PRK Eye Surgery Procedure: Photorefractive Keratectomy

PRK laser eye surgery, or Photorefractive Keratectomy is part of a family of procedures called “surface ablations” because the laser is applied directly on the surface of the cornea rather than under a flap, as with LASIK. Surgeons worldwide have performed PRK for over 20 years now. It’s continued popularity is a testimony to the long term stability and efficacy of the procedure observed over this time period.

Why Trust Diamond Vision With Your PRK Laser Eye Surgery?

While a Major in the US Air Force, Dr. Stetson (formerly Chief of the US Air Force Academy laser eye clinic) studied surface healing on PRK patients using many different methods to remove the epithelium such as alcohol and laser-assisted, before it became clear that using a rotational brush offered the most efficient and consistent surface preparation of the corneal surface in his hands. As a result, Diamond Vision uses a rotating brush (Amoils Brush) to gently and safely remove the surface cells in the treatment zone in just about 10 seconds! Though more expensive for us, this is far faster then alcohol-assisted removal, and allows us to maintain better control over the duration of the surgery while minimizing anxiety for our patients by reducing their time under the laser.

THE PRK LASER EYE SURGERY IS DONE UNDER TOPICAL ANESTHESIA AND TAKES ABOUT 5 MINUTES PER EYE

Mitomycin C (MMC) for PRK laser eye surgery treatments

We also use mitomycin C (MMC) for our PRK laser eye surgery treatments which require the removal of more than 30 microns of tissue. MMC has been shown to reduce the risk of corneal haze/scarring in many peer- reviewed studies while having a good track record of minimal adverse effects. For more on why we use the Amoil brush for our primary PRK treatments, and MMC in our larger PRK surgery treatments, and to review references to related studies, click below.

Advantages of PRK surgery:

You keep more corneal tissue than with LASIK, ensuring the long-term stability and integrity of your eyes.
You are also better able to have a ‘touch up’ procedure if necessary
There is no risk of flap-related complications.
You are at less risk for dry eyes, because there is less disruption in the nerves that tell your eyes to produce tears.
PRK is more comfortable during the procedure.

Disadvantages of PRK eye surgery:

Recovery takes longer after PRK. Most people do not work for at least 2 days after surgery to allow their eyes to rest. In a Diamond Vision survey of patients who have had surface ablations, seventy-five percentere back to work after 3 days.
Compared to LASIK, PRK is not as comfortable for a few days afterwards. However, advances in follow-up care have considerably improved the comfort of PRK. When patients in our Diamond Vision study were asked to rate their discomfort from zero to four, the majority (56%) said their discomfort was zero or one.

What should I expect after PRK laser eye surgery?

Once the eye is corrected, the surgeon will place a soft contact lens to protect your eye while the healing takes place. During the healing time – 5 to 7 days – it is normal to experience blurry or fluctuating vision, light sensitivity, dryness and/or a foreign body sensation. It is common for one eye to heal faster than the other, so do not be alarmed if your vision is better in one eye compared to the other. You will be given oral pain medication if necessary, along with topical eye drops. You may find that you do not feel confident driving while the protective lenses are in.

At your one-week visit the contact lenses are removed and your vision will slowly improve. Drops will be given to use for several weeks, which will aid in healing and prevent inflammation.

Although it can take a few weeks to a few months for patients to fully reach their optimal vision, your visual outcome will be the same as if you had LASIK. However, the long-term safety and stability of your eyes will be higher than if you had LASIK. A few days or weeks of patience will be rewarded by a lifetime of better vision.

What is better for me, LASIK or PRK surgery?

In most cases, PRK is recommended for patients who have thinner corneas, slightly irregular corneas, or are at risk for dry eyes or other conditions. Your Diamond Vision doctor will be able to make a recommendation for you based on extensive testing.

In other cases, patients who are candidates for LASIK chose to have PRK eye surgery instead, because they prefer a flapless or bladeless procedure.

How do I learn more about what is PRK surgery?

If you would like to discuss the procedure with patients who have had PRK (or a very similar procedure, LASIK), please ask our staff for a list of patient phone numbers. As always, we encourage you to speak to our knowledgeable doctors for any questions regarding this procedure

What is better for me, LASIK or PRK surgery?

In other cases, patients who are candidates for LASIK chose to have PRK eye surgery instead, because they prefer a flapless or bladeless procedure.

Why is PRK laser surgery becoming more and more popular?

Many studies show that LASIK and PRK produce the same visual results after a few weeks or month. Now that the disadvantages of the “old PRK” have been conquered, doctors like the extra long-term safety afforded by PRK in many patients.

Diamond Vision’s Expertise

As we mentioned earlier, when it comes to PRK Surgery, our Medical Director, Dr. Stetson, has extensively studied the different methods and results of surface healing of PRK patients. After observing which techniques provide the best results, it was only natural for him to implement them into Diamond Vision’s processes. As such, our practice uses an Amoils Brush (or rotating brush) that gently removes the surface cells in the treatment zone. This method brings better results than alcohol-assisted removal and speeds up the procedure, minimizing patient anxiety.

About the PRK Procedure

Otherwise known as Photorefractive Keratectomy is a “surface Ablation” procedure where the laser is applied directly on the cornea’s surface and not under the flap, like in the case of LASIK. It removes the tissue from the surface of the cornea and thus, depending on the problem, may treat astigmatism, nearsightedness, or farsightedness.

A lot of patients wonder whether PRK surgery hurts. Our eye surgeons use eye drop anesthesia to numb the eyes prior to the procedure. Then, they will remove the epithelium, which is the thin protective skin covering the cornea.

