Photorefractive Keratectomy (PRK) Eye Procedure


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What is photorefractive keratectomy (PRK) surgery? 

PRK is a type of refractive laser surgery to correct myopia short-sightedness (myopia), farsightedness (hyperopia), astigmatism (unevenly curved cornea). PRK is the predecessor to the popular LASIK procedure.

During a PRK procedure, the cornea's shape is changed so that the patient’s vision becomes less blurry.

Am I eligible or an ideal candidate or eligible for PRK eye surgery?

The PRK procedure would be a suitable procedure for you if:

  • you are above 18 years of age to undergo a PRK surgery  
  • You have  thin corneas
  • your vision has been stable at least for one year prior to the procedure date.
  • you are generally healthy, with a robust constitution, and lead an active life
  •  you have mild corneal conditions or a thin cornea, and have realistic expectations from the PRK surgery along with awareness of the risks and benefits of this procedure

This surgery is not for you if:

  • you are pregnant or nursing
  • you suffer from eye diseases or retinal and optic nerve diseases such as keratoconus, glaucoma, cataracts, corneal disease,
  • If you suffer from medical conditions such as herpes simplex, herpes zoster, autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, or Lupus, or conditions such as diabetes, arthritis, collagen vascular disease, then you are not a good candidate for PRK surgery.  
  • if you take steroids or immunosuppressants or are prone to allergies or keloids.

How is the PRK eye procedure done? 

The PRK procedure differs from the LASIK procedure, in that, no flap is created in the PRK procedure. The procedure includes the following steps. 

  1. At the outset of this procedure, anesthetic drops are applied in the eye to numb it.
  2. An eyelid holder will be placed between your eyelids to prevent blinking and restrict any eye movement.

                  Please Note: During this procedure, scalpels are not used and neither are any incisions made. 

              3. The surgeon will carefully remove the complete upper layer of your cornea (epithelium) and then use targeted laser or excimer laser to correct and reshape the cornea. 

                   Please Note: The epithelium regenerates within 3 to 5 days. 

              4. After the surgery, a clear contact lens which acts like a bandage will be placed over your eye for 4-6 days.

              5. The same process is repeated with your other eye. 

PRK surgery is performed to correct myopia (nearsightedness), hyperopia (farsightedness) and astigmatism. This surgery is considered to be ideal for people with thin corneas. 

What are the side effects of PRK eye surgery? 

Following the procedure, there could be irritation in the eyes, coupled with watering for at least 3-4 days. 

Other side-effects can include infections, inflammations, scarring, and dry eyes, within the first week after the surgery, when the cornea is healing. These conditions can be treated with antibiotic drops. 

Though highly rare, occasionally, in some patients irregular astigmatism may occur after PRK surgery. This can be treated with an additional minor procedure.

Another side effect that may occur is overcorrection or undercorrection of eyesight. When overcorrection occurs nearsightedness gets altered to farsightedness, and it is vice versa for undercorrection. These residual power error conditions can be corrected through enhancement or retreatment surgeries. If however, your cornea is too thin or steep the surgeon will advise you to not go in for additional surgeries and will instead prescribe you glasses or lenses to correct your vision. 

What are the possible complications of PRK surgery?

Corneal haze is another complication that can arise after a PRK surgery. This condition usually resolves itself as the eye heals, but can take from 6 months to one year, therefore doctors prefer to treat it with medication or more laser treatment. 

A more aggressive complication which is uncommon, but can occur post a PRK surgery is corneal ectasia. Corneal ectasia is an umbrella term for a group of eye disorders characterized by abnormal corneal thinning or irregular thickening from the centre of the cornea to the periphery. The most common among these disorders is keratoconus.
Corneal ectasia can occur if the cornea is too weak. 

It has been observed that corneal crosslinking treatment helps to arrest conditions such as keratoconus. In this procedure, custom-made riboflavin drops saturate the cornea, which is then activated by ultraviolet light. According to studies, this increases the amount of collagen cross-linking in the cornea thus strengthening the cornea.
This method, however, is not currently FDA approved. 

Unlike LASIK surgery, after the PRK surgery, there are no flap-related complications. 

Are there any pre-surgery guidelines to be followed before a PRK eye procedure? 

Prior to going for an evaluation by an ophthalmologist, it is recommended to stop using contact lenses for four weeks and switch to wearing glasses. Wearing contact lenses over a long period of time changes the shape of the cornea. The cornea then takes a long time to assume its natural shape.  It is similar to how a watchband leaves an imprint on the hand when worn for a long time. Therefore, an evaluation and surgery based on the cornea which has not assumed its natural shape can have negative implications. 

During the evaluation you need to discuss in depth with your doctor about whether you are a good candidate for PRK surgery, what are the alternative surgeries you can opt for, what are the risks and complications involved, what can you expect after the surgery, and what are the pre and post surgery guidelines. 

On the day of the procedure do not wear any jewellery, and do not apply any cream, and make-up, or use any perfume. You may be asked by the doctor to frequently scrub your eyelids and lashes gently, 2-3 days before the surgery, to get rid of any accumulated oil or debris.  

