Photorefractive Keratectomy (PRK): Everything You Need to Know

An ophthalmologist performs photorefractive keratectomy (PRK) surgery to improve vision by altering the shape of your cornea. Lasers are used to fix refractive errors (the way your eye bends incoming light).

For patients who want to see better, PRK can serve as an effective alternative to LASIK or other procedures. Here's what you should know about PRK surgery.

What Is PRK Surgery?

PRK surgery is a form of laser eye surgery for patients who want to reduce their reliance on eyeglasses or contacts. It is typically an outpatient procedure that's scheduled in advance.

Contraindications

Patients with advanced glaucoma, cataracts that impact vision, and a history of certain eye infections are not good candidates for PRK surgery. Proper healing is essential to the success of PRK surgery, so individuals with uncontrolled diabetes, a history of excessive scarring, or diseases that impair healing should not get PRK surgery.

If the refractive error in your eye is unstable or changing, your healthcare provider may recommend a different type of vision surgery. Pregnant and nursing women should hold off on elective eye surgery to avoid unnecessary risks.

Potential Risks

PRK surgery offers numerous advantages. However, here are some of the risks associated with the procedure:

• Corneal haze: If your eye doesn't heal properly after PRK surgery, your vision may seem cloudy. Corneal haze usually gets better with time. Use of the medication, mitomycin C, during surgery can help prevent this issue.
• Glare: You may notice a halo effect around images or scattering light. Glare is usually a temporary symptom that should dissipate after a week or so.
• Reduced vision potential: You may be able to achieve better vision with glasses than with PKR surgery. Once you have the surgery, it's possible that your clearest possible vision will be diminished.
• Regression of results: Patients with astigmatism and significant farsightedness may lose some of the benefits initially gained after surgery.

As with any surgery, PRK surgery poses the risk of infection. Your healthcare provider will review signs to watch out for to ensure proper healing and safe recovery. You'll also be provided with antibiotic eye drops to help prevent infection after surgery.

Purpose of PRK Surgery

PRK surgery reshapes the cornea with lasers to correct sub-optimal vision. People who are tired of relying on glasses or contacts to see may consider PRK or other types of laser eye surgery.

PRK surgery is ideal for patients with a thin, scarred, or irregularly-shaped cornea that prevents them from being a good candidate for LASIK. Those with astigmatism or poor depth perception may benefit from PRK surgery.

Before deciding if PRK surgery is right for you, an ophthalmologist will test your vision and evaluate your eyes' level of refractive error. You'll be screened for other eye conditions that could be exacerbated by PRK surgery.

They'll measure the size of your pupil and advise you on the best course of action after examining the thickness and surface qualities of your cornea.

Lifestyle also plays a role in determining which eye surgery is best for you. If you have a job or hobbies that could cause an impact on your eye (such as mixed martial arts) you might be better off with PRK surgery instead of LASIK. LASIK creates an eye flap that can potentially open up with vigorous movement.

How to Prepare

Here are some things to keep in mind in the weeks leading up to your PRK surgery.

Location

PRK surgery is typically performed at an outpatient surgery center. It is a short procedure that should entail a visit of under two hours. You will not be able to drive after the procedure, so you may want to arrange for someone to bring you and wait at the center to bring you home.

What to Wear

Do not use any eye makeup on the day of surgery. Avoid any hair accessories that will make it difficult to arrange your position under the laser. You can wear comfortable clothing to your surgery appointment.

Food and Drink

Eat a light meal on the day of your procedure. You will not need to fast as it does not involve general anesthesia.

Medications

Some medications impact the eyes, so you'll need to talk to your healthcare provider about what to avoid before and after surgery.

Pre-Op Lifestyle Changes

Remove your contact lenses at least 24 hours before your surgery. Depending on the type of lens, you may have to remove them as much as three weeks before surgery, so be sure you understand what is required in your case.

What to Expect on the Day of Surgery

Here's how you can expect PRK surgery to play out on the day of your operation.

Before the Surgery

Once you arrive at the surgery center, you'll have a pre-op eye exam and meet with the medical team for any last-minute questions.

During the Procedure

If you're anxious about PRK surgery, you might be relieved to find out that it usually takes no more than 15 minutes from start to finish. The laser will be on your eye for just 30 to 60 seconds.

The surgeon begins by placing topical eye drop anesthesia to completely numb your cornea. An eyelid holder will help stop you from blinking.

Then, the center of the cornea's thin outer layer is removed and an excimer laser works to reshape the cornea. To finish up, the surgeon places a contact lens over the cornea to protect the eye as it heals.

Some surgeons use a special brush, blade, or alcohol solution to remove the cornea cells. Talk to your healthcare provider to find out the details of how your PRK surgery will be performed.

After the Surgery

Before you're discharged, the surgeon will put antibiotic and anti-inflammatory eye drops in your eye, which you'll continue to use at home for a specified time. Since you won't be able to see clearly for a few days after surgery, you'll need someone to drive you home and stay with you during the initial phase of recovery.

Recovery

Recovery from PRK surgery takes longer than LASIK, but most patients can drive and return to work within one to three weeks after the procedure. Avoid exercise for the first three days after surgery, and wait to resume contact sports for two to four weeks. Try to keep water out of your eyes by avoiding hot tubs or swimming for two weeks.

Your surgeon will schedule a series of follow-up appointments to monitor your healing process. After five to six days, the bandage contact lens will be removed at the surgeon's office. If it falls out accidentally before that time, do not reinsert it. Instead, gently tape your eye closed and call the surgeon.

It will be a month before you'll experience the full scope of visual improvements from PRK surgery.

Healing

It's normal to experience some eye irritation and watering in the days following PRK surgery. The cells on the surface of your cornea will take time to grow back.

Coping With Recovery

Light sensitivity is common in almost all PRK patients during the first few days after surgery. Wearing sunglasses and keeping your lights dim at home will make it easier to cope until your eyes have a chance to adjust. Avoid smoky, dry, or dusty environments to reduce discomfort after PRK surgery.

Keep make-up, lotions, cologne, aftershave, and cream away from your face for the first seven days after PRK surgery to prevent irritation. Keeping your eyes closed while showering will help prevent water from getting in your eyes.

Immediately after surgery, you shouldn't feel any pain because your eye will still be numb from the effects of the anesthetic eye drops used during the procedure. Your surgeon will provide you with pain management options for the first week at home.

If you're still in pain after about five days, contact your surgeon to determine if there is anything to be concerned about and for advice on pain management going forward.

Possible Future Surgeries

The outcome of PRK surgery can vary from person to person depending on how their body heals after the procedure. It's possible that additional surgery will be required to achieve optimal results.

Almost all patients achieve 20/40 vision or better after PRK surgery. Even if you still need to wear glasses on occasion, your prescription should be much less than before surgery.