several weeks so they don’t develop hazy vision.

  • PRK surgery is simpler and slightly quicker than LASIK, taking about 10 to 15 minutes per eye. The laser reshaping itself takes less than a minute.

  • PRK is less expensive than LASIK, typically costing a few hundred dollars less per eye.

  • Modern PRK is able to correct mild amounts of astigmatism (abnormal curvature).

  • It takes longer for your eyes to reach their optimal vision with PRK vs. LASIK.

When you have LASIK surgery:

  • The surgeon uses a laser “knife” to create a thin flap of the superficial cornea, which is folded back while the surgeon reshapes the corneal tissue underneath. The flap is put back into place and reattaches permanently as it heals. 

  • LASIK typically produces minimal discomfort because the epithelium is not removed.

  • LASIK surgery takes about 30 minutes per eye, but most of it is preparation time. The reshaping takes less than a minute, the same as PRK surgery.

  • Most people can see clearly in a few hours after LASIK surgery.

  • LASIK can reverse nearly all types of astigmatism-mild or extreme. 

  • Most people can resume their daily activities (not including sports, swimming or exercise) the following day.

A newer type of vision corrective surgery, LASEK, is a combination of PRK and LASIK. The surgeon uses an alcohol solution to separate the epithelium from the stroma as in PRK. Instead of discarding the epithelium, the surgeon pushes the epithelial flap to the side during the actual laser reshaping step. Afterwards, it is repositioned over the cornea, as in LASIK. You wear a specialized contact lens to protect the eye surface as it heals. A variation of LASEK is epi-LASEK, where the surgeon uses a special blade (rather than alcohol) to separate the epithelial from the stromal layer of the cornea.

PRK, LASIK, and other refractive correction procedures are elective surgeries and not covered by insurance. Both have high rates of success but there can be complications, which include undercorrection, overcorrection, and vision loss. You may have dry eyes or see glare, halos and starbursts, which go away in many people but may persist for many years in some cases.

Whether PRK or LASIK is a good choice for you depends on several factors. You should discuss your options with an ophthalmologist (eye surgeon), and you may want to get a second opinion before choosing a procedure. Factors that affect whether you are a candidate for PRK vs LASIK include:

  • If you wear glasses with a high correction (above -8.00), LASIK may not be able to reshape the cornea sufficiently but PRK may. 
  • If you have very thin corneas you may not be a candidate for LASIK but you may be able to have PRK surgery.
  • If you participate in strenuous sports, PRK can be a safer alternative to LASIK because there is no flap that can be damaged if struck. 

Most people will have significant improvement in their vision after either PRK or LASIK. More than 90% of people will have 20/40 vision or better following surgery and about 3 out of 4 will have 20/20 vision. Every surgery comes with risks, however, and there can be complications with PRK or LASIK. Make sure you understand the benefits and potential side effects, both short and long term, of any laser surgery to correct your vision.



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Luke Everdeen

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