Given the chance of corneal haze after PRK, is it better to have Lasik?

Question

PRK vs Lasik, what is the best treatment for the haze?

Mark Golden, MD · Answer

There are a variety of reasons to have PRK instead of LASIK.  In my practice we perform PRK on those with corneas too thin for safe LASIK and those who postoperatively are likely to receive blows to their eye putting them at significant risk for movement of their flap.  The US military performs more laser procedures than anyone other organization and the vast majority are PRK.  This is done because of the concern or flap movement in combat.  Patients of mine who box or are involved in serious basketball where it is likely that they will be hit in the eye receive my recommendation for PRK based on the safety of no flap.  Modern PRK may be better called Advanced Surface Ablation (ASA) has an extremely low incidence of haze with modern methods of surgery including the use of medicine at the time of surgery to prevent haze.  To further lower risk, we suggest that patients wear sunglasses for a year to limit UV exposure and take a gram of Vitamin C for a year as well.

Emil William Chynn, MD, FACS, MBA · Answer

i stopped doing PRK a decade ago, because of the pain, delayed recovery, and haze/scarring risk

	then i switched to LASIK, which eliminated these problems, but added risk of Keratoconus or KC

	you can't do LASIK on higher prescriptions safely, because your cornea would be too thin after

	so 5 years i joined the movement called Back To The Surface which is gaining steam among surgeons

	now i do an Advanced Surface Ablation, which is either a LASEK or an epiLASEK

	the recovery is quick, there is no pain, and there is also little to no risk of scarring

	the reason is by removing the epithelium in 1 piece, rather than grinding or scraping it off

	you don't crush millions of epithelial cells, which is what initiates the inflammatory cascade

	with an ASA, with Vit C, MMD, oral steroids, branded PredForte, and UV protection

	i am lasering a patient every week who is between -10.00 and -15.00, without any haze or scarring!

	so for high prescriptions, like myopia over -8, an ASA is safer than either PRK or LASIK

Anthony J. Kameen, MD (retired) · Answer

The first item of importance to convey is that, all things being equal, the long term outcome and quality of vision has been found to be the same with either PRK or Lasik. The discussion in this question is more surrounding short term issues and healing. There is no question that in the mid 1990's, when PRK(Photorefractive Keratectomy) was first approved by the FDA, we saw some issues with corneal haze during healing. Sometimes this haze lasted for months. In the early part of the last decade, most laser eye surgeons of merit switched to what is now called Advanced Surface Ablation, which is a much improved version of PRK with many additions to lessen pain during healing, speed healing and avoid corneal haze. As a result, there has been a resurgence of surface procedures as compared to Lasik. In my practice, I still perform about 85% Advanced Lasik and 15% Advanced Surface Ablation. The reason is the speed of recovery. If I know the patient will have a great outcome with either procedure, and there is no clinical reason to do one procedure over the other, I will lean more toward Lasik, because the recovery(vision and comfort) is faster. If I feel there is a clinical advantage to PRK(Advance Surface Ablation), then I will, obviously, recommend it.

Given the chance of corneal haze after PRK, is it better to have Lasik?

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Given the chance of corneal haze after PRK, is it better to have Lasik?

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