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What is Photorefractive Keratectomy (PRK)?

With PRK the cornea is sculpted with an Excimer laser. The thin skin that covers the cornea must first be removed. The laser is then applied. Over the next 3-4 days, the skin (epithelium) grows back over the cornea. PRK is a simpler procedure than LASIK. PRK has a longer visual recovery than LASIK because the vision will not be fully improved until the epithelium has completely healed and become smooth again. There is also more discomfort with PRK as the nerves in the cornea are exposed when the thin skin is removed. Because PRK is a simpler procedure there is less potential for some complications that can happen with a LASIK flap (see below). Because nerves are not cut, there is less chance for dry eye problems after the procedure.

How do lasers used in PRK treat Refractive Error?

To improve vision the focusing problems of the eye need to be corrected. Laser technology is used to reshape the cornea. By making the cornea more flat or more curved, the light rays are bent differently and focusing can be improved. The Excimer (excited-dimer) laser uses light energy to break chemical bonds in the cornea. The ultraviolet light energy (wavelength of 193 nm) comes from an Argon-Fluoride laser, which produces very short pulses of energy (10 nanoseconds). These pulses of light energy actually dissolve or ablate the collagen fibers. By using a computer to guide the location of each laser application into a complex pattern of overlapping spots, the shape of the cornea is sculpted to a new and improved shape, resulting in better focus and clearer vision.

What are the risks associated with PRK?

LASIK and PRK are very safe procedures with a track record of success over 15 years. Treatments and technology improve each year, bringing the opportunity to achieve better vision with minimal risk. However, each person responds differently to surgeries, and any surgical procedure can have risks involved. Some of the main risks include…

Following LASIK surgery some patients will be aware of increased glare or halos at night. This tends to occur in patients with night vision symptoms before the surgery, in patients with a larger correction, and patients with larger pupils. The glare is related to light rays coming into the eye from the edges of the cornea where the normal cornea meets with the ablated cornea.

Because the nerves are damaged with the flap creation and corneal ablation it is common to have some dry eye symptoms for up to 3 months after the procedure. If you have a dry eye problem before surgery, LASIK may not be the best option and PRK or ICL should be considered. You will likely need to use artificial tears during the day until your corneal nerves recover.

Because the protective surface of the eye is removed with either PRK or LASIK there is a chance that bacteria get into the cornea and cause an infection. Antibiotic eye drops are used to prevent an infection, but even with this protection, rare infections can develop. The risk of an infection is less than 1 in 1,000.

LASIK and PRK make the cornea thinner, which in some people can weaken the structure of the cornea. If the cornea becomes weak it can change shape, leading to worsening vision. Pre-operative testing and good decision-making can usually help prevent this complication.

The cornea is amazing clear tissue. An injury to the cornea can lead to scar tissue formation, which causes the cornea to become cloudy in the area of the scar. PRK is a very mild trauma to the eye and therefore some people develop a slight haze to the cornea. In most cases, this does not have a significant impact on the quality of the vision, but if haze is extensive it may make your vision less clear. Severe scarring would be unusual. In the case of severe scarring, a corneal transplant surgery may be necessary.

Your eye is a living organ. Very precise measurements need to be made and then appropriate treatments applied to achieve the best possible vision. In some cases, it is difficult to get accurate measurements and different people can respond differently to the treatments. Because of this, some treatments will lead to over-correction or under-correction, meaning that the vision does not turn out to be 20/20 after the procedure. If this occurs an enhancement procedure can be completed. Usually, the eye is allowed to heal for at least 3 months before an enhancement is initiated. You may need to wear glasses or contact lenses for a few months during this time.

Choosing Bilateral Surgery

You have the choice to do PRK/LASIK in both eyes on the same day, or separate the two surgeries into two different days. The safest option is to do the eyes on two different days. This allows Dr. DeBry the opportunity to assess the outcome of the first surgery before the second procedure. Based on the first procedure, small adjustments in laser power can be made prior to the second eye being done. However, many people have scheduling constraints with work or family responsibilities that make it difficult to take extra days off to do the surgeries on different days. If you choose to have the surgeries done on the same day we will have you sign an extra consent form acknowledging this choice. The risk of a severe bilateral problem such as an infection is very rare. Plan on your vision being blurry for the first day or two while the eye is healing from the procedure. We recommend you don’t plan any important meetings or travel for at least a few days after the procedure to allow your vision time to improve.

Are there any restrictions after the procedure?

The most important thing to avoid after the procedure is rubbing your eyes. This can displace the flap if you had LASIK or the bandage contact lens if you had PRK. Otherwise, there are very few restrictions. You can bathe and shower like normal, just avoid getting soap and water in your eyes. It would be a good idea to avoid visually demanding tasks for a few days after the procedure. You should stay out of the swimming pool or hot tub for a few weeks after the procedure.

What if I need an enhancement?

LASIK and PRK change the shape of the cornea, but there can be regression over time. Also, some people don’t achieve perfect results after the first treatment and a second treatment needs to be applied. Some people require an enhancement procedure years after LASIK/PRK. Our policy is that enhancements are included with the original surgery fee for the first year. If an enhancement is needed years later there will be a new fee for those services.

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