PRK Eye Surgery: What To Know

PRK eye surgery is a type of laser-assisted eye surgery designed for people aiming to correct visual refractive abnormalities, such as myopia (nearsightedness), hyperopia (farsightedness) and astigmatism (a refractive error that causes blurred vision).

The surgery involves the removal of your cornea’s outer layer of cells (known as the epithelium) with a special device, such as a blade or alcohol solution. The exposed cornea is then reshaped using a laser instrument programmed with your eye measurements. This procedure is meant to improve vision by correcting the manner that light rays focus on the retina.

PRK eye surgery is ideal for people with astigmatism, hyperopia or myopia. Clear vision requires the correction of refractive errors that cause your eyes to refract (or bend) light improperly. An integral part of PRK is rectifying those refractive errors with a laser instrument.

Unlike laser in situ keratomileusis (LASIK) eye surgery, PRK doesn’t require flap formation to reshape the cornea. The surgery may appeal to people with a great risk of flap dislocation. This is one of the many reasons why eye surgeons may recommend PRK over LASIK. Another reason is that PRK compensates for LASIK’s lack of ability to help with thin, flat or steep corneas among other complications.

PRK may not fully correct presbyopia. However, you could opt for PRK to get monovision, which leaves one eye slightly nearsighted so that you can see clearly for reading or other close vision tasks and adjusts the other for distance vision. Monovision is not a desirable correction for everyone, so it’s important to talk to your eye doctor about this particular choice.

New York City-based ophthalmologist Yuna Rapoport, M.D., and Washington D.C.-based board-certified eye surgeon Michael Brusco, M.D., explain the procedure below:

Pre-Surgical Process

First, your ophthalmologist will call you in for a thorough examination to ensure that you’re a candidate for PRK. “You need to [refrain from wearing] contact lenses for three to seven days (depending on prescription),” says Dr. Rapoport. Failure to do so can lead to inaccurate eye measurements, as some contact lenses have a reshaping effect on the cornea. “Imaging and a lot of measurements will be performed.”

The examination process includes:

• Testing your vision for refractive errors and abnormalities
• Assessing other eye health issues that could jeopardize a successful outcome
• Measuring your cornea and pupil size

Additionally, you and your ophthalmologist will likely sit down to discuss realistic expectations regarding the surgery and your vision needs as it relates to lifestyle. Ophthalmologists consider the latter when recommending treatment options.

During the Surgery

“You will receive an oral relaxing tablet—like Ativan or Xanax—so you will be completely relaxed,” says Dr. Rapoport. “[After] your eye is numbed with topical numbing drops, the epithelium is then removed and the laser changes the shape of the cornea.” During the laser portion of the surgery, you’re expected to stare at the target light to avoid eye movement.

Following extraction, the ophthalmologist typically covers the cornea with a bandage contact lens to minimize pain. “The entire process takes about 15 minutes total,” says Dr. Rapoport.

After the Surgery

“After the PRK procedure, you’ll be guided to a room where you will rest your eyes for a few minutes before the doctor looks over your eyes once again before you’re discharged,” says Dr. Brusco.

Once you’re discharged, the ophthalmologist will send you home with the “bandage” contact lens over your eye. This is meant to accelerate healing during your recovery period. You should also plan to have someone pick you up after the surgery.

Recovery is the perfect time to get plenty of rest and maybe take a few sick days from work. For the first week, you’ll also want to refrain from strenuous activity to avoid delaying the healing process. According to Dr. Rapoport, individuals may experience itchiness and discomfort for the first two days. “[You can remedy the side effects] with numbing drops, a bandage contact lens and oral pain medication,” she says.

In terms of follow-up appointments, Dr. Rapoport says “you’ll be seen about a week after, during which [your ophthalmologist will remove] the bandage contact lenses. [From there], you’ll be seen for regular eye visits.” Sun exposure can cause further vision problems after surgery due to possible corneal scarring. Thus, your ophthalmologist will likely suggest wearing outdoor sunglasses for a recommended length of time.

Considering that the desired outcome of PRK eye surgery is successful vision correction, the procedure can benefit people who prefer to avoid wearing eyeglasses or contact lenses daily.

“[The main] risks include topical infection and topical inflammation,” says Dr. Rapoport. “The procedure doesn’t [require going] inside the eye, so there is no risk of glaucoma or retinal detachments.” Surgical completion may also result in the following side effects:

• Corneal infection or scarring
• Cloudy vision (known as corneal haze)
• Glared night vision that causes you to see halos around lights

If you’re affected by any of the above side effects, reach out to your ophthalmologist.

It’s important to note that PRK eye surgery doesn’t always lead to successful outcomes. The surgery can result in under-corrected or overcorrected vision, which may require you to continue wearing eyeglasses or contact lenses post-surgery. Blindness is another potential worst-case scenario of this procedure. However, both are rare occurrences.

The right candidates for PRK eye surgery are those who meet the following requirements:

• Candidate should be 18 or older (preferably over the age of 21)
• Has a stable glasses prescription for at minimum one year
• Must have refractive errors that can be corrected with PRK
• Possesses healthy corneas and generally good eye health

If you’re currently pregnant or nursing, or you struggle with abnormalities like advanced glaucoma, corneal disease or unstable refractive errors, PRK eye surgery won’t be a fit for you. Consult with an ophthalmologist to confirm whether or not you’re a qualified candidate for the procedure.

“It is important to go to a specialist who only performs vision correction surgeries exclusively and routinely, and who offers all six forms of modern vision correction procedures to avoid getting a procedure that isn’t best for their eyes,” says Dr. Brusco.