PRK or LASIK

[michaelscai]

I'm considering PRK instead of LASIK from the stuff I read here, am I a good candidate? I'm 39 and -6 on one eye and -1.75 on the other, have enough thickness for Lasik

are there any downside of PRK other than more discomfort and longer recovery time?

[LasikExpert]

I am biased toward PRK for one simple reason: No Lasik flap means no possibility of a Lasik flap complication. Even though the probability of a Lasik flap complication is low, no possibility is almost always going to be better than a low probability.

PRK has a slightly higher risk of infection, which is accommodated with medication.

Discuss your options with a competent surgeon after a comprehensive examination.

[PRKorIntacs]

Perhaps consider getting PRK in the -6 eye and leave the other alone for monovision. If monovision isn't for you, get the -6 eye down to -1.75 to match the other eye and eliminate anisometropia/aniseikonia.

[michaelscai]

Perhaps consider getting PRK in the -6 eye and leave the other alone for monovision. If monovision isn't for you, get the -6 eye down to -1.75 to match the other eye and eliminate anisometropia/aniseikonia.

interesting thoughts. if I get the -6 eye down to -1.75, do I still have the option of further correction without much complication to 20/20 if I want to do that later?

what's the monovision you are refering to?

is there any other downside for PRK vs lasik other than initial discomfort, higher infection possiility? I read lasik is about 90% of lasik surgery, if PRK is superior for long term, why don't more people opt for PRK..

thanks.

[LasikExpert]

if I get the -6 eye down to -1.75, do I still have the option of further correction without much complication to 20/20 if I want to do that later?

Yes. In theory, you can have as many enhancement surgeries as you want, so long as there is enough corneal tissue to maintain stability.

what's the monovision you are refering to?

See our article about monovision.

is there any other downside for PRK vs lasik other than initial discomfort, higher infection possiility? I read lasik is about 90% of lasik surgery, if PRK is superior for long term, why don't more people opt for PRK.

Lasik provides nearly instant results with virtually no pain. PRK provides slow vision recovery with discomfort. Considering that Lasik is so successful in the vast majority of cases and the long-term advantage of PRK is relatively small, it is not surprising that PRK is less popular.

[michaelscai]

I'm thinking of PRK over lasik - no flap, same results for near sightedness, less intrusive, less dry eye?

Is PRK patient less prone to dry eye because it's less intrusive to the cornea compare to lasik?

[LasikExpert]

It is generally believed that the deeper into the cornea that tissue is disturbed, the greater the probability of dry eye issues because nerves are being disrupted deeper.

You have already had Lasik and you would have experienced whatever dry eye problems Lasik would create, so you know what you could expect if you were to have Lasik enhancement instead of PRK on the Lasik flap.

[michaelscai]

Is PRK easier for enhancement as well if enhancement is needed at a later time? since no flap to lift again??

Also, I'm readying about this LASEK which is a modified form of PRK, is there any point of going with LASEK vs PRK? so confusing

[LasikExpert]

Is PRK easier for enhancement as well if enhancement is needed at a later time? since no flap to lift again??

"Easier" is a relative term. PRK on the Lasik flap is probably easier for the surgeon, but your vision recovery will be slower with PRK than with a Lasik enhancement. It may not be possible to do PRK on the Lasik flap if the flap is too small or too thin. Your surgeon can measure flap thickness before a final recommendation. As a (very) general rule, PRK is on the surface and does not require lifting the flap. That is likely to be less traumatic to the eye, but the removal of the epithelium makes for slower vision recovery.

Also, I'm readying about this LASEK which is a modified form of PRK, is there any point of going with LASEK vs PRK? so confusing

My personal opinion is that LASEK is unnecessary. There is no proven long-term advantage to LASEK over PRK. The original purpose of LASEK was to reduce the probability of corneal haze, but that is resolved nearly completely with the use of Mitomycin C (MMC) during the PRK surgery. If you read LASEK vision recovery you will find that it is a little better than PRK in the first few days, gets worse than PRK at about 2-3 weeks postop, and then ends up taking just a bit longer than PRK to finally resolve. Talk to your surgeon about his/her personal preferences and question why.

[The Pezman]

My personal opinion is that LASEK is unnecessary. There is no proven long-term advantage to LASEK over PRK.

