PRK (Photorefractive Keratectomy)

If you’re not a good candidate for LASIK, you may be a candidate for vision correction with a similar procedure called photorefractive keratectomy, often referred to as PRK. In Sacramento, San Francisco, Walnut Creek, and other Northern California locations, Kaiser Permanente offers this and other laser vision correction procedures to help women and men see more clearly and get the most out of life.

What is PRK?

PRK is a type of refractive surgery used to correct nearsightedness, farsightedness, and astigmatism. It is a very similar procedure to LASIK; in fact, it is performed with the same excimer laser. Here is a brief comparison:

LASIK uses a femtosecond laser to create a partial thickness flap in the clear cornea, or front portion of the eye, whereupon the flap is lifted, and the excimer laser is used to reshape the cornea in order to effectively change the prescription of the eye.
PRK, by contrast, is applied to the surface of the cornea just below the surface layer (epithelial layer). Following PRK, the surface layer replaces itself by healing quickly over the next 4 to 7 days. This is the main reason for the moderately delayed visual acuity recovery associated with PRK. During this healing phase, people experience mild to moderate discomfort for which they take medicated eyedrops and oral medications.

Once healed, the visual acuity outcome for PRK is the same as LASIK and becomes very sharp approximately 1 to 2 months postoperatively. LASIK, by contrast, offers a faster visual recovery (around 2 to 5 days).

In Their Own Words...

My laser vision experience with Kaiser was amazing. My initial evaluation was timely and thorough. Dr. Chandra is a master at what he does, and I was very glad to have him as my physician. I had considered LASIK years ago but was never quite ready. Now, I think I was meant to wait so that I could have the privilege of having such a skilled physician for such a delicate procedure. My evaluation showed that one of my eyes was borderline for having either traditional LASIK or PRK, which is more detailed, for lack of a better word. After having the choice and consequences explained, I chose the PRK. Although it was more painful and had a longer wait for the final result, I didn’t mind since I didn’t want to chance any unnecessary consequences with my eyes. Needless to say, I am extremely happy with my results. After having had to wear glasses since I was 9, being without them is a wonderful thing. I still need reading glasses in low light, which I was told everyone will require sooner or later no matter what, but that is nothing compared to the joy of the freedom from glasses that I have longed for. You can count on honest and friendly care from a great, health care-based hospital to support any follow-up needs. I recommend Kaiser Permanente and Dr. Chandra for anyone considering laser vision correction.

— Lana W., PRK patient in Walnut Creek Read More Patient Testimonials

So why do people choose PRK over LASIK?

Not everyone is a good candidate for LASIK, which is often the case for people with any of the following conditions:

Slightly irregularly shaped corneas
Thin corneas
High prescriptions

Your refractive surgeon can explain these subtle points on an individual basis. Other reasons some patients choose to have PRK include those who have very low prescription powers and people who engage in contact sports where there is significant risk of ocular injury.  Some people with dry eye will also choose PRK as there is slightly less dry eye associated with PRK than with LASIK. The PRK procedure also involves less manipulation by the surgeon than with LASIK, which means that patients who have phobias about things near their eyes can find it easier to tolerate PRK.

What are some of the disadvantages of PRK over LASIK?

A slower visual recovery and more discomfort can mean more time off work, and most people will need to take up to a week off from work. There is a slightly higher risk of haze with PRK as well, but since there is no flap being created, PRK does not involve the risk of complications with the flap as with LASIK.

What is the PRK experience like?

Your surgeon will first perform a workup that includes a careful measurement of refraction, thorough examination, and careful study of your cornea mapping to ensure you are a good candidate. Once you have been deemed a good candidate, you may then elect to schedule surgery after a full discussion of the risks, benefits, and alternatives with your surgeon.

The day of the procedure, you will be given a mild sedative to help you relax. You will then be given topical eyedrops that numb your eye. An eyelid device called a speculum will gently hold your eye open so you will not need to worry about blinking.

The surgeon then removes the central area of epithelium with a buffing device or dilute alcohol and then uses the excimer laser to precisely reshape the cornea to neutralize the prescription. As this is happening, you will be asked to look at a blinking target within the laser. The laser will also track the movements of your eye and respond accordingly.  

A bandage contact lens is then applied to alleviate pain and allow your eye to heal effectively. You will need a ride home from a friend or family member.

What can I expect after PRK eye surgery?

You will need to apply steroid and antibiotic eyedrops as directed by your surgeon for 4 to 8 weeks following the PRK procedure. During the first week, your vision will be quite blurry, although you should be able to care for yourself and put in your eyedrops. The bandage contact is removed in 5 to 7 days when your eye has completely healed. During the healing process, it’s important to:

Limit your use of electronic devices to 2 hours a day at most to give your eyes time to rest.
Wear eye shields at night for the first week to prevent nighttime eye rubbing.
Avoid driving while your vision is blurry.

How long does it take to recover from PRK surgery?

The healthy, new surface layer of skin remodels and smooths during the 3 to 4 weeks after surgery, yielding crisp and clear vision. Some people will have a somewhat longer wait to achieve their fine, crisp vision, as this process can take up to a few months. Still, most people can see to drive and work after recovering for 1 week. When the eyes are fully recovered, the results will be the same as if LASIK had been done.

To find out if PRK is right for you, request a consultation online.