Photorefractive Keratectomy (PRK) Eye Surgery: Pros, Cons, and What to Expect

Photorefractive keratectomy (PRK) also known as Advanced Surface Ablation (ASA) surgery is a corneal laser vision correction surgical procedure. Laser vision correction surgery corrects a refractive error which is where your eye does not bend light correctly and one can not see clearly. An important question for someone interested in surgery is to understand how PRK works. PRK works by changing the shape or curvature of the cornea or front part of the eye. When this is done light rays come into perfect focus on the retina and images are then viewed clearly.

Who Is a Good Candidate for PRK?

Good candidates for PRK procedures are above age 18 and have a refractive error that requires that they wear glasses or contact lenses. When a person tires of contacts and glasses and would like to minimize or possibly eliminate their use laser vision correction surgery in the form of PRK, SMILE or LASIK can be considered as an option. Refractive errors that can be corrected with PRK include:

Myopia (nearsightedness).
Hyperopia (farsightedness).
Astigmatism (the shape of your eye causes blurry vision).

Who Can Have a Photorefractive Keratectomy (PRK)?

Good candidates for PRK should meet certain requirements and they include:

Be 18 years old, or older.
Have healthy corneas.
Have healthy eyes with no active disease in general.
Have an eye prescription that is stable for the prior year.

PRK Procedure

PRK can be considered for patients that have nearsightedness, farsightedness, or astigmatism and who want to minimize or eliminate their need for glasses and or contact lenses. A complete ocular evaluation with the eye surgeon and team should determine if one is a good candidate and their expectations after surgery can be achieved with high probability.

How to Prepare for PRK Eye Surgery

Prior to PRK or ASA eye treatment, several recommendations are worth considering. One should complete the following.

Review the risks, benefits, alternatives, and costs of PRK with your surgeon and the care team. All of your questions and concerns should be reviewed.
Your doctor should review your medical and eye history, test your vision and the power of your eye, examine your eyes, and measure your cornea and eye with specialized tests to make sure you are a good candidate and PRK is an acceptable procedure for you.
A good candidate should be 18 years of age or older and have a stable correction for the prior year.
You may not be a good candidate if you are pregnant, nursing, or have pre-existing conditions, such as active corneal disease or prior trauma, uncontrolled diabetes, cataracts, untreated dry eye syndrome, or advanced glaucoma.

What to Expect on the Day of ASA Eye Surgery

Several issues should be considered on the day of your PRK / ASA surgery.

Since you likely will have taken a sedative and your vision will not be ideal so you will need to arrange for a driver to get you home.
PRK is performed as an outpatient typically in an office-based laser suite.
Don’t wear makeup or use perfume on the day of your surgery.
Wear comfortable clothing.
The procedure takes about 10 minutes per eye but expects to spend about 90 to 120 minutes at the office the day of the procedure.
It is ok to eat a light meal prior to your procedure.
Unless told otherwise you can take your normal medications excluding sedative medications.

What Happens During the PRK Surgery?

An expected and frequently asked question is “How long does PRK take?“. The procedure itself takes about 10 minutes per eye but expect to spend about 2 hours at the office the day of your procedure. During your procedure you can expect the following:

Most patients will take a mild oral sedative pill.
The surface of your eye will be numbed with topical anesthetic drops.
A lid guard will be used to prevent a full eyelid closure during your procedure.
The skin surface of your cornea will be removed (keratectomy) to prepare the cornea for the laser treatment.
You will be asked to look at a fixation light during the procedure. You will hear the ticking sound of the laser as it reshapes the surface of the cornea.
A bandage contact lens will be placed over the cornea at the end of the procedure.

