PRK

What is PRK?

PRK stands for Photorefractive keratectomy.

PRK is like the old model of laser eye surgery. While today LASIK is by far the more popular option, and is talked about frequently, PRK (photorefractive keratectomy) used to be the most common refractive surgery procedure, and is still used today.

PRK was invented in the early 1980s, but was not approved by the FDA is the US until 1995. However, this does not mean people were not getting this surgery before that. In fact, it was being performed in many other countries for years. Many people in the US who wanted this surgery went to Canada to get it before it was available in the US.

How is PRK performed?

PRK is performed with an excimer laser. This laser type uses a cool ultraviolet light beam to precisely remove small pieces of the cornea in order to reshape it and make it work better. Reshaping it can help those who have had trouble focusing light into the retina properly to provide clearer vision.

Who can benefit from PRK?

Obviously not every vision problem can be corrected with this surgery type, but both nearsighted and farsighted people can benefit from PRK. The procedure is done slightly differently for the various problems. With nearsighted people, the goal is to flatten the too-steep cornea; with farsighted people, a steeper cornea is desired. A PRK can be performed to correct astigmatism as well, the excimer lasers can be used to smooth an irregular cornea into a more normal shape.

PRK versus LASIK

PRK is a type of laser surgery, and yet LASIK had become the far more popular option, and this begs the question of why. Both are grouped under the umbrella "laser eye surgery," but each is a little different, and each has their own set of advantages and disadvantages.

For example, LASIK patients have less discomfort and obtain good vision more quickly. With PRK surgery the improvement may be gradual, and could take a few days, or even a few months to improve.

PRK is less risky, and offers better results for patients with larger pupils or thin corneas.

Your eye care professional will be able to help you find the best surgery type for you, whether it is the older PRK, or the newer, popular form of laser eye surgery, LASIK.

Let's take a look at how PRK surgery works:

Before Surgery

If you are considering PRK, your first step is to choose a surgeon. Most ophthalmologist are skilled in PRK surgery, as it has been around for a long time, but this does not mean that every surgeon is created equally, which means if you want to have the lowest risk surgery, you should do your research to find the best surgeons.

Before you have surgery you will have an eye exam where your doctor will examine your eyes to determine exactly what kind of vision correction you need and how much laser ablation is needed. Basically, the extent of your needed correction is mapped out. To do this a corneal topographer will be used; this is an instrument that photographs your eye and creates a kind of "map" of your cornea, this map displays your specific irregularities, and the steepness or flatness of the cornea, which your surgeon will then fix.

During your final exam before surgery your eye doctor will ask about other medical conditions you have, allergies, and the like to ensure that you do not have unforeseen complications during the surgery because of a different medical condition. Some conditions may disqualify you altogether as a PRK candidate; others may mean a postponement of the procedure or require you to have special care afterward. With any eye surgery an anesthesia is going to be used, so your doctor should determine if you respond well to it.

During Surgery

When you get PRK it is a same day surgery, which means you walk in, have the surgery, and walk out again. Generally you are kept awake during this surgery, but if a child is getting this surgery, they will probably be put under. The surgery only takes a few minutes, in fact, once you are all prepared, the surgery usually takes less than minute, and you will be awake the whole time. If you are anxious or worried, your doctor may give you a mild sedative.

Most people don't feel pain during PRK because your eyes are first anesthetized with special drops, you will lie down, and the surgeon will position the laser directly above the eye. Only one eye is operated on at a time, and so even if you are going to have surgery on both eyes, it will take place one at a time. A retainer is placed over your eyes to keep your eyelids open, and out of the way during the surgery. This is not uncomfortable. The retainer also has a suction ring to keep your eye pressurized and immobile so that you do not mess up the surgery by moving.

The surgery is done using a computer, the surgeon will use a computer to adjust the laser for your particular prescription based on the topography you get during pre-surgery. The doctor will have a target light they ask you to focus on, and they will observe your eye during this time to ensure it is in the right position before they turn on the laser. Once they are certain, they will send pulses of light to your cornea using the laser, and it will painlessly remove the tissue. Your job will be to keep your gaze fixated on the target light. Doing this helps you have the best results.

You will be awake during the procedure and you will be able to hear the laser machine as it will make a steady clicking sound while the laser pulses are happening. You may also be able to smell a faint odor during the tissue removal. This is not out of place, it is normal, so do not let it worry you.

While most PRK surgeries take under a minute to perform, the higher your prescription, the more time the surgery will take. In other words, if you have a lot of irregularities that you need to have corrected, it will take longer to get the surgery.

Once the surgery is done, the doctor will talk to you and tell you what to expect, they may also give you a prescription for pain medication in case you have any pain after the surgery, however, usually this is not the case, while a scratchiness is often reported, real pain is rare.

After the laser is turned off and your surgery is complete they will have you rest for a while to help your eye recover. If you are having surgery on both eyes, you will rest one for a short time and then they will do the surgery on the other eye. If you have extensive repairs to be made, your eye surgeon may have you space the two eyes a week apart.

After PRK

Once the surgery is over, you need to be sure to follow the instructions from your doctor. Many people do not think they have to rest of be careful because the surgery was so short and the pain so minimal, but you should remember it is your vision at stake here, so be sure to get the right rest, fill and use your prescriptions if you have any, and if you are worried or suspect a problem get on the phone right away and call your doctor because waiting can mean vision loss, while responding quickly can mean taking care of a problem if there actually is one.

A lot of the recovery of vision is based on what happens after surgery as much as what happens during. So, make sure you have someone to drive you home after the surgery, as you will not be allowed to drive, and then make sure you do not have plans for several hours.rest your eyes, take a nap, and be sure to protect your eyes.

Most people can go back to work the next day, but if you sit in front of a computer all day, or do anything that may require strenuous activity, it may be best to not go back to work for two or three days in order to give your eyes time to heal.

You will be told not to rub your eyes, as this can cause trauma, and you will be asked to come back into their office every day for a few days after for checkups and to ensure the epithelium is healing the way it is supposed to. In addition to that, you may be asked to wear special contacts or glasses, and use special eye drops for a few weeks after just to help the eye heal properly.

If things go right, you should get 20/20 or better vision with PRK surgery. Some people only get 20/40 vision, but this is considered good enough to drive without glasses etc. in most states. Sometimes the extent of your irregularities are severe enough that you may still need to wear contact lenses and or glasses after the laser vision correction surgery, but your prescription will be lower.

There are some risks, and some people experience complications. For example, some people have trouble seeing at night, or may see glares, but the fact is, your vision should be better.