Picking Between PRK vs. LASIK Eye Surgery

A Presurgical Planning Guide

Medically reviewed by Christine L. Larsen, MD

LASIK (laser in situ keratomileusis) and PRK (photorefractive keratectomy) are surgeries to help correct your vision. Both lower and even sometimes eliminate your need for glasses or contact lenses.

This article discusses what happens during LASIK and PRK surgeries, the typical results, recovery for both surgeries, and costs.

A Quick Rundown of Each Eye Procedure

An eye surgeon will evaluate your eyes before either procedure to ensure you are a good candidate. This involves taking several measurements and images of the eye.

You will likely need to refrain from using contact lenses for a few weeks before your surgeon takes these measurements to ensure the most accurate results.

The surgeon and staff should also explain any risks, benefits, and alternatives to the procedure if you qualify for LASIK or PRK.

How to Know If You Need LASIK or PRK

LASIK and PRK can correct several types of refractive errors (vision issues that make it hard to see clearly). Refractive errors that LASIK and PRK can correct include:

• Myopia (nearsightedness; seeing objects up close clearer than distant objects)

• Hyperopia (farsightedness; blurry vision at all ranges)

• Astigmatism (when the front surface of the eye isn't curved as it should be, causing blurred vision at all distances)

For LASIK or PRK, your vision prescription should be stable, and you should be at least 21 years old.

You may qualify for PRK but not LASIK if you have a higher refractive error, thin corneas, large pupils, or you have a high risk of eye injury on the job or in contact sports.

What Happens During a LASIK Procedure

During LASIK, the eye surgeon will use a laser to alter the shape of your cornea, the dome-shaped area in the front of the eye.

Once your eye is numbed with special drops, the surgeon will place an eyelid holder and a suction ring on your eye to stop blinking or moving. Then, they'll make a thin cut in the corneal tissue called a cornea flap. This flap is lifted and folded back.

While staring at a target light, the eye surgeon then reshapes your cornea with help from a laser that contains measures for your eye. The surgeon will place the flap back down over the eye when finished. The entire procedure will take about 30 minutes. You will need someone to drive you home afterward.

What Happens During a PRK Procedure

Like LASIK, PRK involves using a laser to alter the shape of your cornea; however, it does not involve making a flap in the cornea.

During PRK, you'll receive numbing eye drops, and the eye surgeon will use a special holder to stop your eye from blinking. They'll remove the epithelium (outer layer of cells on the cornea). Next, you'll stare at a light while the surgeon reshapes your cornea with a laser using your eye's specific measurements.

PRK lasts about 15 minutes for both eyes. You will need someone to drive you home afterward.

Am I a Good Candidate for LASIK or PRK?

Good candidates for LASIK or PRK:

• Are 18 or older (some eye surgeons will prefer 21 or older)

• Are not pregnant

• Have good eye health

• Are in good overall health

• Have had a stable vision prescription for a year or longer
  

If you have a high refractive error, you may still be a candidate for PRK but not LASIK. Also, LASIK usually isn't recommended if you have a very thin cornea. Your eye surgeon will measure this value when evaluating whether you are a good candidate.

Some patients experience dry eye after surgery. Having dry eye before surgery won't necessarily disqualify you from having LASIK or PRK. Your eye surgeon can review your symptoms and discuss your options.

PRK vs. LASIK: Which Is More Painful?

Neither PRK nor LASIK should hurt during the surgery itself, although you may feel some pressure in the eye.

PRK is associated with slightly more postsurgical pain than LASIK. That's because PRK removes the corneal epithelium. You may have some pain in the eye for a couple of days. Usually, you can take over-the-counter (OTC) pain relievers for any pain after PRK.

It's also possible to feel some pain or discomfort immediately after LASIK. Again, your eye surgeon will likely recommend OTC pain relievers. You may also feel burning, itching, or as if something is in your eye. Let your eye surgeon's office know immediately if you are experiencing severe pain after eye surgery.

Side Effects

Both LASIK and PRK have some similar side effects, including:

• Blurry vision

• Dry eye

• Eye pain

• Glare or halos in your vision

• Light sensitivity

• Scratchy eyes

• Watery eyes

These side effects are more common in the month after surgery and should go away within that time frame. Talk with your eye surgeon if these side effects continue longer than a month.

