Photorefractive keratectomy, or PRK, has been approved by the Food and Drug Administration in the United States since 1996. The PRK procedure corrects vision by reshaping the cornea. It is used to treat low to high levels of nearsightedness, farsightedness, and astigmatism. PRK differs from LASIK in that the epithelium, or the outer layer of the cornea, is removed entirely during the procedure in order to access the stroma, or inner layer of the cornea. It is often recommended to those who cannot undergo LASIK due to having thin corneas that cannot accommodate a tissue flap.
For nearsighted patients, the goal of the PRK procedure is to flatten a steep cornea. To improve vision in farsighted patients, PRK is used to increase the curvature of a cornea that is too flat. To treat astigmatism, the procedure reshapes the cornea, making it more spherical. Dr. Andrew Holzman can assess your PRK candidacy during a consultation at one of his five Washington, D.C.-area offices.
How Does PRK Differ From LASIK?
You've likely heard of LASIK, but many of our patients are less familiar with photorefractive keratectomy (PRK). Both types of refractive surgery share the same goal: to reduce or eliminate your dependency upon corrective eye wear like glasses and contacts. Both surgeries can correct nearsightedness, farsightedness, and astigmatism by reshaping the cornea. The two differ in their approach to reshaping the corneal tissue.
During PRK, the entire outer layer of the cornea, the epithelial layer, is removed. Dr. Holzman uses a "buffing" device to remove the corneal epithelium, and an excimer laser to precisely reshape the curvature of the tissue underneath. During LASIK, on the other hand, the inner layers of the cornea are accessed through a surgically created flap. Following LASIK surgery, the flap is simply closed shut. After PRK, a soft "bandage" contact lens will be placed to facilitate healing of the eye. New epithelial cells will begin to regenerate within three to five days.
Assessing Patients' Candidacy
During your initial consultation with Dr. Holzman, he will determine if PRK or another treatment is the best way to achieve your goals. In order to make this decision, he will thoroughly examine your eyes to assess corneal thickness, the size of your pupils, the moistness of your eyes, and the degree of correction you require. He will also review your medical history and current medication intake to check for any conditions that would contraindicate PRK.
You can be assured that Dr. Holzman will not recommend PRK unless he determines that you are an excellent candidate.
Patients who are not good candidates for LASIK are often good candidates for PRK. LASIK requires a certain corneal thickness to facilitate creating a hinged tissue flap in the outer layer of the cornea. If your cornea is too thin to accommodate a flap, PRK may be the recommended alternative.
Meanwhile, patients with large pupils, thin corneas, corneal scars, a history of radial keratotomy, or corneal implants should not have LASIK, but may be candidates for PRK. Patients who participate in contact sports or have jobs that may subject them to eye injuries may not be good candidates for LASIK due to the possibility of flap complications. These patients may be better candidates for PRK.
To be a good candidate for PRK, you should:
- Be over 18 years of age to ensure that your eyes have matured and developed properly.
- Have stable vision for at least a year.
- Not be taking medication such as Imitrex®, Accutane®, Cordorone®, or any steroids because they can interfere with healing processes.
- Have no abnormalities of the external eye or cornea. Patients who have or are at risk for keratoconus, for example, should not undergo PRK.
- Have no allergies to local anesthesia, since your eyes will be numbed before surgery.
- Not have an autoimmune disease or immunodeficiency, which can interfere with proper healing.
- Not have diabetes or arthritis.
- Not be predisposed to keloids, which is irregular or excessive scarring at the surgical site.
- Not have collagen vascular disease, since it can lead to corneal ulceration.
- Not have glaucoma.
- Not be pregnant or breastfeeding.
Dr. Holzman has performed over 70,000 vision correction procedures with life-changing outcomes. You can be assured that he will not recommend PRK unless he determines that you are an excellent candidate.
Risks and Benefits
As with all laser vision correction techniques, there is a very small risk of scarring or infection as a result of the procedure. Dr. Holzman and TLC Laser Eye Centers use special protocols and medications to specifically minimize all risks and adverse side effects. PRK surgery is minimally invasive and is performed on an outpatient basis, meaning patients can return home the day of surgery.
Comparable Results to LASIK
PRK candidates can expect to achieve results similar to LASIK. Although it typically takes longer to fully recover and achieve optimal results following PRK, the procedure remains the vision correction method of choice for patients with especially thin corneas or scars that prevent them from being suitable candidates for LASIK. In general, more than 90 percent of patients achieve at least 20/40 vision after PRK, and more than 70 percent achieve 20/20 vision. As few as one percent of patients require a touch-up procedure following their initial surgery. Just five percent of patients need to continue wearing glasses or contacts (usually at a much lower prescription) after PRK. Patients who undergo PRK surgery should take extra precautions when driving, as vision and depth perception may fluctuate.
