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PRK Eye Surgery and PRK Recovery

San Francisco LASIK and PRK Surgeon - Dr. Scott HyverFor many patients with irregular corneas, PRK surgery (or photorefractive keratectomy) is preferred to LASIK eye surgery for the correction of Nearsightedness (myopia), Farsightedness (hyperopia), and/or Astigmatism. Unlike LASIK, PRK eye surgery doesn't require an incision in the cornea. For someone with unusually thin corneas, for example, this is a huge advantage since the long-term structural integrity of the eye is not likely to be compromised by PRK surgery. During the procedure, Dr. Hyver removes the thin outer membrane of the cornea, called the epithelium, thereby exposing the surface of the thick central part of the cornea, called the stromal bed. Dr. Hyver then uses a laser to reshape the stromal surface (thus the PRK moniker, "surface ablation") according to the patient's vision error.

The entire PRK procedure takes just minutes to perform. The epithelium then heals over the exposed surface during the following several days, during which time the eye can experience varying degrees of irritation. Although vision is typically improved immediately following the procedure, maximum vision recovery can take several weeks.

While the PRK recovery is longer than LASIK, this is a relatively small price to pay to enjoy visual outcomes comparable to LASIK eye surgery, but without the unique risk that LASIK poses for some patients.

WHY PRK?

What's the difference between PRK vs LASIK?
PRK and LASIK are procedures; that is, they are different surgical methods by which Dr. Hyver prepares the eye to receive the laser. In LASIK surgery, he creates a corneal flap — the hallmark of LASIK — then lifts the flap, treats the underlying tissue with the laser, and restores the flap, whereupon it heals. In PRK eye surgery, he instead removes the cornea's outer membrane, called the epithelium, applies the laser to the newly-exposed surface, over which a new layer of epithelium then grows in the days following the treatment.

Why wouldn't I qualify for LASIK?
Because the thickness and/or shape of your cornea may be unusual, and therefore a surface treatment like PRK surgery, that doesn't require a corneal flap as in the LASIK procedure, is apt to prove a safer long-term solution.

What's the likelihood that after PRK eye surgery, I'll see 20/20 or better, free of my contact lenses and glasses?
A patient's visual outcome is a function of many variables, including age, prescription type and size, best-corrected vision with glasses prior to surgery, and corneal healing profile. Having said that, the majority of our PRK patients now achieve 20/20 or better.

Are there any potential complications of PRK?
PRK like LASIK and, for that matter, all other elective surgery, is not risk-free. Although the risk profile of PRK differs from that of LASIK -- e.g., PRK patients are more susceptible to post-op corneal haze -- there are some commonalties, such as the potential risk for dry eyes; visual disturbances such as halos, glare, starbursts, and double vision; and vision loss. The patient may still need to wear glasses or contact lenses even after treatment. Further, you should be aware that there may be alternatives to PRK for the correction of your vision error including, but not limited to, eyeglasses, contact lenses, and other refractive surgeries. You should thus ensure you have a clear understanding of the alternatives to and potential risks of the surgery before you elect PRK treatment.

Can PRK results correct both distance and reading vision?
Patients over the age of 40 typically experience some degree of presbyopia, or "aging eyes," that causes a loss of reading vision. Presbyopia is caused by a stiffening of the lens, the internal focusing element of the eye. Since laser vision correction, including PRK, only operates on the cornea, the external focusing element of the eye, we can't directly address the problem of the aging lens. Instead, we offer monovision, wherein Dr. Hyver corrects one eye for distance, and produces a target amount of nearsightedness in the other eye for reading purposes. Learn more about monovision and your reading options.

PREPARING FOR PRK

How do I prepare for PRK surgery?
One of Dr. Hyver's patient counselors will review your pre-operative instructions with you. Generally, if you wear contact lenses, you'll need to remain out of them for a specific period of time. You'll also need to use a combination of over the counter and prescribed medications, including antibiotic drops, over a specific timeframe and frequency.

Will I need to arrange to have someone drive me home after my PRK procedure?
Yes. If you're not able to arrange for a ride, please call us and we'll help coordinate this.

WHAT TO EXPECT DURING PRK SURGERY

What can I expect when I arrive for my PRK?
After you check-in, we'll perform some additional tests on your eyes to help refine our understanding of your vision error. You'll then be seated in an exam room, shortly after which a technician will take you to the laser suite.

Can I get a payment receipt to submit to my "flex" pre-tax health reimbursement account administrator?
Yes, just request this when you pay at check-in.

What can I expect during the PRK procedure itself?
You can expect several steps to occur, first to one eye and then to the other. And because your eyes will be anesthetized, you will experience little or no discomfort throughout the entire process.

  1. After prepping your eye, Dr. Hyver will use a special tool to remove a small area of the epithelium (i.e., the ultra-thin outer membrane of the cornea).
  2. Dr. Hyver will then apply the laser, programmed to treat your specific vision error, to this exposed area. You will not feel the laser as it treats your eye.
  3. After the laser treatment, Dr. Hyver will apply a special contact lens over the treated area to protect it during the initial healing period. We'll remove the contact lens at your first post-op exam.
After your PRK procedure, a technician will take you to an exam room, where one of the doctors will check your eyes through the microscope to ensure everything is in order. After donning a pair of sunglasses that we'll give you, you're free to leave with your ride.

PRK RECOVERY: WHAT TO EXPECT

Between one and three days after your PRK, you can expect some discomfort, potentially including irritated, burning eyes; light sensitivity; tearing; and swollen eyelids. Most of this discomfort can be attributed to the removal of the epithelium, which acts as a natural barrier between your eye and your environment. However, keep in mind that some patients experience little or even no discomfort during this time. We'll provide you with a prescription for pain relief medication and other pain prevention support.

Between four days and one week after your PRK, your vision may be blurred and hazy, but the discomfort of the first few days should be over. You should also be seeing equal to or better than 20/40, the minimum acuity for driving vision in California, and should be back to your normal lifestyle by this time. During this period, we will remove the protective contact lenses that Dr. Hyver placed on your eyes during your surgery.

Between one and three months after your PRK, the new growth of epithelium over your treatment area will smooth and even out, producing clearer and clearer vision.

Between three and six months after your PRK, your new vision should be stable, and you should be enjoying vision results equal to or in some cases better than patients with comparable prescriptions who had LASIK instead.

Why is the recovery period longer than that of LASIK eye surgery?
Because LASIK employs a corneal flap that essentially preservers the epithelium layer when the flap is restored over the treatment area. It's the removal and absence of the epithelium — a necessary step in the PRK process — that creates the discomfort during the early healing period, as well as the longer vision recovery.

How soon can I fly in an airplane?
Altitude has no effect on the vision or the healing of the eye after PRK. So, you can actually fly the next day if you like. However, be aware, that the air blowing from the vents above you may make your eyes feel more dry. Just bring your teardrops with you.

Once my recovery is complete, how long will my new PRK vision last?
Laser vision correction, including PRK, is designed to be permanent and durable.

Watch our video of one of our patient's PRK post-op recovery spanning over a two month period. Meet Ricannia and watch her story. PRK Recovery Video

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