Photorefractive Keratectomy Eye Surgery

Medically Reviewed by Zilpah Sheikh, MD on January 10, 2024
Written by Sarah Vanbuskirk
5 min read

Also known as PRK, this type of laser eye surgery can help if you are nearsighted, farsighted, or have astigmatism. It works best if your eye problem is mild or moderate.

All laser vision correction surgeries work by reshaping your cornea, the clear front part of your eye. Think of it like a windshield: Light travels through it and focuses on the retina in the back of your eye.

During PRK, an eye surgeon uses a cool pulsing beam of ultraviolet light on the surface of your cornea. LASIK, another type of laser surgery, works underneath your cornea.

Photorefractive keratectomy vs. LASIK

PRK and LASIK are similar surgeries that achieve similar results. Both procedures use lasers to reshape the cornea. The main difference is that a flap is cut into the cornea during LASIK before using the laser. During PRK, the laser is used directly on top of your cornea. LASIK heals quicker, giving you clear vision within hours or days, while PRK takes a few weeks.

You are an ideal candidate for PRK if are 21 years or older with vision that has not changed in year or longer. You also need to have healthy corneas and eyes and have the type of vision problem that this surgery can repair.

PRK surgery contraindications

PRK is not right for you if you have certain problems with your eyes, such as very dry eyes, cataracts, a history of eye infections, high pressure in your eyes (glaucoma), scarring, or other eye conditions. Don’t get PRK if your vision is changing, you have diabetes, or you are pregnant or nursing. 

It’s highly accurate in correcting many cases of nearsightedness. Most people have 20/20 or at least 20/40 vision without glasses or contact lenses 1 year after the surgery.

It isn’t a walk in the park. You might have:

  • Mild discomfort, including minor eye irritation and watering, for 1 to 3 days after the procedure.
  • A longer recovery time. People who get LASIK notice improvements in less than a month. With PRK it can take 1 to 3 months.
  • A need for glasses.

You’ll have mild to moderate discomfort in the first 24 to 72 hours after surgery. Some people experience dry eyes or the feeling of having sand or grit in the eyes.

You might be sensitive to light for a while, too, and you’ll need to be on a regimen of eye drops for a few weeks. You won’t be able to drive for a week or more. Other possible side effects include cloudy vision (called corneal haze) or seeing glare or halos when looking at lights, especially at night. Less commonly, you could get an eye infection or scarring on your cornea.

Within the first 6 months you might notice that you need eyeglasses for improved vision. In rare cases, surgery results in loss of vision or blindness.

 

First you’ll meet with an eye surgeon or a coordinator to talk about what you should expect during and after surgery. They’ll discuss your medical history and check your eyes. Likely tests include:

  • Corneal thickness measure
  • Refraction
  • Corneal mapping
  • Eye pressure check

After that, your surgeon will answer any questions you have. Then you’ll schedule your surgery.

If you wear contacts, you’ll need to stop for a while before the evaluation:  

  • Gas permeable: 2 weeks
  • Other types: 5 days

On the day of surgery, eat a light meal before going in, and take all of your prescribed medications. Don’t wear eye makeup or bulky hair accessories that will make it hard to place your head under the laser. If you don’t feel well that morning, call the doctor's office to find out if the procedure needs to be postponed.

The doctor will numb your eye with a medicine called a topical anesthetic.  The surgery usually takes about 10 minutes, at most -- and that’s for both eyes. They'll carefully remove an area of surface epithelium, or “skin,” to get to the top layer of your eye. Then the doctor will use a laser to reshape it. This laser, which delivers ultraviolet light, is used on the cornea’s surface.

Who performs photorefractive keratectomy eye surgery?

Eye doctors, also called ophthalmologists, perform PRK. Cornea specialists tend to be the most experienced, but other types of eye doctors can do laser eye surgeries as well.

Most of the time, the doctor will apply a bandage contact lens after surgery. You’ll wear it for the first 5 to 7 days to let the surface of your eye heal. You’ll see the eye doctor at least a few times during the next 6 months. The first visit is usually 1 day after surgery; the second visit, in which the doctor will remove the contact lens, happens about a week later.  

Your vision may switch from clear to blurry for the first few weeks. Until it evens out, you might need glasses to read or drive at night. Your eyes will be dry, even if they don’t feel that way. The doctor will prescribe eyedrops to prevent infection and keep your eyes moist. They might sting or blur your vision for a few seconds. Don’t use any drops your doctor hasn’t approved.

Your vision will get better slowly. You should be ready to drive within 1 to 3 weeks. But you probably won’t see your best for 6 weeks to 6 months.

Probably so. That’s because presbyopia (blurred reading vision but great distance vision) happens to almost everyone in their 40s. Reading glasses solve the problem. So does a process called monovision, where one eye focuses up close and the other focuses far away. You can get it with contacts or through laser refractive surgery, like LASIK or PRK. Ask your doctor if it’s right for you. 

PRK is an elective surgery that most health insurance companies do not cover. This means you will likely need to pay for the procedure yourself. Cost varies widely. The average price is between $1,000 to $3,000 per eye.

If you are a good candidate, PRK can improve your vision. You will usually no longer need to wear glasses or contact lenses. Talk to your eye doctor to find out if PRK is right for you.  

  • Is PRK really better than LASIK?

Both surgeries are safe and work well, giving most people 20/20 or better vision. PRK is a slightly shorter and less costly procedure, but healing takes longer than with LASIK. PRK is a better option if you are very nearsighted, have thin corneas or dry eyes, or play competitive sports.

  • Is PRK more permanent than LASIK?

Both surgeries give you permanent vision correction.