Then, patients are told to look at the target light directly, and in only a few seconds, the brush will remove the unnecessary tissue.

Potential Side Effects

Until the epithelium heals fully, patients may experience hazy and/or blurry vision for a few days, along with some discomfort. However, all of this can be minimized by using pain medication, eye drops, and protective contact lenses.

Recovery Timeline

As mentioned above, the healing process following PRK eye surgery can take a bit longer than with LASIK. The epithelium may take four to five days to heal, and during this time, patients might feel discomfort and experience blurry vision. However, once the epithelium heals, the discomfort subsides, and the vision starts to clear up, sometimes taking several weeks to a month. Total improvements in visual clarity and crispness after PRK will continue for three to six months.

It’s also vital for patients to know that even though the success rates for PRK surgery are high, not everyone will get perfect results. Nearly 5% of all PRK patients find that their vision could still be better. If this is the case, eye surgeons will usually recommend enhancement procedures, most notably, another PRK surgery for small corrections six months after the initial procedure.

MEDICATIONS TO TAKE BEFORE YOUR PRK PROCEDURE

Your vision will depend on good post-operative care. Please carefully follow these instructions and record your daily medication usage on the form that was given to you. Shake all bottles before using. Place one drop in each operated eye. Wait one minute between drops. When using drops, do not let the bottle top touch your eye. You do NOT need to wake up to put drops in if you are napping or sleeping. THE DAY OF SURGERY Please use in the following order:

Antibiotic (Endsin — Floxacin) 4 times a day;
Steroid (Durezol or Prednisolone) every 2 hours;
Prolensa or Ketorolac (in clear package) 3 times a day for 3 days;
Artificial Tears (Refresh Plus Preservative Free) every 2 hours (at least 8 times per day) for 3 months. Keep refrigerated when at home;

FILL PRESCRIPTION:

800 mg Ibuprofen or 4 Advil tablets 3 times a day. To take the first 3 days by mouth even if you do not experience any pain!
Vicodin 1 to 2 tablets by mouth every 6 hours as needed if you still have pain. Vicodin is a narcotic prescription drug. Do not drive or operate heavy machinery while taking this medication!

MEDICATIONS TO TAKE AFTER YOUR PRK PROCEDURE

THE DAYS AFTER SURGERY

Starting the day after surgery until the contact lenses are removed BY THE DOCTOR, please use in the following order:

Antibiotic (Endsin-Floxacin) 4 times a day;
Steroid (Durezol) 2 times a day. If it’s prednisolone, then 4 times a day;
Acular (in clear package) 4 times a day for pain for the 1st 3 days following your procedure;
Artificial Tears (Refresh Plus Preservative Free) every 2 hours (at least 8 times per day) keeping refrigerated when at home.

FILL PRESCRIPTION:

800 mg Ibuprofen or 4 Advil tablets 3 times a day. To take the first 3 days by mouth even if you do not experience any pain!
Vicodin 1 to 2 tablets by mouth every 6 hours as needed if you still have pain. Vicodin is a narcotic prescription drug. Do not drive or operate heavy machinery while taking this medication!

Precautions

DO NOT REMOVE CONTACT LENSES!
Follow the prescribed course of eye drops (see medications);
Do not read, watch television or work on a computer AFTER your surgery for the rest of the day;
If the contact lenses happen to fall out, DO NOT try to put them back in! CALL 888–678-4341
The doctor will remove contact lenses about 5–7 days after surgery;
Wear your eye shields at night for 1 week (optional);
Do not rub your eyes for 3 weeks;
You may take a shower the day AFTER surgery but keep your eyes closed. Do not allow water to spray directly onto your face. Avoid soap or shampoo in your eyes for 1 week;
Eye cosmetics should not be used for 1 week;
Avoid excessive workouts for 5 days;
Do not swim, use a sauna or hot tub for 2 weeks following your surgery;
No scuba diving for 3 weeks;
Sunglasses are recommended when outdoors for the first 3 weeks to protect your eyes from wind and dust;
You may fly 3 days after surgery.

What to expect after laser eye procedures

Pain and discomfort are normal, and will often increase over time until the contact lenses are removed;
Blurred vision is normal, and may get worse over time, especially on days 3–5;
During the first 3–4 days after surgery, your eyes may burn, sting and tear excessively;
You may feel a foreign body sensation and tearing in the operated eye(s) for the next 12 hours;
Your vision may fluctuate slightly over the next 2 months (especially when reading or using a computer);
You may initially notice loss of detail at night with glare and starbursts. These symptoms tend to resolve gradually over the next few months.

This treatment is designed to restore the natural oil flow to the tear film that covers the eye’s surface.

Preservative-free artificial tears should be used 8 times a day for two months.

After the contact lenses are removed, continue the steroid and antibiotic for 2 days and then use Lotemax or fluorometholone. Your use of Lotemax will depend on your prescription before surgery.

If you had ‑3 diopters of prescription or less, use Lotemax or fluorometholone as follows: 4 times a day for 2 weeks, 3 times a day for 2 weeks, 2 times a day for 1 week

If you had between ‑3.00 and ‑6.00, use Lotemax or fluorometholone as follows: 4 times a day for 2 weeks, 3 times a day for 3 weeks, 2 times a day for 2 weeks

If you were over ‑6.00 and for all hyperopes, use Lotemax or fluorometholone as follows: 4 times a day for 3 weeks, 3 times a day for 3 weeks,2 times a day for 2 week, 1 times a day for 1 week

Please return for an eye examination 6 weeks after contact lenses are removed.