Photorefractive Keratectomy (PRK) Laser Eye Surgery: What you need to know!
Mr Tariq Ayoub - 10 Apr 2021
PRK or Photorefractive Keratectomy is a commonly performed type of laser vision correction procedure. It is usually performed in patients not suitable for other types of laser vision correction procedures such as LASIK or SMILE. In this article, we summarise the key points you need to know about Photorefractive Keratectomy (PRK) laser eye surgery.
How is PRK performed?
Unlike LASIK, no flap is created in PRK. Instead, a laser is used to remove the inner layers of the cornea called the stroma to re-shape the cornea to correct your prescription. This is often combined with a laser to remove the surface layer of the cornea called the epithelium. This dual-use of laser to remove the epithelium followed by resurfacing of the stroma is called trans-PRK and is often described as the non-touch technique for laser vision correction. A bandage contact lens is then applied to the eye which is removed after 4-7 days. During the procedure, the eyes are kept open with the help of specially designed clips. Watch an animation of the procedure here: How is PRK performed?
LASEK is a similar procedure to PRK except in LASEK the surface layer of the cornea, the epithelium, is manually removed often with the aid of specially designed alcohol. At Oculase, we prefer to use the non-touch technique trans-PRK.
Is PRK painful?
No, it is not a painful procedure as numbing anaesthetic eye drops are instilled in both eyes. However, after the procedure, the eyes can be painful for 2-3 days as the surface layer of the eye called the epithelium heals. You will be given painkillers and drops to alleviate the pain.
What can PRK correct or treat?
Using advanced laser technology, PRK can treat short/near-sightedness (myopia), near/long-sightedness (hyperopia) reading vision (presbyopia) and astigmatism. However, extreme prescriptions of myopia, hyperopia or astigmatism may be better treated with Implantable Contact Lens Surgery or Refractive Lens Exchange if you are above the age of 50.
Who is suitable for PRK?
Several factors help determine your suitability for Photorefractive keratectomy. If you have thin corneas then you may be better suited for PRK rather than LASIK. Soldiers or police officers are better suited to PRK as are athletes such as boxers, wrestlers and martial arts fighters. This is due to the increased risk of flap dislodgement with trauma in LASIK, unlike PRK where no flap is created.
Additionally, you should be 18 years or older with a stable eye prescription. Your corneas need to be healthy and the overall health of your eye must be generally good.
Your ophthalmologist will advise you on the best treatment option based on the assessment of your eye.
Who is unsuitable for PRK?
You may be unsuitable for PRK if you have:
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- Severe dry eyes
- Skin or other diseases that can affect healing
- Corneal disease
- Keratoconus
- Advanced glaucoma
- Cataract affecting vision
- Poorly controlled diabetes
- Pregnant and breastfeeding women
- Extreme glasses prescription
If you have the above then you may be suitable for an alternate procedure such as Implantable Contact Lens or RLE, or you may not be suitable for any refractive procedure. At Oculase, we will discuss the best procedure for you based on your examination findings, your scans and your individual circumstances.
What are the side effects or complications of PRK?
Most people make excellent recovery after PRK. However, the recovery is slightly slower than LASIK. Usually, there is some pain after the procedure as the surface of the cornea heals. The pain is controlled with analgesia. The visual recovery is also slower during the healing process. However, at about 1 week after surgery, the vision is similar to LASIK.
You may also experience some temporary side effects which generally resolve in most people. These side-effects include:
- Hazy or blurry vision
- Difficulty with night vision or driving at night
- Scratchiness, dryness and other symptoms of dry eye
- Glare, halos or starbursts around lights
- Light sensitivity
While these side effects might seem severe, they resolve in most people with no lasting effects. Modern laser technology has reduced the occurrence of these side effects significantly. At Oculase, we use the latest laser technology to ensure the best outcomes. However, to ensure these outcomes, it is important you prepare for the surgery as best as you can.
Can you go blind from Photorefractive Keratectomy (PRK) Laser Eye Surgery?
Total blindness, where you cannot even see light, is extremely rare. No one has ever gone completely blind from Laser Eye Surgery according to reports by The American Refractive Surgery Council. However, deviating from the aftercare guidelines can result in potential vision problems. Therefore, it is imperative that you follow the aftercare instructions for a successful outcome.
How to Prepare for PRK Laser Eye Surgery?
In order to have an optimal outcome and have the best experience, it is important to follow the instructions of your surgeon. In general, you should prepare by doing the following:
- Stop wearing contact lenses: Wear your glasses and stop wearing your contact lenses for at least 2 weeks prior to surgery. The longer you are off the contact lenses the better!
- Stop using make-up: It’s advisable not to wear any eye makeup, lotions, or cream for 3 days before surgery and on the day of surgery.
- Take a shower: It is advisable not to shower for 2-3 days after surgery. Therefore, take a shower, and wear clean and comfortable clothes on the day of surgery.
- Have a light meal: On the day of surgery avoid heavy meals. Equally, make sure you eat something to prevent any dizzy episodes.
- Have someone accompany you: Make sure you have someone to drive you back home as your vision may be temporarily blurred soon after surgery
- Bring your sunglasses: It is important to wear your sunglasses after surgery to help reduce the photosensitivity people experience after surgery.
Precautions after PRK Laser Eye Surgery
- Use your drops: you must use your drops as prescribed. For the first few days after surgery, have someone help you with the drops.
- Don’t take a shower or wash your hair: you can take a bath but avoid taking a shower or washing your hair or getting any water into your eyes until your contact lens has been removed.
- Don’t touch or rub your eyes: you may gently dab around the eyelids but don’t touch or rub your eyes for at least 2 weeks after surgery. Touching the eyes unnecessarily may affect the healing of the surface layer of the eye.
- Avoid driving: You must not drive until your doctor tells you it is okay to do so.
- Wear your sunglasses: Invest in a good UV protecting pair of sunglasses. Use this for the first few days after surgery and every time you are out in bright sunlight for at least 6 months after surgery.
- Avoid swimming or heavy exercise: You must allow your eyes to heal. It is best to avoid swimming or heavy exercise for 2 weeks after the surgery
- Avoid eye make-up: Don’t use eye make-up for 1 week after surgery to reduce the risk of infections. Discard partially used products to prevent infections.
Benefits of having PRK eye surgery
- Most people notice an improvement in vision as the eyes heal over the first week after surgery.
- As there is no flap, there is no flap related risks or complications unlike in LASIK
- It is the preferred procedure for laser vision correction in people who do contact sports or whose jobs involve an increased risk of trauma, such as policemen or army personnel
- Most people can return to work 4-5days after surgery
- 95-98% of people notice an improvement in vision without glasses after surgery. In a small percentage of people, an enhancement may improve this further.
- No stitches are required for the surgery
What are the alternatives to PRK Laser Eye Surgery?
If you are not suitable for PRK, you may be suitable for an alternative procedure such as LASIK or Implantable Contact Lens or Lens Replacement (RLE) surgery. At Oculase, our experienced and certified refractive surgeon, Mr Ayoub will assess you and discuss the most suitable option for you.
Learn more about London and Birmingham’s best laser eye surgeon, Mr Tariq Ayoub.
