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If you have dry eyes or thin corneas and want to have refractive surgery, PRK may be a good choice for you. This is because some other types of refractive surgery, such as LASIK, are not recommended if you have these conditions.

Also, if you have a very active lifestyle or job, PRK may be a better option for you than LASIK or similar procedures. This is because PRK does not involve cutting a flap in your cornea like LASIK and similar surgeries do. If you are highly active, you could accidentally dislodge a corneal flap, causing problems.

Some people who have certain lenses put in their eyes during cataract surgery may have PRK to fine-tune their vision.

To have PRK, you need to meet certain requirements:

• You should be 18 years or older (ideally, over 21 years old, when vision is more likely to have stopped changing).
• Your eye prescription should not have changed in the last year.
• Your refractive error must be one that can be treated with PRK.
• Your corneas need to be healthy, and your overall eye health must be generally good.
• You need to have realistic expectations about what PRK can and cannot do for you.

Some people are not candidates for PRK. They include people with:

• An unstable (changing) refractive error
• Skin or other disease that can affect healing
• A history of a lot of scarring
• Corneal scars or disease
• Advanced glaucoma
• A cataract affecting vision
• Uncontrolled diabetes
• Pregnant or nursing women
• History of certain eye infections

Your ophthalmologist can talk with you about other conditions that may keep you from having PRK.

To determine whether you are a candidate for PRK, your ophthalmologist will examine your eyes. Here’s what will be done:

• The overall health of your eyes will be checked.
• Measurements of your cornea will be taken.
• Your refractive error will be measured.

Surface ablation may be preferable to LASIK in patients with epithelial basement membrane disease and in patients who have had corneal surgery before, like corneal grafts.

They were thought to offer a distinct advantage in patients with thin corneas, but with new technologies for LASIK, this is no longer true.

Before PRK Surgery

You and your ophthalmologist will discuss your vision needs based on your lifestyle. For example, if you play sports, you may be seeking clear distance vision from surgery.

Also, you and your ophthalmologist should discuss your expectations for PRK. People who have PRK to achieve perfect vision without glasses or contacts run the risk of being disappointed. PRK allows people to do most of their everyday tasks without corrective lenses. However, you might need to wear glasses for certain activities, such as reading or driving at night.

Your ophthalmologist will thoroughly examine your eyes and make sure you are a candidate for PRK. Here is what they will do:

• Test your vision. This is to make sure that your vision has not changed. It also shows how high your refractive error is and whether PRK can be used to correct your vision.
• Check for other eye problems. Your ophthalmologist will make sure that you do not have eye problems. This is because other problems could affect your surgery, or PRK could make those other problems worse.
• Measure and map the surface of your cornea. Your ophthalmologist will check the thickness of your cornea and make precise measurements of the cornea’s surface. Your eye surgeon uses these measurements to program the computer-based laser used during surgery.

During Photorefractive Keratectomy (PRK)

PRK is usually done in an outpatient surgery center. The procedure usually takes about 15 minutes. Here is what to expect:

• Your eye will be numbed with eye drops.
• Your eye surgeon will place an eyelid holder on your eye to keep you from blinking.
• Then your ophthalmologist will remove the outer layer of cells on your cornea, called the epithelium. To do this, he or she may use a special brush, blade, laser or alcohol solution.
• You will be asked to stare at a target light so that your eyes will not move. The ophthalmologist then reshapes your cornea using a laser. The laser is a special instrument that has been programmed with measurements for your eye. While your ophthalmologist is using the laser, you will hear a clicking sound.

Post Surgery Discomfort

After the removal of the epithelium, patients may experience moderate discomfort for three to five days. This sensation can vary and is often described as pain, discomfort, or a feeling of something foreign in the eye. Although there haven’t been direct comparisons between PRK and Touch-less LASIK, many surgeons agree that post-operative discomfort is quite similar.

Extended Recovery Time

Surface laser procedures necessitate the use of a bandage contact lens for several days until the epithelium fully regenerates. During this healing phase, patients are advised to avoid typical activities, including work and driving, due to impaired vision. While many notice improvements in their vision within days of surgery, full results may take 3-6 months to manifest.

Risk of Corneal Haze

One concern with surface ablation techniques like PRK and Touch-less LASIK is the potential for increased corneal haze, particularly in patients with higher refractive errors. Incomplete removal of epithelial cells can lead to irregular healing, causing visual disturbances that may be distressing.

Higher Risk of Corneal Ulcers

The absence of the protective epithelial layer during the extended healing phase raises the risk of infections like keratitis or corneal ulcers compared to LASIK.