Temporary Side Effects
Even safe PRK surgery performed by an experienced surgeon will result in some temporary side effects, including irritation, sensitivity to light, and unstable vision. By following your surgeon's directions and attending follow-up screenings, these side effects will gradually subside.
Dr. Holzman's vast experience in PRK and other refractive surgeries can minimize risks and ensure a successful outcome.
There are few serious risks involved, making it one of the safest vision correction procedures available. Patients are often at a greater risk of an allergic reaction to the sedative or their prescription pain medications than any complications related to the surgery itself.
The steroidal eye drops prescribed following PRK surgery also carry some risks. Minor risks include irritation and itching, as well as redness and inflammation. More severe risks may include a rise in intraocular pressure, which can result in glaucoma, as well as damage to the optic nerve and the development of cataracts. In addition, PRK risks include:
- Undercorrection or Overcorrection: Depending on the method your surgeon uses to assess the amount of correction you require, your surgery could result in too little or too much corneal tissue being removed, resulting in less-than-perfect vision.
- Regression: For some patients, as the cornea heals, it may regenerate cells that reverse the corrections made by the surgery. These new cells can lead to a regression in vision. Mitomycin C, a prescription medication, can reduce this risk.
- Loss of Clarity from Best Corrected Vision: Following PRK, there is a chance that you will not see with the same clarity you would have with glasses or contacts.
- Corneal Ulcers: A rare but serious risk of PRK is the development of corneal ulcers. Antibiotics can help reduce this risk.
- Astigmatism: If a patient’s eyes heal improperly, or there is an error in the modification of the corneas, the patient may develop astigmatism, or corneal asymmetry resulting in a compromised ability to focus.
- Increased Intraocular Pressure: Increased intraocular pressure (IOP) can result from PRK surgery. If IOP is not controlled, it can damage the optic nerve, leading to partial or total vision loss.
Careful assessment of your PRK candidacy can dramatically reduce the risk of complications and boost the likelihood of a successful surgery. For example, if you have an autoimmune disorder, take steroids, or have keratoconus, you may not be able to safely undergo the procedure. Dr. Holzman conducts an in-depth evaluation before recommending PRK or any refractive surgery to ensure the safety and satisfaction of his patients.
Patients must understand that even if they are excellent candidates, and if an experienced surgeon performs their procedure, the results of PRK will not last forever, and they may not provide complete freedom from corrective eyewear. As we age, vision inevitably declines, and this is true for those who have undergone refractive surgery as well as those who have not. Presbyopia, or age-related farsightedness, is a condition in which the crystalline lens loses elasticity, and can no longer complement the cornea to provide the same degree of focus. Patients may eventually elect to have a "touch-up" procedure to restore the results of PRK, or undergo other treatments to keep their need for corrective eyewear at a minimum.
“... the eye consultation was free and my sister spoke very highly of TLC. so I researched them a little more and went for the consultation. They only do laser eye correction and the doctors were extremely positive and informative. None of my interactions ever seemed rushed and they genuinely seem to care about how things r going... I ended up getting prk... I'm at 20/15 vision and very happy!!”Lola S. - January 24, 2018
How Much Does PRK Cost?
When you meet with Dr. Holzman, you will have the opportunity to discuss your total treatment cost. PRK cost is determined using a variety of factors, including the region in which we practice, but you should know it is never a good idea to compromise quality for price. Simply put: choose a doctor with extensive experience, modern techniques, and sophisticated technology to ensure that you are making a quality investment in your vision.
Choosing a credentialed surgeon can help you experience the best returns on your investment in PRK.
Factors to Consider
In determining PRK cost, doctors take a variety of factors into consideration. Considerations vary widely from doctor to doctor, but most of them include:
- Regional pricing
- Experience of Doctor
- Complication and extensiveness of procedure
- Cost of anesthetic or sedative
- Advanced equipment
We strive to show patients the quality of care they are receiving here, and that their care is provided at a competitive price. During your consultation, you can ask more about the costs associated with your specific procedure, as well as how we decide on the final PRK cost.
Regardless of what doctor you choose, there is always a chance that you will require revision surgery. Despite the sometimes cheaper pricing, it is essential to trust your care to a doctor who is dedicated to the quality of your vision and who will be there when you need them. If the doctor you are considering is new to the area, they may be employed by a larger corporation that rotates its staff around the country. In the event that you require additional visual correction, you may have to turn to a new doctor, who may not be able to acquire the medical information they need to provide you with effective care.
Dr. Holzman strives to help his patients achieve clearer vision and keep it sharp, and goes to great lengths to ensure a high standard of care.
Dr. Holzman is an established local doctor, and has performed many secondary procedures for his extensive patient base. He also offers touch-ups at no additional charge during the year following your initial surgery.
