PRK (Photorefractive Keratectomy)

Before your procedure begins, you will receive numbing eye drops to ensure you feel no pain during surgery. Your surgeon may also provide a mild sedative to help you relax. Your eye will be gently held open with a small device called a lid speculum, and you will be asked to focus on a fixation light to keep your eye steady and properly aligned with the laser.

The surgeon carefully removes the thin outer layer of corneal cells, called the epithelium, to expose the underlying tissue where the laser treatment will be applied. This can be accomplished using a surgical brush, a diluted alcohol solution to loosen the cells, or in some cases a laser. The method chosen depends on your specific anatomy and your surgeon's expertise. This step is painless due to the numbing drops.

Once the epithelium is removed, the excimer laser precisely reshapes your cornea according to your exact prescription. The laser is controlled by a computer that maps your unique corneal topography and refractive error. The laser removes microscopic layers of tissue in a customized pattern, with each pulse of the laser lasting only a fraction of a second. You may hear clicking sounds and notice a faint odor during this phase, both of which are completely normal.

After the laser treatment is complete, your surgeon will place a soft, clear bandage contact lens over your eye. This special therapeutic lens serves as a protective barrier while the epithelial cells naturally regenerate over the next 4 to 7 days. The bandage lens reduces discomfort, protects the healing surface from your eyelids, and helps maintain a stable environment for proper healing. You will return to the office to have this lens removed once your epithelium has regrown.

The procedure itself is not painful because numbing eye drops completely anesthetize your eye. After surgery, most patients experience moderate discomfort that feels like a scratchy, gritty, or burning sensation for 2 to 4 days. This discomfort is manageable with prescribed eye drops and over-the-counter pain relievers. The discomfort significantly improves once the epithelium heals and the bandage contact lens is removed.

Most patients return to desk work and light activities within 3 to 7 days after PRK, once the initial discomfort subsides and vision begins to clear. Driving is usually possible within 1 to 2 weeks once your vision meets legal requirements and you feel comfortable. Strenuous exercise and heavy lifting can typically resume after 1 to 2 weeks, while contact sports may require waiting 2 to 4 weeks or longer. Always follow your surgeon's specific recommendations based on your healing progress.

The vast majority of PRK patients achieve excellent distance vision without corrective lenses, allowing them to drive, watch television, and participate in most activities without glasses. However, people over 40 will likely still need reading glasses for close work due to presbyopia, a natural age-related loss of near focusing ability that affects everyone and is not corrected by PRK. Some patients may choose to keep a weak prescription for specific situations like night driving, though most do not need this.

Both PRK and LASIK are extremely safe procedures with high success rates when performed on appropriate candidates. PRK is considered safer for people with thin corneas, certain corneal irregularities, dry eyes, or high-risk occupations because it does not create a flap that could be displaced. PRK avoids flap-related complications entirely and may have a lower long-term risk of chronic dry eye. Both procedures achieve equivalent visual outcomes, with over 95 percent of patients reaching excellent vision.

Yes, PRK is highly effective at correcting astigmatism up to approximately 4 diopters. The excimer laser reshapes the cornea to create a more uniform, spherical surface, eliminating the irregular curvature that causes the blurred and distorted vision characteristic of astigmatism. Many patients with astigmatism are excellent candidates for PRK and experience dramatic improvements in visual clarity.

Your vision will be quite blurry for the first few days after PRK, gradually clearing as the epithelium regenerates. You may experience fluctuating vision, with some days clearer than others, for several weeks. Temporary visual disturbances like glare, halos around lights, mild double vision, and reduced contrast sensitivity are common, especially at night. These symptoms typically diminish significantly by 4 to 6 weeks and continue improving for several months as your cornea stabilizes and any mild haze resolves.

Yes, PRK results are permanent because the laser permanently alters the shape of your cornea. The vision correction achieved does not fade or wear off over time. However, your eyes can still undergo normal age-related changes that are unrelated to PRK, such as presbyopia, which affects near vision and typically begins around age 40, or cataracts, which may develop later in life. These natural aging processes do not diminish the distance vision correction achieved with PRK.

Mild to moderate dry eye does not automatically disqualify you from PRK, but the condition should be evaluated and treated before surgery to optimize your comfort and healing. Your surgeon may recommend pre-treating your dry eye with artificial tears, prescription medications, or other therapies for several weeks before PRK. Some studies suggest PRK may have a lower impact on dry eye compared to LASIK because it causes less disruption to corneal nerves, though temporary dryness is still common during healing.

The cost of PRK typically ranges from $1,500 to $3,000 per eye, with most practices charging between $2,000 and $2,600 per eye. The exact price depends on factors such as your geographic location, the surgeon's experience and reputation, the technology and equipment used, and what services are included. Most comprehensive pricing includes pre-operative evaluations, the procedure itself, post-operative medications, and follow-up care for a specified period. Be sure to confirm exactly what is covered in your quoted price.

Most health insurance plans consider PRK an elective cosmetic procedure and do not provide coverage for the surgery. However, you may be able to use funds from a Flexible Spending Account or Health Savings Account to pay for PRK with pre-tax dollars, which can result in significant savings. Some insurance plans may offer partial coverage or special discounts if PRK is deemed medically necessary rather than purely elective. Many practices also offer financing options to make PRK more affordable.

The most common alternative to PRK is LASIK, which offers faster visual recovery and less discomfort but requires adequate corneal thickness and may not be suitable for people at high risk for eye trauma. Another option is SMILE, a minimally invasive procedure that treats nearsightedness and astigmatism through a very small incision. For patients with very high prescriptions or thin corneas who are not good candidates for laser surgery, implantable collamer lenses may be an excellent alternative. Your surgeon can help you understand which option is best suited to your eyes, prescription, lifestyle, and goals.