PRK Laser Eye Surgery: What You Need to Know

Pros

• There’s a high success rate with PRK. The majority of RealSelf members say it’s “Worth It,” and studies show that approximately 90% of PRK patients have 20/20 vision one year after surgery, while over 95% have 20/40 or better without glasses or contacts, according to the Cleveland Clinic.  
• It’s fast—even faster than LASIK. Dr. Katzman said it takes less than five minutes per eye. 
• Results are long-lasting. One PRK treatment may be all you need for your lifetime, depending on how old you are at your first treatment. Some people need a follow-up “enhancement” procedure, but oftentimes it’s needed in only one of the eyes.  
• It’s an effective option for people with thin corneas who aren't good candidates for LASIK or other refractive surgery.
• Unlike LASIK, there’s no risk of corneal flap complications (because there is no flap).

Cons

• The recovery time is slow. Your vision will likely be blurry for the first week or longer—and not perfectly clear until healing is complete, one to two months later.  
• It’s not painful while the procedure is being performed, but it can be for a few days afterward. “At most times, it feels like you have an eyelash or a grain of sand in your eye. At more severe times, it feels like a burning pain or a deep eyeball discomfort,” says RealSelf member wefeelyourpresence. 
• There is a risk of infection because the outer surface of the cornea is removed. It’s exposed and vulnerable for at least the first week. 
• The most common risks are hazing and scarring of the cornea. The higher your prescription, the higher the risk of scarring with PRK.  
• If you have delayed healing (which can be caused by various medical conditions, including severe dry eye), you may experience more complications.
• The FDA suggests that the ideal PRK candidate is at least 18 years old, but many doctors on RealSelf suggest waiting a few years longer, to ensure that your prescription is stable. Otherwise, you run the risk of needing an additional surgery in the future.

• Average Cost:
• $3,475

• Range:
• $2,305 - $5,900

Some experts say PRK is cheaper because unlike LASIK, it doesn’t involve the additional step of creating a corneal flap, but there are more follow-up visits needed, so the total cost is very similar. Your surgeon’s experience level and practice location also factor into the final price. 

Refractive eye surgery is typically considered elective, not a medical necessity, so it’s usually not covered by insurance. However, if you need vision repair due to an injury or can’t physically wear glasses or contact lenses (such as an allergy or impairment), your plan may cover the procedure.

PRK surgery was FDA-approved in 1995, a few years before LASIK eye surgery came into existence. However, LASIK quickly became the more popular of the two refractive surgery options. The main difference between the two? During LASIK, the surgeon cuts a flap in the cornea before treating the underlying tissue with the laser. With PRK, the surgeon removes the thin outer layer of the cornea, called the epithelium, before addressing the corneal tissue with the laser. PRK is easier to tolerate, less painful than LASIK, and delivers very similar results to LASIK, but PRK recovery time is a lot longer, so it’s not as popular. 

Experts say PRK is a good option for those who aren’t good candidates for a LASIK procedure, which requires a certain level of corneal thickness. If you have thin corneas, you’re likely a better candidate for PRK. Unlike LASIK, this procedure doesn’t involve cutting a flap into the cornea, so the same-strength treatment (your glasses prescription) doesn’t impact the corneal architecture the same way. PRK technically leaves your anatomy more “intact” than LASIK does. 

Dr. Lee Katzman, an ophthalmologist in San Diego, says PRK is also a better choice for someone with a job that involves regular physical contact with the face or eye area because there’s no risk of the corneal cap becoming dislodged, like there is with a LASIK flap.

Your procedure will start with numbing eye drops and an oral sedative if you’re especially anxious. Your surgeon will then remove your epithelium, the outermost layer of your cornea. “It sounds scary, but it’s actually not painful at all,” says Dr. Katzman. Most commonly, it’s done by swiping the surface of the eyes with an alcohol-based solution. 

The next step in PRK surgery is identical to the second part of a LASIK procedure: The surgeon uses an excimer laser to reshape your cornea. “The patient looks straight ahead, and the laser will fire for less than 10 to 20 seconds,” says Dr. Katzman. 

After that, a chemical called mitomycin C is placed onto the corneal tissue for 10–20 seconds, followed by a sterile water flush to remove it from your eye. A temporary “bandage” contact lens is then placed onto the eye, to help heal the surface, and you’re given eye drops.

Someone will have to take you home from the appointment, and you won’t be able to drive for at least one week, possibly two. You can expect some eye pain and discomfort for the first two or three days. Some eye doctors even prescribe prescription pain medication for that period. 

At a one-week follow-up appointment, your doctor will remove the bandage contact lens. “At this point, your vision will likely be legal to drive by DMV standards, but you may need a few more days to recover, especially if you plan to drive at night,” says Dr. Katzman. 

RealSelf members also report the common side effects of dry eye, tearing, and irritation post-procedure. “The dryness can be effectively controlled, in most cases, by using preservative-free artificial tears,” says Dr. Katzman.  

Hazy vision is another common complaint, but new technology in lasers and medications has made it less of an issue in recent years. “Most surgeons now use a drug called mitomycin, which reduces the chance of haze substantially,” says Dr. Mark Golden, an ophthalmologist in Chicago.

RealSelf Tip: If you're over age 40, it's possible that you'll still need glasses to manage presbyopia (difficulty focusing on nearby objects) after PRK surgery--unless your eye surgeon uses a PRK technique called monovision. This corrects the nondominant eye for reading distances and the dominant eye for distance. This may not completely reverse presbyopia, but it will reduce your dependence on glasses when you're reading or using a computer.

“It is an amazing feeling to wake up and be able to read a clock!”—FutureMrs, RealSelf member

• Immediately following surgery, it’s advised that you go directly home and rest. Keep your eyes closed, and avoid fans or vents blowing air (it can dry out your eyes). 
• Post-procedure anesthetic eye drops can soothe painful eyes, but using them too often can actually slow down the healing process. Use them sparingly.
• Don’t rub or touch your eyes from cheekbone to browbone for one week post-procedure.
• Don’t use any eye makeup or eye creams for the first week post-procedure. 
• Avoid exercise for at least one week—you don’t want to get sweat in your eyes—and skip contact sports for one month, to avoid getting hit in the eyes. 
• While you can shower the day after your PRK procedure, you’ll need to avoid swimming or getting into hot tubs for two weeks.
• Additionally, avoid any environment with lots of dust or dirt blowing (including gardening) for two weeks.
• You’ll have to wait until your doctor gives you the green light to drive again. 
• If you have scabbing or crusting on the eye or lashes, ask your doctor if you can clean them carefully off with a cotton swab soaked in warm water. 
• You’ll have to wear an eye shield for sleeping (your doctor will provide) and sunglasses to help avoid sensitivity to light. It’s recommended to wear both for about three days post-procedure.

RealSelf Tip: If you wear contact lenses, you’ll have to stop wearing them prior to your procedure. If they’re gas-permeable lenses, your surgeon may have you stay out of them for one to three months, depending on how long you have been wearing them; stop wearing all other types three days before your surgery.

With every passing week after your procedure, your vision should get clearer. “After one week, the tissue is mostly regrown, but there is often a small central area that is not completely intact. This can make vision worse after one week than it was in the previous days,” says Dr. Jay Bansal, an ophthalmologist in San Francisco, in a RealSelf Q&A. 

By one month, you should have the majority of your vision back, and it’ll get even better by the second month. “At one month, most of my patients are happy and have 90% of their vision correction potential; the additional 10% will happen by month two,” says Dr. Katzman.

Your results should be long-lasting, but as you age and your vision changes, you may need an enhancement procedure.