One of the most important benefits of undergoing PRK surgery is that patients almost always save money in the long run. Refractive surgery eliminates the cost of contact lenses, glasses, contact lens solution, repeat prescriptions, and additional vision products that can add up to hundreds of dollars per year. And if you could put a value on the convenience of vision care following PRK surgery, the savings would be even more profound.
Health complications as a result of contact lense use requiring additional care are no longer a concern when you choose refractive surgery. Corneal infections are common among even the most diligent contact users, often requiring multiple doctor visits, antibiotics, and expensive professional-strength eye drops. Pair this with the time you could be losing at work as a result, and the choice is simple
What to Expect during Treatment
Though each patient's experience will differ slightly, you can expect several stages of care:
The Day of Your Procedure
After arriving at your scheduled time, a friendly member of our staff will give you a sedative to help you relax. We will then prepare you for surgery. We will clean the area around your eyes and then apply anesthetic eye drops to your eyes to keep you comfortable during the procedure. There is no need for any needles or injections. Once your eyes are completely numb, we will place an instrument called a speculum to hold your eyelids open and prevent you from blinking during the procedure.
In general, more than 90 percent of patients achieve at least 20/40 vision after PRK, and more than 70 percent achieve 20/20 vision.
Once you have been prepped, Dr. Holzman will remove the epithelium, which is the thin outer layer the cornea. This tissue is discarded, but regenerates on its own in about a week. He will ask you to look directly at a target light while he uses the laser to reshape your cornea. The laser is programmed according to the information about your refractive error gathered during your pre-operative exam. The laser treatment takes less than a minute per eye to complete.
After PRK Surgery
Following your PRK procedure, Dr. Holzman will examine your eyes with a slit lamp. He will then shield them with soft clear contact lenses that act like bandages. You will wear these for three to five days after surgery as they foster the healing process. You may experience blurred or hazy vision for one to five days. As the epithelium heals, you may notice some discomfort. To minimize any pain, we can provide you with eye drops and pain medication. In most cases, you can return to normal activities within one to three days. Your vision may continue to fluctuate for up to six months following the procedure.
To ensure that your healing process is quick and comfortable, you should follow specific guidelines:
- Do not rub your eyes
- Wear protective eyewear as you sleep
- Sweat can harm the healing of your eyes, so only do moderate exercise
- Use artificial tears to keep your eyes moist
- Do not go into a sauna or hot tub
- You can shower normally
- Do not go swimming until you are cleared by your doctor
- Avoid getting particles from smoke, dirt, dust, soap, and other substances in your eyes
- Take Vitamin C and Omega 3 supplements to help the healing process
- Avoid extreme weather conditions for several months
- Notify Dr. Holzman if your bandage contact lens becomes dislodged or if you have symptoms such as irritation or yellow pus in your eye
If you follow Dr. Holzman’s postoperative instructions, you should be able to return to daily activities quickly. As your vision improves over the first few days, you can watch TV, use a computer, or read. Many patients are able to safely drive within the first week following surgery.
PRK Recovery Timeline
The recovery timeline for PRK is a bit longer than LASIK, but can result in comparable enhancement. During the PRK recovery period, patients may also experience a glare or halo effect and light sensitivity. The typical recovery is complete within six months:
- One to Three Days: Over the first few days of your recovery, you may experience some irritation and discomfort. You may also notice some sensitivity to light. The medications and eye drops Dr. Holzman provides can help minimize these side effects. It is usually best to take these days off work or school so you can rest your eyes and allow the epithelium to regenerate.
- Three to Five Days: You will return to our office three to five days after your surgery. Dr. Holzman will remove the bandage contact lenses at this time since most, if not all, of your epithelium will have grown back. You may have blurry vision temporarily but you can usually return to your regular activities at this point.
- One to Three Months: Your vision should continue to sharpen and stabilize during this time. Fluctuations should become less frequent.
- Three to Six Months: By this time, your vision should be stabilized completely and you can fully enjoy a reduced or eliminated need for glasses or contacts.
“I just had my PRK procedure yesterday at TLC in Charlottesville VA. I've been wearing glasses since 2nd grade & I can't thank the staff and Dr. Holzman for giving me the best experience with lasik I could have asked for. Would highly recommend them to anyone who is looking into having LASIK.”Madalyn Waybright Quinlan - May 11, 2016
Learn More about PRK
If you are tired of relying on contacts or glasses to correct your vision, contact our office to schedule a laser vision correction consultation with Dr. Holzman. He will evaluate your current vision, ocular health, and goals to determine whether PRK or another procedure is right for you.
“Dr. Holzman is the best - very honest, very professional yet very friendly and personable.” Ben E.