PRK (Photorefractive Keratectomy): A Complete Guide

Introduction to PRK Surgery

PRK (Photorefractive Keratectomy) is a type of laser eye surgery designed to correct vision problems like nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. Unlike LASIK, which creates a corneal flap, PRK involves gently removing the outer layer of the cornea (epithelium) before reshaping the underlying tissue with an excimer laser. This makes PRK an excellent option for people with thin corneas or those involved in contact sports.

Developed in the 1980s, PRK was the first laser vision correction procedure approved by the FDA. While LASIK has gained more popularity in recent years, PRK remains a trusted alternative, especially for patients who aren’t ideal LASIK candidates. The recovery period is slightly longer, but the long-term results are just as effective, with many patients achieving 20/20 vision or better.

If you're tired of relying on glasses or contact lenses, PRK could be a life-changing solution. In this guide, we’ll explore how PRK works, who it’s best for, the procedure details, recovery expectations, and more.

How PRK Works: The Science Behind It

PRK works by reshaping the cornea—the clear, dome-shaped front surface of the eye—to improve how light is focused onto the retina. The procedure uses a cool ultraviolet laser (excimer laser) to precisely remove microscopic amounts of tissue, correcting refractive errors.

Here’s a breakdown of the science:

• Step 1: Epithelium Removal – Unlike LASIK, PRK doesn’t involve a corneal flap. Instead, the surgeon gently removes the thin outer layer (epithelium) either with a specialized brush, laser, or alcohol solution.
• Step 2: Corneal Reshaping – The excimer laser then removes precise amounts of corneal tissue to flatten it (for nearsightedness), steepen it (for farsightedness), or smooth irregularities (for astigmatism).
• Step 3: Natural Healing – Since no flap is created, the epithelium regenerates naturally over a few days. A protective bandage contact lens is placed to aid healing.

Because PRK doesn’t require cutting a flap, it’s safer for people with thinner corneas. The results are permanent, though age-related vision changes (like presbyopia) may still occur later in life.

PRK vs. LASIK: Key Differences

Both PRK and LASIK are laser eye surgeries that correct vision, but they differ in technique, recovery, and candidacy. Here’s a comparison:

While LASIK offers quicker recovery, PRK is often the better choice for those with corneal irregularities or higher physical activity levels. Your eye surgeon can help determine which procedure suits you best.

Who is a Good Candidate for PRK?

PRK isn’t for everyone, but it’s an excellent option for certain individuals. Ideal candidates typically meet the following criteria:

• Stable Vision Prescription – Your glasses or contact lens prescription hasn’t changed significantly in the past year.
• Healthy Corneas – While PRK works for thinner corneas, you should have no active eye diseases (like keratoconus).
• Moderate to High Refractive Errors – PRK can treat myopia (-1.00 to -12.00 diopters), hyperopia (+1.00 to +6.00 diopters), and astigmatism (up to 6 diopters).
• No Severe Dry Eye – Mild dry eye may be acceptable, but severe cases could worsen after PRK.
• Age 18+ – Eyes should be fully developed.
• Realistic Expectations – Understanding that PRK improves vision but doesn’t guarantee perfect 20/20 vision for everyone.

People in high-impact professions (military personnel, police officers, athletes) often prefer PRK because there’s no risk of flap dislocation. A thorough eye exam with an ophthalmologist will confirm if PRK is right for you.

PRK Procedure: Step-by-Step Breakdown

If you’re considering PRK, knowing what to expect can ease anxiety. Here’s a detailed breakdown of the procedure:

1. Pre-Operative Evaluation – Your surgeon conducts a comprehensive eye exam, measuring corneal thickness, refraction, and overall eye health.
2. Anesthesia – Numbing eye drops are applied to ensure comfort. Some clinics may offer mild sedation for relaxation.
3. Epithelium Removal – The outer corneal layer is gently removed (takes about 30 seconds per eye).
4. Laser Reshaping – The excimer laser reshapes the cornea based on your prescription (usually 30-60 seconds per eye).
5. Bandage Contact Lens – A soft contact lens is placed to protect the eye as the epithelium heals.

The entire procedure takes about 10-15 minutes for both eyes. You’ll need someone to drive you home afterward, as your vision will be blurry initially.

Recovery Process & What to Expect

PRK recovery is longer than LASIK but manageable with proper care. Here’s a timeline:

• Day 1-3 – Blurry vision, mild discomfort, light sensitivity, and tearing are common. Use prescribed antibiotic and anti-inflammatory drops.
• Day 4-7 – The epithelium regenerates. The bandage contact lens is removed around day 4-5. Vision starts improving but may fluctuate.
• Week 2-4 – Vision gradually sharpens. Most return to work within a week, but avoid strenuous activities.
• Month 3-6 – Vision stabilizes. Final results are typically evident by 6 months.

Tips for Smooth Recovery:

• Wear sunglasses outdoors to protect against UV light.
• Avoid rubbing your eyes.
• Use artificial tears to combat dryness.
• Follow all post-op instructions from your surgeon.

Most patients achieve 20/40 vision or better within a month and 20/20 by three to six months.

Potential Risks & Side Effects of PRK

PRK is safe, but like any surgery, it carries some risks. Common temporary side effects include:

• Dry Eyes – Usually improves within weeks to months; artificial tears help.
• Haze (Corneal Clouding) – Rare, but more likely with high corrections. Prevented with steroid drops.
• Glare/Halos at Night – Typically diminishes over time.
• Infection – Extremely rare if post-op care is followed.
• Undercorrection/Overcorrection – May require an enhancement procedure.

Serious complications (like vision loss) are exceedingly rare. Choosing an experienced surgeon minimizes risks. If you experience severe pain or sudden vision changes, contact your doctor immediately.

Benefits of Choosing PRK Over Other Surgeries

Why choose PRK over LASIK, SMILE, or other refractive surgeries? Key advantages include:

• No Flap Complications – Ideal for athletes or those in physically demanding jobs.
• Works for Thin Corneas – LASIK requires thicker corneas; PRK doesn’t.
• Lower Risk of Dry Eye – Though dry eye occurs, it’s often less severe than with LASIK.
• Long-Term Stability – Studies show excellent results even 10+ years post-surgery.
• FDA-Approved for More Corrections – Can treat higher degrees of myopia than LASIK in some cases.

While the recovery is slower, the long-term benefits make PRK a smart choice for many patients.

FAQs About PRK Surgery