You need to discontinue any cold or allergy medicines at least 4 days prior to the surgery. If you take any blood thinners you need to check with the doctor whether you need to stop taking them for some time prior to the surgery. 

You will need to stop smoking and drinking alcohol 48 hours before and after the surgery. 

On the day of the surgery, you should not take insulin if you are a diabetic. You will need to arrange for a driver to take you home after the surgery. 

Are there any post-surgery guidelines to be followed after a PRK eye procedure? 

After the surgery you will be advised to:

  • not rub your eyes.  
  • avoid any form of strenuous exercise, such as heavy lifting, or swimming, that could result in eye injury for at least a month
  • avoid driving till your vision is absolutely clear.
  • wear sunglasses for a week after the surgery, even while indoors. (Ideally, glasses should be worn for the first six months after the surgery to avoid UV rays and avoid haze formation.)
  • avoid applying any makeup or lotion on the face
  • avoid any situation involving dirt for 7-10 days.
  • not to get face wash or soap in your eyes  while washing your face, or showering (In fact, you need to keep water and shampoo away from your eyes for at least 7 days after the surgery.)
  • avoid swimming and hot tubs for at least a month after the surgery.
  • apply eyedrops in your eyes at regular intervals as prescribed by the doctor.

How long will it take to recover from a PRK surgery? 

The initial vision recovery period could take up to 4 days during which you will also experience mild discomfort in the eye.

You might experience sensitivity to light, which is accompanied by the feeling of tearing, or at times the feeling of a foreign body in the eye. This is the period when the epithelial layer of the cornea is regenerating. The discomfort vanishes by the fourth day. The vision, however, remains cloudy. 

It may take 4-6 weeks for your vision to become clear so that you can start performing finer activities or detailed tasks. 

After a period of six months, the vision stabilizes and becomes absolutely clear. 

It usually takes 3 - 6 months to completely recover from a PRK surgery and achieve clear vision. 

What is the cost of PRK surgery in India? 

A PRK procedure will cost anywhere between Rs. 35000 - Rs. 40000 in India. 

Are the results of PRK surgery permanent? 

In most cases, a PRK procedure is sufficient for vision correction. However, in some cases a person might not achieve the desired optimal result from the surgery, in such cases, the doctor may advise a second PRK procedure to further enhance the results. 

The PRK procedure permanently corrects the shape of the cornea, however, this does not stop the natural vision abnormalities that occur with aging. 

More Topics on Opthalmology Procedures

People interested in this topic  also read: 

References

1. Naderi M, Ghadamgahi S, Jadidi K, Photorefractive Keratectomy (PRK) is Safe and Effective for Patients with Myopia and Thin Corneas [Internet]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347191/

2. Mayor S, People considering laser eye surgery should be warned of risks, says NICE [Internet]. https://www.ncbi.nlm.nih.gov. 2018 [cited 13 April 2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420724/

3. Pepose JSLim Bon Siong R Mardelli P, Future shock: the long-term consequences of refractive surgery [Internet]. http://bjo.bmj.com/. 2018 [cited 13 April 2018]. Available from: http://bjo.bmj.com/content/81/6/428


Would you like to consult a doctor for Photorefractive Keratectomy (PRK) Eye Procedure ?

Questions answered by trusted doctors

Verified User
I had my prk surgery on dated 5th of April right now the condition of my eyes is 80/100 this condition is from the first week there is no improvement till date night vision is very bad dry eyes all through out the day will it be improve by the coming days or will remain the same I am very worried about it as I had left my job due to this surgery as I do Not know much about it. My doctor prescribed me to do prk as my cornea thickness is 490 & eyes power right eye 6.0 & left eye 6.5 .
Dr. A K Goel
Ophthalmologist/ Eye Surgeon, Moradabad
Your parameters are pl and you must recover fully in about 6wks.if that doesn't happen then please contact your operating surgeon.
Dr. Vaibhev Mittal
Ophthalmologist/ Eye Surgeon, Sangrur
Hello

Please don't worry
This will improve with time
Wait for at least 6 weeks

Verified User
It's been a week since I had got done prk eye surgery..my contacts have been removed yesterday so can I smoke a cigarette or two..
Dr. Meeta Mungale
Ophthalmologist/ Eye Surgeon, Vadodara
Actually u can.. Unless as mentioned u rub the eye
Dr. A K Goel
Ophthalmologist/ Eye Surgeon, Moradabad
no you must avoid  smoking  bcoz  the  smoke  may cause  irritation in the eye and  if unknowingly  you rub your eyes  then it  may be damaging.
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Did you know?

PRK surgery ideal for people with thin corneas

Unlike LASIK, PRK does not involve the use of a blade to create a flap in the cornea. Therefore there is no risk of flap complications, making it an ideal procedure for many people who have thin corneas.

PRK causes more discomfort than LASIK

It's important to know that PRK causes more discomfort than LASIK the first few days after surgery, and complete visual recovery after PRK surgery can take longer than LASIK recovery time.

PRK is good for people who are at a risk of eye injuries

Since there is no risk of flap complications after a PRK surgery, it is good for people who are engaged in activities that put them at risk for eye injuries. Boxing and martial arts are some good examples.

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