As with any surgery, there's a risk of infection. There's also the risk of glare, trouble driving at night, or dry eye persisting beyond the initial recovery period. In very rare cases, there's a risk of vision loss.

Cost

The cost of PRK or LASIK will vary depending on your location and what your eye surgeon's office charges.

The average cost for LASIK is about $4,400 for both eyes or about $2,200 per eye. This includes appointments needed before and after surgery.

The average cost for PRK is similar to LASIK, although it can be slightly less expensive.

Why Is PRK Cheaper?

PRK may be slightly less expensive than LASIK because it's quicker. However, the price will depend on where you live.

Results of PRK and LASIK

It will take a month or so for your vision to stabilize so you can see clearly after LASIK or PRK.

Approximately 90% of people who have had LASIK have vision between 20/20 (seeing objects clearly from 20 feet away; considered "normal" vision) and 20/40 (seeing at 20 feet what someone with normal vision would see at 40 feet) without help from glasses or contact lenses. The results are similar to PRK.

In a five-year follow-up of people who had LASIK, 91% were satisfied with their vision. Almost 95% did not wear glasses or contacts to correct their distance vision.

If you aren't happy with your results from LASIK or PRK, your eye surgeon may choose to perform an enhancement surgery. You may also use glasses or contacts to make up for any vision problems the surgery did not fix.

Related: 20/20 Vision and Visual Acuity

How Many Years Does PRK Last?

PRK is a permanent change to your vision. However, some of the natural age-related changes to your vision, such as presbyopia (a loss of up close vision), will still occur, likely in your 40s.

You may also still develop a cataract (a clouding of the lens that can affect your vision), which becomes more common with age and can be removed with cataract surgery.

Recovery From PRK or LASIK

Here are a few things to keep in mind with the recovery process after LASIK or PRK eye surgery.

Recovering From LASIK

The recovery from LASIK is faster than PRK, and you should be able to resume normal activities after one to two days.

It's normal to have some discomfort after surgery, as well as itching or burning. You should be able to use pain relievers for these symptoms.

During the week after surgery, you may experience the following:

• Dryness

• Halos around the eyes

• Puffy eyelids

• Sensitivity to light

Plan to rest your eyes in the first few hours after surgery and to wear sunglasses when you go outside. Your eye surgeon may ask you to wear eye shields at night while sleeping.

Let your eye surgeon know as soon as possible if you experience any severe pain.

Recovering From PRK

The recovery from PRK can be a little longer because the epithelium of the eye has to regrow. This can take three to five days.

After surgery, you will wear a bandage contact lens to protect your eye and let it heal. You may have to take off work for a couple of days and avoid strenuous activities for a week as they could prolong your healing. Ask your eye surgeon about any other activities to avoid in the weeks following surgery.

Some health issues you may experience during the recovery period after PRK include:

• Dry eye

• Eye irritation

• Light sensitivity

Generally, around one-third of people report little discomfort after surgery, one-third report mild pain, and one-third report more significant discomfort after PRK. You should be able to use OTC medicine for eye pain after surgery. If you think you need something stronger, let your eye surgeon know.

You may also have to use eye drops for a month after PRK. You should wear sunglasses for the length of time your eye surgeon recommends to help protect your eyes from scarring and vision loss.

Achieving your best vision after surgery may take a month or up to six months.

Is One Better Than the Other?

Both LASIK and PRK are effective; they just take slightly different approaches. PRK may be a better option if you have thin corneas or are concerned about dry eye. PRK may also be the right choice if you are very active, as this surgery does not involve cutting a flap in the cornea.

You should discuss with your eye surgeon which vision correction surgery is best for your needs.

Summary

LASIK and PRK are both types of surgery to correct your vision. To qualify, you should have a stable vision prescription for at least a year and have healthy eyes. These surgeries can cost upwards of $2,000 per eye.

Both LASIK and PRK have some side effects, such as eye irritation, mild pain, dry eye, and light sensitivity. The side effects should decrease within the month after surgery. Most people are satisfied with their surgical results.

Read the original article on Verywell Health.