What is PRK? Is It Painful?

It may be hard to believe these days, when everything is "LASIK this" and "LASIK that," but PRK (photorefractive keratectomy) used to be the most common refractive surgery procedure.

Both are grouped under the umbrella "laser eye surgery," but each is a little different when it comes to advantages and disadvantages.

LASIK patients have less discomfort and obtain good vision more quickly (with PRK improvement is gradual and over a few days or even months), but many surgeons prefer PRK for patients with larger pupils or thin corneas. Dr. Drucker is one of these surgeons, and, in fact, is a PRK specialist.

PRK was invented in the early 1980s. The first FDA approval of a laser for PRK was in 1995, but the procedure was practiced in other countries for years. In fact, many Americans had the surgery done in Canada before it was available in the United States.

PRK is performed with an excimer laser, which uses a cool ultraviolet light beam to precisely remove ("ablate") very tiny bits of tissue from the surface of the cornea in order to reshape it. When you reshape the cornea in the right way, it works better to focus light into the eye and onto the retina, providing clearer vision than before.

Both nearsighted and farsighted people can benefit from PRK. With nearsighted people, the goal is to flatten the too-steep cornea; with farsighted people, a steeper cornea is desired. Also, excimer lasers can correct astigmatism by smoothing an irregular cornea into a more normal shape.

PRK is the process of lasering the front of the eye after removing the protective skin or epithelium that covers the eye and has many nerve endings.  It is not the PRK itself that is painful, but the denuded surface which is a large corneal abrasion which must heal.

Many things can be done to minimize discomfort such as topical medications (drops), contact lenses, systemic analgesics (pain pills) and cool compresses.  Usually the pain is relatively short in duration lasting just a few days, but sometimes it can be severe.

This is why LASIK is so popular because it is relatively pain free and accomplishes the same visual result.  Some people are better suited to PRK and in these cases, the discomfort is worth it.  We have had a number of patients who report only mild discomfort with PRK so it is variable.