Alphabet Soup – PRK vs. LASIK


There are several options that patients and eye surgeons have for vision correction surgery. Two of the more common procedures are PRK and LASIK. PRK stands for Photorefractive Keratectomy and LASIK stands for Laser-Assisted In Situ Keratomileusis. LASIK is by far the most commonly performed laser vision correction surgery but that does not always mean it is the best option for all patients. This article compares and contrasts PRK vs LASIK so that you, the consumer, can make an informed decision.

During PRK, the eye surgeon uses an excimer laser first to ablate (remove) the outermost portion of the cornea then to reshape the curvature of the eye. There are no needles or cutting involved with PRK. Most patients require prescription pain medications to relieve the residual pain and soreness after PRK. Also, protective contact lenses are kept in place for up to five days to protect the ablated region. PRK is sometimes referred to as “No Touch” or “Laser Only” laser vision correction.

For most people, LASIK is less painful than PRK. The eye surgeon first uses a very thin, sharp blade called a microtome to slice the front portion of the eye on three sides, thereby creating a flap. This flap is opened to allow the laser to shape the eye and then returned to its original position so that it may heal. There are usually no sutures required for closure, though some surgeons may place a single, self-dissolving suture to hold to flap in place.

While there might be more pain with PRK vs LASIK, both procedures are painless at the time of the procedure. Despite PRK generally causing more pain than LASIK, the flap formed during LASIK can cause problems in one out of 50 treated eyes, which is a relatively high complication rate. Some flap complications that occur with LASIK are dry eye symptoms, an improperly formed flap, a free cap (in which the flap is completely removed), displaced cap (usually from eye rubbing), and debris, inflammation, or infection under the flap. The flap may also become wrinkled which can interfere with vision. Since a microtome is used, the surface of the cornea may become abraded (scraped) which is painful and may prolong LASIK recovery time.

In general, most patients will undergo LASIK vs PRK. PRK is available for myopia between -1.0 D (diopters) to -6.0 D and hyperopia +1.0 D to +4.0 D. PRK can correct astigmatism of 0.75 D to 3.0 D. Outside of these parameters, LASIK is the preferred treatment option. For most revisions to vision correction surgery, LASIK is preferred over PRK except in patients that previously had LASIK. In patients with previous LASIK, PRK is often preferred over a second LASIK procedure. PRK may also be the treatment of choice of anisometropic amblyopia in children.

There are several factors that can influence your decision between PRK vs LASIK including recovery time, cost (PRK is slightly less), and expected benefit. Your eye surgeon will be happy to discuss both PRK and LASIK with you to help you reach a decision, but you have to ask. Ask what is including in the price of PRK vs LASIK, her personal complication rate, the cost of associated drugs and bandages, the number of follow-up visits required and their cost. A decision regarding which laser vision correction surgery is right for you should be discussed at length with your eye surgeon.

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