PRK, LASEK, and Epi-LASIK for Nearsightedness

Surgery Overview

PRK (photorefractive keratectomy), LASEK (laser epithelial keratomileusis), and epi-LASIK (epithelial laser in-situ keratomileusis) use a laser to reshape the cornea. By reshaping the cornea, these surgeries allow light to focus on the retina. This corrects a person's vision.

With PRK, the top layer on the surface of the cornea (epithelium) is removed. Then the laser reshapes the cornea. The laser removes tissue from the cornea very accurately. It doesn't damage nearby tissues. The layer grows back during the healing process. PRK may be used to correct nearsightedness and astigmatism at the same time.

With LASEK, the surface layer of the cornea is loosened and pushed to the side. After the laser reshapes the cornea, the surface layer is put back in place.

Epi-LASIK is similar to PRK and LASEK. With epi-LASIK, the surface layer over the cornea is lifted with a special machine. Like LASEK, the layer is replaced over the cornea after the laser reshapes the cornea.

These procedures don't require a hospital stay. They are done under local anesthesia in a surgeon's office or a same-day surgery center. The procedure takes about 30 minutes. Most of this time is spent preparing your eye and the laser. The actual treatment time is very short. The entire process may take about 2 hours, including preparation time, care right after the surgery, and paperwork.

PRK, LASEK, and epi-LASIK are sometimes called surface ablation. They are different from LASIK (laser in-situ keratomileusis) because they don't involve cutting flaps of the cornea.

Many people have PRK or LASEK done instead of LASIK because of the shape and condition of their eyes. PRK or LASEK may also be safer for people with certain lifestyles, such as professional athletes, police officers, and firefighters.

What To Expect

After surgery, you may wear a patch or contact lens on the eye. You will also get instructions on how to manage your pain. Someone must drive you home and then back to the surgeon's office in the next day or two. During this second visit, the surgeon will check your eye and prescribe eyedrops to prevent infection and reduce inflammation. More follow-up visits are required, usually the next week and then throughout the first year after surgery.

• Recovery from these surgeries is longer and more painful than recovery from LASIK. But you may return to your normal activities within a few days.
• For 2 to 3 days after surgery, some people may have pain, aching or throbbing. Or they may feel like there's something in the eye.
• Your vision will be reduced for several days after surgery. Your vision may remain blurry for days to weeks after surgery. Do not drive until your vision has cleared.
• For 2 weeks after surgery, avoid vigorous sports, eye makeup, and activities that may get water in the eye. The surgeon may recommend that you shower before the surgery and then not shower for a day or two afterward. This can keep you from getting water in the eye.

Unstable vision is common in the first 3 months after surgery. It may last for up to 1 year. The surgery doesn't always give 20/20 vision. So you may still need to wear glasses or contact lenses after the surgery.

Why It Is Done

PRK, LASEK, and epi-LASIK are all procedures that correct nearsightedness in otherwise healthy eyes.

They may not be the right choice for people who have more severe nearsightedness (high myopia). That's because the results are harder to predict, complications are more likely, and regression is more likely. Also, PRK may not be right for you if you have keloids.

The procedure may not be done during pregnancy or breastfeeding. You also may not be eligible for the surgery if you have an uncontrolled autoimmune or connective tissue disease.

How Well It Works

PRK, LASEK, and epi-LASIK work well to reduce mild to moderate nearsightedness.^{footnote 1}

Overall, the results of these surgeries are stable over the long term. The results have improved as techniques and lasers have evolved and changed.

Almost everyone notices improvements in their vision after one of these surgeries. But not everyone gets perfect 20/20 vision. Studies show that after PRK or LASEK:^{footnote 1}

• More than 94 out of 100 people have 20/40 vision or better.
• More than 61 out of 100 people who had PRK and more than 74 out of 100 people who had LASEK have 20/20 vision or better.

In a study done one year after epi-LASIK treatment, all of the people's eyes had 20/40 vision or better. And more than 3 out of 4 eyes had 20/20 vision or better.^{footnote 2}

In general, most people with mild or moderate nearsightedness can expect to have uncorrected vision of 20/40 or better (without glasses or contacts) after surgery. Results in people who are more nearsighted are harder to predict.

Risks

The risks associated with PRK, LASEK, and epi-LASIK for nearsightedness and farsightedness are similar.

One of the most common problems is clouded vision (sometimes also called haze). Some people's eyes have some clouding of the cornea as a result of healing. This clouding may occur within a year after surgery and then clear up. It has been linked with spending a lot of time in the sun. Clouding appears to be more common in people who are very nearsighted. Some doctors may give you eyedrop medicine during or after the surgery to lower the chance of haze.

Avoid direct sunlight and wear sunglasses for as long as your doctor recommends. The doctor may also advise you to take vitamin C.

Other complications of these surgeries may include:

• Dry eyes. For a few months after your surgery, you may need to use artificial tears without preservatives.
• Night vision problems, such as halos. (These are often described as a shimmering circle around light sources such as headlights or street lamps.)
• Glare, or being more sensitive to bright light.
• Double vision (diplopia), usually in one eye. Some people describe this as "ghosting" around an object, rather than a doubling.
• New astigmatism.
• Overcorrection, undercorrection, or regression. These are caused by abnormal healing of the cornea or thickening of the treated area. Some doctors suggest medicines to limit it.
• Loss of best corrected vision, which is the best possible vision you can achieve using glasses or contact lenses. This loss isn't common. But the risk rises with severe nearsightedness.

You may get treatment again if you end up with nearsightedness caused by undercorrection or regression.

Serious but rare complications may include:

• Infection.
• Sores (ulcers) on the cornea.
• Elevated pressure inside the eye (intraocular pressure) and glaucoma.

Experts don't yet know about all of the long-term side effects or complications.