How do I decide between PRK and LASIK?

For some people the choice is easy. There are certain conditions which may be present which mean you only qualify for PRK. For others who qualify for both LASIK and PRK the choice can be more challenging.

In order to make a good decision it is important to gather as much infomation you can about PRK and LASIK. You must understand the basics of these two methods of laser vision correction before you can begin to make a well informed choice.

With both procedures numbing drops are used to freeze the surface of the eye. For PRK the surface cells are removed and the laser energy is applied to the corneal surface. For LASIK a flap is created with a device called a microkeratome. The flap is lifted and the laser energy is applied to the corneal tissue underneath the flap. More detailed information about the two types of laser vision correction can be found on our webiste. Other websites which have reliable information include http://www.aao.org/ (American Academy of Ophthalmology) and http://www.mayoclinic.com/ .

You should watch the DVD or video provided at the pre-operative evaluation, read all information provided to you by your surgeon (including consent forms), and ask a lot of questions. There are many basic questions that can be answered by qualified staff, but if you are feeling unsure about your choice you should request to speak to your surgeon. It may help to make a list of all your questions to bring to the appointment or to guide you during a telephone conversation with staff.

There may be individual factors which make you a better candidate for LASIK or PRK. For example, extremely farsighted (hyperopic) people may have a better result with LASIK due to a tendency to heal back towards farsightedness following PRK. For nearsighted (myopic) people this is not an important factor with the newer PRK techniques. Another example is thin corneas. If a cornea is too thin for a given correction then PRK may be recommended since it is not as deep a treatment and does not weaken the cornea as much.

As a general rule the following would be true for people who qualify for both LASIK and PRK:

These results will be the same with PRK or LASIK

– the longterm results are equally good for most prescriptions
– if you are over 40 you are likely to need glasses for reading and other close work

– the night vision may take longer to improve (up to 12 months in some cases)

– most people feel their night vision is similar to pre-operative night vision

– glare or halo present with corrective lenses may be present permanently after surgery

– dry eye is a common side effect of laser vision correction, usually improving over months

– the overall sharpness of vision can improve up to a full year

– there is a chance a second treatment (enhancement) may be needed for best vision

– safety glasses for sports or activities such as using power tools is always recommended

These results may be different with PRK or LASIK

– LASIK is more complex and a deeper treatment and carries a slightly higher risk

– risks of LASIK include flap problems during an after surgery

– the LASIK flap can be shifted even years later with trauma to the cornea

– PRK is a simpler procedure with less risk for most people

– PRK does not create a flap so there is less risk with future injury

– PRK is not as deep a treatment so there is less risk of weakening the cornea (ectasia)

– for thin corneas or irregular corneas PRK may be preferred

– for high farsighted or high astigmatism corrections LASIK may reduce enhancements

– there is a very slight chance of haze or scarring with PRK

– the chance of haze or scarring with PRK is greatly reduced with newer lasers

– PRK takes longer to recover with 7-10 days before return to activities like driving

– with PRK the vision may be blurry for up to a month or more

– LASIK has less discomfort in the first few days compared to PRK

– LASIK has more rapid visual recovery with return to usual activities in 1 or 2 days

Overall if you qualify for both PRK and LASIK the bottom line is that you trade a higher risk with LASIK for more rapid recovery. With PRK you are choosing a lower risk with the understanding that the recovery of vision is more gradual and there may be more discomfort in the first few days following surgery.

There may be factors individual to your own eye health, your correction, your overall health or medications, or lifestyle requirements that may make you a better candidate for one procedure or the other. It is important to listen carefully to the recommendations of your surgeon. If you have any questions be sure to ask.

You can get more information by scheduling a free consultation with Dr. Anderson Penno at Western Laser Eye Associates.