LASIK (Laser-Assisted in situ Keratomileusis) and PRK (Photorefractive Keratectomy) are both laser-based corrective eye surgeries that take place in just five minutes per eye. While both procedures cost about the same ($1,000 - $3,000 per eye), LASIK has a faster recovery time and less post-op discomfort. Moreover, LASIK can be performed on both eyes in just one sitting, while PRK patients usually space the procedure two weeks apart for each eye.

Patients are usually able to choose between LASIK and PRK for themselves, but in some cases the condition of the cornea determines which procedure is a better choice.

Comparison chart

LASIK versus PRK comparison chart
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Acronym for Laser Assisted In Situ Keratomileusis PhotoRefractive Keratectomy
Type of Laser-based corrective eye surgery to reduce dependency on glasses or contact lenses. Laser-based corrective eye surgery to reduce dependency on glasses or contact lenses.
Treatment for Myopia (nearsightedness), hyperopia (farsightedness), astigmatism. Myopia (nearsightedness), hyperopia (farsightedness), astigmatism. Prefered for people who have a thin cornea.
Eligible Age 21-40 21-40
Cost $1,000 to $3,000 per eye $1,250 to $3,000 per eye
Pros Faster recovery; Decreased risk of post-surgery infection inflammation, haze; Decreased post-op discomfort; Peak vision achieved faster than PRK; Both eyes done at the same time. Decreased depth of laser treatment; No complications from corneal flap; Corneal thickness regulated.
Cons Increased depth of laser treatment Possible complications from corneal flap. Recovery slower than LASIK Increased risk of post-op complications Greater post-op discomfort Patients sometimes wait one to two weeks between eyes.
Potential Side Effects Light sensitivity during nighttime; Night blindness – halos around lights; Dry eyes; Infection; Dislodged corneal flap Light sensitivity during nighttime; Night blindness – halos around lights; Dry eyes; Infection
Criteria No eye injuries or infections within a year; Stable prescription for minimum one year; No history of dry eyes; Normal depth cornea. No eye injuries or infections within a year; Stable prescription for minimum one year; No history of dry eyes.
Post-Op Protective sunglasses; Prescription antibiotic eye drops. Protective sunglasses; Prescription eye drops (antibiotic and anti-inflammatory).
Recovery Blurring and discomfort gone within 24 hours; Vision improved immediately, though may take a few days to several weeks. One to three days for blurring and discomfort to subside; Up to six months before peak accuracy and clarity in vision is reached.
Outcome 20/20 vision or better 20/20 vision or better

Applications

LASIK is used to treat nearsightedness, farsightedness and astigmatism, and is usually the preferred surgery because of its short recovery time.

PRK was originally developed only to treat patients with myopia, or nearsightedness, but advancements in the technology has extended it as treatment for hyperopia (farsightedness), and astigmatism. PRK is recommended for patients with thin corneas.

Ophthalmologists require patients meet the following criteria for either LASIK or PRK treatments:

PRK and LASIK Explained

These videos by PreOp Patient Education explain when PRK and LASIK are performed and what to expect:

What is PRK and how does it work?

What is LASIK? How does LASIK work?

Procedure

Both procedures work by changing the shape of the cornea so that light is focused correctly for improved vision. The surgeon first numbs the eye with anesthetic drops and inserts eyelid holders to prevent blinking.

For LASIK, a corneal flap is created using either a blade or a laser. The flap is lifted and an excimer laser is used to reshape the cornea by ablation (removing microscopic layers). The cool ultraviolet pulses are controlled by a computer. When finished reshaping, the flap is restored in its original position. There is no need for contact lens, bandages or stitches. The corneal flap heals naturally. The procedure takes approximately five minutes.

For PRK, surgeons remove a central area of the corneal epithelium (cellular layer of the cornea) with a blunt surgical instrument, an alcohol solution or a buffing device. They then use an excimer laser to ablate layers of the cornea. A computer controls the pulses of cool ultraviolet light according to the specifications of patients' vision correction. A soft contact lens is placed as a bandage to protect the eye until the corneal epithelium grows back, which usually takes five days. Like LASIK, the procedure takes approximately five minutes in all. Some patients choose to have the second eye done during a separate visit.

Post-Operation

Both surgeries require patients to have someone drive them home. Patients can also expect to wear protective sunglasses and use prescription antibiotic eye drops. In addition, PRK patients may use anti-inflammatory eye drops.

Patients typically recover more quickly from LASIK. They experience blurry vision and discomfort for the first few hours, but improve within 24 hours. Vision is improved immediately in most cases, although some patients are known to have waited a few days or even a few weeks to achieve peak clarity in vision.

Patients who undergo PRK have to wait one to three days for the blurring and discomfort to subside. Vision often takes between a few days to a couple weeks to show improvement. However, patients typically do not achieve peak accuracy and clarity in vision for three to six months.

Patients undergoing either procedure can expect 20/20 vision. Either procedure may call for enhancement surgery, an additional LASIK or PRK, for maximum results.

Permanence

The corneal reshaping in both LASIK and PRK is permanent, especially if the eyeglass prescription was stable before surgery. It does not, however, prevent age-related vision changes in the future. Age-related changes depend on the family history, and may occur regardless whether you go in for LASIK or PRK.

After-Effects, Risks and Advantages

LASIK and PRK cost about the same - $1,000 - $3,000 per eye - and like any surgical procedure, carry some risks. The most typical side effect is increased dryness in the eyes, necessitating the use of eye drops long after the eyes have healed. Many patients report light sensitivity during the night. This usually manifests as night blindness, or seeing halos around lights. Either procedure can result in an infection. If patients rub their eyes after LASIK, they may dislodge the corneal flap. There are other possible complications that LASIK patients need to be aware of.

The common flap-related complications include thin flap, button holing, free caps, flap dislocation and flap striae. The interface complications of diffuse lamellar keratitis, epithelial ingrowth and microbial keratitis are potentially sight threatening. Compared to PRK, there is less inflammation and faster healing after LASIK, but there is a longer period of sensory denervation leading to the complication of dry eyes. The refractive complications include under-correction, regression, irregular astigmatism, decentration and visual aberrations.

LASIK has some advantages over PRK. Patients recover more quickly and suffer from less risk of infection, inflammation and hazy vision. They feel less post-op discomfort and achieve their peak vision results more quickly. Both eyes are usually done in just one visit. However, LASIK patients sometimes suffer from complications surrounding the corneal flap, such as dislodging it. Surgeons also go deeper with the excimer laser in LASIK than in PRK. Surgeons are able to regulate the thickness of the cornea more easily with PRK. All types of corneal refractive surgery cause transient reduction of tears secretion[1], especially during the first three postoperative months. But the secretion of tears is reduced most significantly with LASIK.[2]

With PRK, patients sometimes wait one to two weeks between eyes. They feel greater post-op discomfort and have more risk of complications such as infection, inflammation and hazy vision. They also have to wait up to six month to achieve peak acuity and clarity in their vision.

References

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