Save This Page to Del.icio.us PRK - Photorefractive Keratectomy SurgeryInformation
PRK Surgeon Directory
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Photorefractive Keratectomy (PRK) Resources for Patients
PRK Overview
PRK Information Center
What is PRK?
Before PRK Treatment is Performed
The PRK Procedure
Are there risks, complications, and side effects?
Who is a typical PRK candidate?
Summary
Photorefractive Keratectomy, commonly referred to as PRK, is a vision correction procedure which uses an Excimer Laser to reshape the surface of the cornea, the transparent outer portion of the eye. First performed in the 1980’s, the use of an Excimer Laser for performing PRK for treatment of myopia (nearsightedness) received FDA approval in the United States in 1995. This is the use for which PRK is most commonly performed. In 1998, it was also approved for hyperopia (farsightedness). After its approval, and until the approval of the use of lasers for LASIK, PRK was the most popular form of corrective eye surgery and continues to be regularly performed. It is often used for patients who are not good candidates for LASIK, but still fit within the appropriate criteria for refractive eye surgery. This can include patients with thin corneas, dry eyes, corneal dystrophies, corneal scars, or recurrent corneal erosions.
PRK is elective same day surgery. Under eye drop topical anesthesia, the central surface cells of the cornea (epithelium) are removed either mechanically or chemically. Next, the Excimer Laser is used to reshape the cornea to lessen or eliminate the patient’s need for spectacles or contact lenses. The surgery is typically painless and usually takes only a few minutes. The surgery is performed on one eye at a time. Sometimes both eyes will be treated on the same day, but frequently they are done a week or more apart in order to allow healing and vision restoration.
While each individual’s results will be unique, typically over 90% of the patients have 20/40 vision after having PRK and most achieve 20/20 or better. Like many people with good distance vision, it is not uncommon for individuals, as they reach their 40’s to need reading glasses after PRK. This is due to an age related condition called presbyopia which is believed to be caused by a stiffening of the natural lens, reducing its ability to adjust for near vision.
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Before PRK Treatment is Performed
By reading this general overview of PRK, you are already embarking on one of the important steps to successful PRK treatment. Proper education, expectations and full consent to the benefits and risks of PRK is essential. The ultimate source of information and the only source of medical advice concerning PRK should be a Board Certified Ophthalmologist who is trained and experienced in PRK treatment.
During your consultation with your doctor and their staff, your eyes will be evaluated for any eye conditions such as glaucoma or retinal damage or any other disqualifying damage or disease. Testing of your visual acuity and a topographical map of your cornea will be performed to look for abnormalities and assist in calculating the amount of correction needed. Your doctor will evaluate your medical history and may do additional tests as their experience determines are necessary.
After the decision to have PRK is made, additional visits may be scheduled for further testing and mapping. If you wear contacts, you will be asked to remain out of your lenses 2-3 weeks for soft contacts and longer for hard contacts. Contacts can cause reshaping of the cornea and could cause miscalculations of the refractive information if the eye is not first allowed to return to its natural shape.
In the weeks or days preceding PRK treatment, you may be given a regiment of drops to put in your eye that prepare them for surgery. Sometimes, upon arriving at the surgical facility, patients are given a medication such as Valium to help them relax before they are taken to the procedure room. When it is time for your PRK, you will be taken to the treatment room and placed on a table where you will be prepped for the procedure.
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The PRK Procedure
Initially, drops are place in your eyes to anesthetize them, providing you with a greater level of comfort and reducing their sensitivity. A special tool is gently placed to hold your eyelids open. The doctor monitors your surgery through a microscope insuring the eye remains in the correct position throughout the procedure. Most modern Excimer Lasers have a tracking device that will follow the eye through small movements during the surgery have a tracking device that will follow the inevitable small movements of the eye during the procedure.
During PRK, the outermost surface cells the cornea are removed by the doctor using either special chemicals, tools or a laser. As you watch a target light, the cornea is reshaped using an Excimer Laser based on calculations the doctor has made and entered into the laser’s computer. The more correction your eye needs, the longer the laser will work, but the duration is typically less than one minute. You will not be able to see the laser, but you will hear a clicking noise as it works. This is completely normal. It is also common to smell an acrid odor as the laser performs the reshaping. Once the reshaping is completed, a bandage contact lens is placed over the surgery area to protect the eye and facilitate healing. This bandage contact will typically be in place for 2 to 5 days.
During the next 3 to 5 days, the outer layer of the cornea regenerates. Mild to moderate discomfort with blurry vision during this time is possible. You will be checked frequently after surgery to monitor healing. The directions which your doctor gives to you should be carefully followed. This can include the use of medications to reduce inflammation and the risk of infection, avoiding rubbing of the eye, eliminating strenuous activity for a given period and other things you doctor feels are required for your particular situation.
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Possible Risks and Complications
Overall, PRK is a safe and effective treatment. But as with any surgery, you should discuss the risks, benefits and alternatives to PRK with your surgeon. Some of the more common side effects include night glare such as starburst or halos, infection, under-correction or overcorrection of your vision, decrease in best-corrected vision, and excessive haze. Some of these can be corrected by additional treatment or decrease or go away with time. A complete list of specific risks and concerns should be obtained from and discussed with your doctor before determining whether you are a candidate for PRK or any elective procedure.
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Who is a typical candidate?
The following are some of the criteria your doctor might consider when helping you evaluate PRK.
- Should be at least 21 years old and have a stable refractive error (glasses prescription). correction for at least 1 year.
- The eyes should be healthy and free of retinal problems and other eye disease.
- Have mild to moderate myopia (nearsightedness), hyperopia (farsightedness) or astigmatism within the treatment range. Your doctor can share this range with you and determine you degree of myopia.
- You are fully informed of the risks and benefits of the surgery compared with other options available to you such as spectacles, contacts or other refractive surgeries.
- You willingly accept the potential risks and benefits
You should consult your surgeon for a full list of considerations. He or she is the ultimate resource for information on PRK and the qualities that make a person a good candidate with greatest probability of a successful procedure.
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Summary
If you feel like PRK is an option for you, please contact a Board Certified Ophthalmologist for a complete evaluation. Your local ophthalmologist is your best resource for evaluating the risks and rewards of PRK surgery. If it is right for you, join thousands who have benefited from the benefits of laser refractive suregery. Ultimately, only you with proper guidance from you doctor can determine if you are a candidate for PRK.