I checked out the Wikipedia article on the subject:

In PRK, epithelium is removed and the outermost layer below the epithelium is treated with laser. In LASEK, epithelium is not removed, but an alcoholic solution is used to cause the epithelial cells to weaken; the surgeon will fold the epithelial layer out of the laser treatment field, and fold it back in its original place after cornea has been reshaped by laser.

If I understand that correctly, this means that LASEK attempts to maintain most of the corneal thickness, whereas PRK just destroys it outright. If that's the case, wouldn't LASEK ultimately be the surgery which leaves your eyes the closest to how they were?

[LasikExpert]

If I understand that correctly, this means that LASEK attempts to maintain most of the corneal thickness, whereas PRK just destroys it outright. If that's the case, wouldn't LASEK ultimately be the surgery which leaves your eyes the closest to how they were?

The epitheliaum is the soft thin outermost layer of the cornea. Epithelial cells do not contribute to the structural integrity of the cornea. The amount of structual cornea removed by a laser is exactly the same in LASEK and PRK.

In both LASEK and PRK the epithelial cells are mortally wounded. All of them die off and are replaced by new cells. Corneal epithelial cells are the fastest reproducing cells in the human body. In PRK the cells are removed during the surgery and are replaced by new cells. In LASEK the dead and dying cells are repositioned back over the cornea, slough off, and are replaced by new cells. The amount of epithelal cells that die and are replaced are exactly the same in PRK and LASEK.

The only difference between PRK and LASEK is that the dead and dying epithelial cells are repositioned over the cornea in LASEK, and removed in PRK. THe reason LASEK has a bit of a roller coaster ride vision recovery is the process of sloughing off the dead cells and replacing them with new ones. PRK just needs to grow new cells. PRK does not need to get anything out of its way to create a new epithelium.

LASEK was developed to resolve a limitation of PRK, which is corneal haze for higher corrections and patient discomfort. It was thought that putting the dead cells back over the cornea would act like a "bandage" and reduce the probability of haze and patient discomfort. There have been several studies that show vision recover at three and six months is exactly the same with LASEK and PRK. Additionally, many studies affirm that there is virtually no difference in patient discomfort between PRK and LASEK.

In my opinion, and the opinion of many fine surgeons, LASEK is just so much expensive luggage.

[The Pezman]

Okay. What about PRK vs LASIK when it comes to follow-up operations? What is the rough likelihood that one will be needed in either case? With LASIK, I already understand the danger of disturbing a flap already reset, but with PRK they could shave off more of your cornea. What are your thoughts on that?

[LasikExpert]

Okay. What about PRK vs LASIK when it comes to follow-up operations? What is the rough likelihood that one will be needed in either case?

Virtually the same.

With LASIK, I already understand the danger of disturbing a flap already reset, but with PRK they could shave off more of your cornea. What are your thoughts on that?

Many doctors now do PRK on the Lasik flap rather than conventional enhancement Lasik surgery that would require lifting the flap.

I am honestly biased toward the surface ablation procedures of PRK, LASEK, and Epi-Lasik over Lasik. Even though the probabability of a Lasik flap related problem is very low, no possibility of a problem is almost always better than a low probability. Of the surface ablation techniques PRK, LASEK, and Epi-Lasik, I believe PRK is the most efficient, but in the long term (3-6 months) the results are likely to be identical.

[michaelscai]

I was leaning towards PRK but from what i read PRK can be pretty painful a few days after the surgery, and takes longer up to 6 months for vision to be stable.. I'm now leaning towards intralase lasik.

do most people experiene little pain after suggery or is it the norm to have a lot of pain for 5-6 days after the surgery? I definitely don't want to have a traumatic experience if I don't have to..

[DeadWomanWalking]

I sincerely beg you with all my heart not to get any of these surgeries on your eyes. Please google something like "lasik complications" or "prk complications." I thought I had done research and I chose a supposedly respected surgeon, but have had devastating and irreversible problems. I am suicidal every day. PLEASE, PLEASE, PLEASE don't do it. Also look into the dry eye complications from these procedures. DO NOT listen to the people who tell you that the complications are rare. If you look into it, you will see how untrue it is. Remember what I did not, it is irreversible. Buy the most advance contact lenses or the coolest glasses. I spent $4000 to ruin my vision 4 months ago and have since spent almost $2500 more going to specialists, buying glasses, eye drops, medication, etc. and there is no end. It has ruined my family and my children's lives and put us in a financial hardship situation. Please!