What is PRK? Is It Painful?

Think of PRK as 'Flap-less LASIK'. Both procedures are identical when it comes to correcting your eyeglass prescription, the only difference is that with LASIK a corneal flap is cut first (with a different machine) and in PRK the surface corneal epithelial cells (thin outer covering of the cornea) are removed first. PRK is often referred to as Surface Ablation because the laser treatment is performed closer to the corneal surface whereas in LASIK, because a flap is cut first , the laser treatment occurs much deeper in the cornea. PRK and other surface ablation procedures (LASEK, epi-LASIK) typically involve a little more post-operative discomfort when compared to LASIK. In my practice the average pain score on the first night and first day after PRK is between 0 and 1 on a pain scale from 0 (no pain) to 5 (worst pain of your life). With modern surgical techniques and medicines the pain after PRK is much much less than it used to be.

PRK means photorefracitve keratectomy.  It is laser eye surgery that corrects vision by reshaping the cornea, very similar to LASIK. 

 

It has been performed in the US for about 15 years with greater than 95% success at eliminating the need for glasses or contact lenses completely and higher for substantially reducing the need for glasses or contact lenses.  The procedure does not require creating a flap in the cornea like LASIK and because most LASIK complications are related to the flap, PRK is very safe.

 

The difference between PRK and LASIK is that during PRK instead of creating a flap the outermost layer of the cornea is simply removed and then the laser is applied to correct the vision. During the healing process this layer of the cornea regenerates and heals. There is some discomfort during the recovery phase (approximately one week), although is becomes progressively less over that period of time.  The initial discomfort has been compared to the feeling after having a contact lens in the eye for too long.

PRK stands for Photo Refractive Keratectomy and has been an FDA approved procedure for laser vision correction since the early 1990’s.  An excimer laser is used to reshape the cornea after removing the cornea’s outermost layer, called the epithelium which then heals over in subsequent days to weeks.  The post operative pain can usually be successfully managed with drops, pain medications and a bandage contact lens.

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.