PRK Recovery

Understanding what to expect with PRK healing time and PRK post-op care will help you prepare for your procedure. Several PRK recovery tips can be helpful including:

At the completion of your surgery, you will need someone to drive you home.
You can expect to be very light sensitive for several days after surgery.
Sunglasses will likely be needed out-of-doors.
You will use prescription medicated eyedrops including steroids anti-inflammatory and antibiotics. They serve to control inflammation and healing and prevent infection.
You likely will be prescribed oral narcotic pain medication.
You should expect mild to moderate pain, burning, light sensitivity, tearing, and foreign body sensation for 3-5 days. The bandage contact lens will reduce most of these symptoms to manageable.
You will be monitored closely over the following weeks. You can expect to be seen at 1 day, 1 week, 1 month, and 3 months after surgery.
It may take several weeks to even months to reach your best vision. Some patients notice continued improvement out to 1 year.

Advantages of a Photorefractive Keratectomy

There are many advantages of PRK and they include:

PRK can accurately correct nearsightedness, farsightedness, and astigmatism. Over 90% of patients have 20/20 unaided vision after PRK.
PRK may be the preferred procedure over LASIK or SMILE. This is typical with patients with thinner corneas, some with higher corrections, or those with irregular corneal surfaces.
Those involved in contact sports are usually recommended to undergo PRK or SMILE instead of LASIK.
PRK can result in the same long term vision of LASIK and SMILE.

PRK Disadvantages and Side Effects

At the time of your decision to undergo surgery, your doctor and team should review PRK risks, benefits, and alternatives to PRK surgery.

Any surgery comes with risks and PRK complications and surgery side effects may include scarring, infection, loss of best corrected vision, halo, glares, and difficulties with night driving.
The accuracy of PRK is excellent but some patients may experience over or undercorrection. This is usually addressed with an additional PRK procedure.
In rare cases, best corrected vision may become worse after PRK.
Recovery to best vision does take longer with PRK than with LASIK or SMILE. It can take typically 5-7 days for the surface epithelium to heal. Once the contact lens is removed the vision progressively gets better.

What Is the Prognosis After a Photorefractive Keratectomy?

Immediately after your surgery and out to 5 days one can expect to have light sensitivity, tearing, foreign body sensation, and pain. When the surface cells heal these should all improve significantly. You should feel comfortable returning to full activities when the bandage contact lens is removed on days 5-7 after surgery. There are no restrictions on what you can eat or drink after surgery. For patients over age 40, you will at some point need reading glasses. For some patients, the doctor may recommend monovision where one eye is focused more for near vision. Most patients take a few days off from school or work. You can return to full activity and a normal schedule when your eyes are comfortable and you are seeing well.

PRK Surgery Cost

At Discover Vision, the price of your PRK (Photorefractive Keratectomy) surgery depends on the amount of correction needed. The first step is to schedule a free consultation, virtual or in-person. There is no obligation to proceed with surgery. From our point of view, this is 100% about education to provide you with the information on whether you are a candidate, which procedure may be best depending on your lifestyle and the cost for your PRK surgery.

Does Insurance Cover a Photorefractive Keratectomy?

PRK surgery is seen as an elective procedure. Insurance options for PRK surgery may include a discount; however, the majority of the cost will most likely be an out-of-pocket expense. Discover Vision has several options to help make PRK surgery more affordable. We offer to See Today, Pay Later financing through Care Credit, subject to credit approval. We also encourage you to use FSA and HSA (flexible spending and health savings accounts) to pay for your procedure with tax-free dollars.

PRK vs. LASIK

After healing is complete PRK has similar vision results to LASIK and SMILE. It is the time between the surgery and the completion of healing that is the difference. With SMILE and LASIK the visual results are excellent after about 4 hours from surgery and there is minimal discomfort. With PRK tearing, foreign body sensation, light sensitivity, and pain can be experienced for 5-7 days. Vision for PRK will get close to the best preop vision by about week four. With SMILE and LASIK medicated drops are used for 5 days after surgery. With PRK medicated drops are used typically for 4 weeks.

The Bottom Line

PRK or ASA is an excellent laser vision correction procedure for those wanting to minimize or eliminate their need for glasses or contact lenses. Schedule a consultation!

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