David Malitz, MD

Assuming a successful outcome, both have virtually identical results.  PRK has no flap related complications and does not weaken the cornea as much as LASIK.  PRK has a longer healing process.  I prefer PRK as I believe it is safer.  With LASIK, the flap never completely heals and even years later can be displaced.  With that said, complications with either procedure are rare and you should be very happy with either procedure.   Other options are just treating one eye and leaving the other for near vision when you become presbyopic.  You are a little young to consider this option but if you can tolerate just your left contact lens, you may be a good candidate to see intermediate and far for many years!  Other benefits of treating just one eye are decreased risk and cost!

All lasers have approval ranges.  All lasers can treat -4.00 effectively.  The next issue is choosing the doctor and center.  An experienced surgeon and staff will optimize your chance of a successful outcome.  The best outcome begins with an accurate determination of your prescription.  Although you state that your prescription is -4.00, it is very unlikely that it is this prescription in both eyes and may actually be -3.87 or -4.08 or a range around -4.00.  A traditional refraction will only determine your prescription to the 1/4 diopter step.  Wavefront refractors generally determine your prescription to the hundredth of a diopter (i.e. 4.03 vs 4.00).   So this is an issue of accuracy and precision.   Practically there is minimal difference but if you are having surgery, you will want to have the exact prescription with an adjustment for the characteristics of the laser that is being used called a nomogram.   At our center we do hundreds of measurements of your eyes and place data in a spreadsheet that I designed to arrive at a prescription that best reflects your actual prescription.  Hopefully the center you select uses a similar methodology and has a track record of success.   With an increased emphasis on the rare negative outcomes of LASIK, it is imperative that patients, doctors and industry take measures to drive negative outcomes as close to zero as possible.  Wish you well with this incredible, life changing procedure!

Only your doctor can determine if you are a candidate for any vision correction procedure, but certainly by your prescription, you would appear to be an ideal candidate for vision correction.   There are multiple procedures for vision correction especially for myopia (nearsightedness).  LASIK is the most popular but RK (generally abandoned for better procedures), Intacs (again, largely abandoned for myopia but still used for Keratoconus by some doctors), PRK, LASIK , implantable contact lenses and a clear lens exchange are options.   For low myopia in younger people, I prefer PRK.  PRK, like LASIK, uses the Excimer laser to reshape the cornea.  Unlike LASIK there is no flap created, therefore there is no possibility of flap related complications such as a displaced flap or inflammation or infection associated with the flap.  Another feared complication of LASIK is ectasia or warpage of the cornea.  This condition is exceedingly rare with modern LASIK and even more rare with PRK.  The downside with PRK is slower healing and more discomfort.  With that said, LASIK is an excellent and safe procedure that results in excellent vision in virtually every patient we have treated!  The patient satisfaction with both procedures nearly 100%.  Naturally, as with every medical procedure, there are risks.  Be sure that you are comfortable with the risks in order to make an informed decision.  Most people are unaware that even contact lenses have risks and lead to infections and loss of vision.  Many doctors suggest and I agree that LASIK is actually safer than long term contact lens wear.

The majority of patients in my hands with your prescription see 20/20 or better with either PRK or LASIK!  Pick an experienced doctor or be willing to travel to find one and you are likely to be exceedingly happy with your life changing procedure! 

Your problem is indeed a "broken blood vessel".  It is generally caused by coughing, sneezing or straining.  The blood vessels in the eye are fragile and visible.  If one breaks the blood will leak under the surface layer and be visible in the mirror or to others.   With LASIK the suction ring will often break small vessels and create a sub conjunctival hemorrhage.  The condition is almost always without concern and weeks later it is either unrelated to LASIK or just discovered as it was under your eyelid.  Issues for concern after LASIK are pain or decreased vision.  Either can indicate a serious issue and you should return to your doctors office ASAP for either.

Naturally, a complete exam is necessary before giving you an absolute direction for your personal situation.  Depending on your age, a clear lens exchange or an implantable contact lens is likely your best option.  A clear lens exchange can correct from -25 to +25 with 6 diopters of regular astigmatism.  Procedures can be combined (often called "bioptics").   Only with a through exam, can your best option be determined.  Many centersoffer FREE screening exams to guide you in the best personalized options.