Doctor using the laser during laser eye surgery

PRK/LASEK

Laser eye surgery on the surface of the eye

PRK/LASEK procedures remove a thin cell layer from the top of the eye so the laser can reshape the underlying cornea. This surgery may be an option for those who are not eligible for LASIK or those who look for the most economic option for refractive laser surgery.

  • What is PRK/LASEK?

    PRK/LASEK

    Surgery on the eye’s surface

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    See how PRK treats refractive errors

    PRK, Photorefractive keratectomy, was the first laser eye surgery method, beginning in the late 1980s. Thousands of patients were treated with PRK before the invention of LASIK. PRK/LASEK procedures continue to be an option for people with mild nearsightedness (myopia), farsightedness (hyperopia), astigmatism as well as those who have other eye conditions.

    Some people choose PRK/LASEK over LASIK, despite the longer recovery period and discomfort after surgery, to avoid the flap. PRK/LASEK procedures also tend to be the most economic option for refractive laser surgery.

    PRK is often thought to be synonymous with LASEK, but they slightly differ in the first step. Both surgeries remove the outer top layer of cells (epithelium) on the eye with an alcohol solution to expose the sub-layer of the cornea to the laser. In PRK, this layer is completely removed. In LASEK, it is pushed to the side and put back on the eye after surgery.

    When the eye is exposed, a laser reshapes the front of the eye so that light passing through is focused properly onto the back of the eye. Finally, a protective bandage lens is placed over the eye until the epithelium grows back, usually within a few days. Full vision recovery takes approximately one month or longer and is longer than alternative Laser Vision Correction methods.

    Characteristics

    Epithelium removal: An alcohol solution will loosen the thin, outer layer of the eye.

    Surface reshaping: A pre-programmed laser removes corneal tissue to correct the refractive error.

    Long visual recovery: After surgery, the doctor will apply a bandage contact lens to assist the healing process, which is typically removed within a week. Vision may take a month or more to stabilize.

    Benefits

    Increased eligibility: This procedure can also be suitable for thinner corneas. PRK/LASEK only removes the very top outer layer of the eye leaving the maximum amount possible of remaining tissue for the laser to shape.

    No flap complications: Possibilities of flap-related complications during and after surgery are eliminated with PRK/LASEK: There is no risk of flap displacement.

    Potential Side Effects

    Like all surgical procedures, no intervention is completely free of risks and side effects. Your ophthalmologist can explain potential risks to you and will decide whether you are eligible for surgery.

    Haze is one of the side effects that can occur after surgery: Since the PRK/LASEK technique is characterized by the application of the laser on the surface, haze or scarring is one of the more significant complications. Haze appears like a slight milky quality of the patient’s cornea. Normally, this haze is not permanent and can be treated with eye drops.

    Further possible complications and side effects of PRK/LASEK and alternative types of Laser Vision Correction are explained on the page that lists potential risks.

     

  • Treatment Steps

    PRK

    Determine if PRK is right for you

    Talk to your eye doctor about laser eye surgery as well as other solutions for your vision problem. Your doctor will decide if you are a good candidate for PRK after completing several diagnostic tests. Together, you and your doctor can determine the best option to suit your needs.

    Preparing For Surgery

    Before and on the day of surgery

    Patients are usually directed by their doctor to:

    • Stop wearing hard contact lenses for at least four weeks and soft lenses for two weeks before surgery, because they may interfere with preoperative diagnostic tests.
    • Wear no make-up, perfume or lotion the day before the procedure. These products may leave debris around the eye and eyelashes, which increases the chance of infection. 
    • Arrange for alternative transportation after the surgery and possibly also for the next few days.
       

    Surgery

    What are the treatment steps of PRK/LASEK?

    Woman on surgical bed for PRK/LASEK

    Numbing the Eye

    To reduce pain during the surgery, anaesthesia drops are used to numb the eye. An eyelid holder is used to prevent the eye from blinking during surgery.

    The epithelium dissolved with an alcohol solution

    Dissolving the Epithelium

    The doctor will administer a few drops of an alcohol solution to dissolve the epithelium.

    The epithelium is removed

    Removing the Epithelium

    The epithelium is removed with a special instrument. In PRK, this layer will be completely removed. In LASEK, this layer is moved to the side and put back in place after surgery.

    Excimer laser sculpts corneal tissue

    Reshaping the Cornea

    A laser will sculpt the corneal tissue based on the eye structure. The new shape of the cornea will correct how light travels through the cornea to enable sharp vision.

    Excimer laser sculpts corneal tissue

    Bandage Contact Lens

    A few drops of a soothing and rinsing fluid are put on top of the cornea after the laser intervention. After the surgery, the doctor will insert a bandage contact lens to support healing and comfort.

    After Surgery

    Long visual recovery, minimal discomfort

    After surgery, it is recommended to:

    • Use eye drops for some days following the surgery to help prevent infection and alleviate dryness
    • Avoid strenuous contact sports for at least one week
    • Not rub the operated eye, rest and to not overexert yourself
    • Wear a patch while sleeping for a week to avoid further irritation
    • Refrain from working during the first week

    The eye might sometimes feel uncomfortable, gritty and itchy after surgery. It normally takes the eye 4 to 5 days to grow back a new layer of cells. After that, your doctor will remove the bandage contact lens. Vision takes about a month to stabilize. Doctors typically require a check-up one day and 4-5 days after surgery. Afterwards, doctors usually require a one month follow-up exam. 

     

  • Questions & Answers

    Frequently Asked Questions about PRK/LASEK

    • What is the difference between LASEK and LASIK?

      There are two big differences between these types of laser eye surgeries. The first is the method to expose the inner layers of the cornea. In LASEK, the doctor applies an alcohol solution to loosen the epithelium, which is temporarily pushed aside. When the doctor applies the laser to ablate tissue during LASEK, this is done at the exposed top-surface level of the cornea.

      In LASIK, a flap is cut with a mechanical device or a laser, folded back for surgery, and then repositioned when surgery is complete. The layer of corneal tissue ablated in LASIK occurs in the stroma, a sublayer of the cornea.

      The second difference is the recovery time and patient experience. LASIK patients typically have a much shorter healing period with less discomfort.

    • I have thin corneas. Does this mean I should get PRK over SMILE or LASIK?

      This depends. The surgery most suitable for you also depends on your prescription and other pre-existing conditions – such as dry eye syndrome. If you are ineligible for LASIK, a possible solution for you could be PRK/LASEK or SMILE. These procedures might be alternatives for those with thin corneas or more severe cases of myopia. Candidates also include those who may be at a high risk for flap complications (e.g. certain jobs, sports and hobbies that are strenuous or involve contact). Consult with your eye doctor to learn which laser eye surgery procedure they believe will be best for your individual case.