Photorefractive keratectomy (PRK) Eye Surgery: A Flap-Free Alternative to LASIK
PRK was one of the first widely performed laser vision correction procedures, but it has not become obsolete. Modern PRK remains an important alternative for patients who are not ideal LASIK candidates or who prefer to avoid a corneal flap.
PRK stands for photorefractive keratectomy. Like LASIK, it uses an excimer laser to reshape the cornea. The primary difference is how the surgeon reaches the corneal tissue being treated.
How Does Photorefractive keratectomy (PRK) Work?
The cornea has a thin outer layer called the epithelium. During PRK, the surgeon removes this surface layer and applies an excimer-laser treatment to the underlying corneal tissue.
A soft bandage contact lens is then placed over the eye while new epithelial cells grow across the surface.
The FDA defines PRK as a procedure in which the surface epithelium is removed and a computer-controlled excimer laser reshapes the underlying corneal stroma.
What Can PRK Correct?
Depending on the approved laser system and the patient’s measurements, PRK may treat:
Myopia
Hyperopia
Astigmatism
The available treatment range depends on the laser platform, corneal thickness, corneal shape, prescription, and surgeon’s clinical judgment.
Like other corneal refractive procedures, PRK does not prevent presbyopia. Reading glasses may still be needed as the natural lens loses focusing flexibility with age.
Why Choose PRK Instead of LASIK?
PRK does not create a permanent corneal flap. It may be considered for:
Patients with corneas that are not ideal for a LASIK flap
Athletes or patients with a higher risk of eye trauma
Certain military, aviation, or occupational situations
Patients with prior corneal surgery
Patients whose surgeon prefers a surface treatment
Some patients requiring specialized topography-guided treatment
PRK may preserve more untouched corneal tissue than a comparable LASIK procedure because no flap is created. However, PRK does not make every thin or irregular cornea safe to treat.
A patient with keratoconus, suspicious tomography, progressive corneal thinning, or an unsafe predicted residual corneal thickness may not qualify for any corneal refractive surgery.
What Is PRK Recovery Like?
PRK recovery is slower and less comfortable than LASIK recovery.
During the first several days, patients may experience:
Burning or stinging
Tearing
Light sensitivity
Foreign-body sensation
Blurred vision
Difficulty keeping the eyes open
The bandage contact lens usually remains in place until the epithelium has healed adequately, often for several days. The surgeon removes it during a postoperative visit.
Vision normally improves gradually rather than overnight. Many patients return to routine activities within several days to a week, but vision may remain blurry or fluctuate for several weeks. Fine visual quality can continue stabilizing for several months.
Prescribed antibiotic and anti-inflammatory drops must be used exactly as directed.
What Are the Risks?
Possible risks and side effects include:
Pain or discomfort during early healing
Delayed epithelial healing
Infection
Corneal haze
Scarring
Dryness
Glare, halos, ghosting, or starbursts
Fluctuating vision
Under-correction or over-correction
Regression
Need for an enhancement
Rare corneal ectasia
Rare loss of best-corrected vision
UV exposure can contribute to corneal haze during healing. Patients may be instructed to use UV-blocking sunglasses consistently after surgery.
PRK Versus LASIK
Both procedures use an excimer laser to reshape the cornea.
LASIK creates a flap and usually offers faster visual recovery with less initial discomfort. PRK avoids the flap but requires the surface epithelium to regenerate.
The final visual results can be similar in appropriately selected patients, but the experience during the first days and weeks is different.
PRK Versus SMILE
SMILE creates a lenticule inside the cornea and removes it through a small incision. PRK works from the surface.
SMILE is currently primarily used for myopia with or without astigmatism. PRK can be used for a broader selection of refractive errors, depending on the laser’s approved indications.
PRK also offers more established options for customized surface treatments and certain previous-surgery cases.
PRK Evaluations in Tampa
PRK may be an excellent procedure when it is selected for the correct eye, but the decision cannot be made from the prescription alone.
At OPT-ISM Eye Care in Tampa, preoperative testing can evaluate corneal thickness, topography or tomography, ocular-surface health, retinal health, prescription stability, and visual goals.
A thorough evaluation can determine whether PRK offers an appropriate balance of vision correction, structural safety, and long-term eye health.
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