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Customized PRK: A Safer Approach for Some Patients

For many patients with irregular corneas, PRK (i.e., photorefractive keratectomy) offers a potentially safer alternative to LASIK eye surgery.  Unlike LASIK, PRK doesn’t require an incision in the cornea, an important difference for someone with unusually thin corneas, where an incision could potentially affect the structural integrity of the eye.

Apart from the safety considerations, the goal of PRK is to help patients see equal to or better than their contact lenses and glasses and, through the use of Wavefront-Optimized techniques, to preserve or even improve their vision quality, especially their night vision.

How Does PRK Work?

Dr. Hyver first removes the thin, outer membrane of the cornea, called the epithelium, exposing the surface of the central part of the cornea, called the stroma.  Dr. Hyver then employs the Alcon EX500 excimer laser to reshape the stromal surface according to your specific vision error and your unique corneal features, after which he places a temporary contact lens over the treated area to protect the cornea while the epithelium layer regrows. The entire PRK procedure takes just minutes to perform, and since your eyes are anesthetized, you’ll experience little to no discomfort during the treatment.

What is Wavefront-Optimized PRK?

Wavefront-Optimized PRK is an advanced surface ablation procedure that customizes your treatment to your prescription and to your unique corneal curvature. Using proprietary Wavefront-Optimized software algorithms, the Alcon EX500 excimer laser precisely adjusts its energy delivery on the periphery of the treatment zone in order to help achieve a natural prolate corneal shape, which can help minimize spherical aberration and therefore contribute to better night vision.

What can I expect during the PRK post-op recovery period?

Between 1 and 3 days after your PRK procedure, you can expect some discomfort, potentially including burning and irritated eyes, light sensitivity, tearing, and swollen eyelids. Most of this discomfort directly relates to the removal of the epithelium, which acts as a natural barrier between your eye and your environment. For your comfort, we’ll provide you with a prescription for pain relief medication and other pain prevention support.

Between 4 days and 1 week after 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 you should be back to work and to your normal lifestyle. During this period, we’ll remove the protective contact lenses that Dr. Hyver placed on your eye(s) during your surgery.

Between 1 week and 3 months after PRK, the new growth of epithelium over your treatment area will smooth and even out, producing clearer and clearer vision. During this time, most patients experience some degree of halos and starbursts around night lighting, the effects of which may make driving at night difficult for the first few weeks following your PRK treatment.

Between 3 and 6 months after PRK, your new vision should be stable, and you should be enjoying your life free of contact lenses and glasses. The nighttime effects described above will gradually diminish and, in the vast majority of patients, fully resolve. For the small percentage of patients for whom these effects persist, the effects are generally mild.

Why is the PRK recovery period longer than that of LASIK eye surgery?

During the LASIK procedure Dr. Hyver creates a corneal flap prior to employing the EX500 laser to reshape the cornea, after which he restores the flap over the treated area.  This LASIK flap essentially keeps the epithelium layer intact, whereas the PRK procedure removes the epithelium layer by design.  It’s the removal and slow regeneration of the epithelium layer — the eye’s outer, protective membrane — that causes the discomfort during the early PRK healing period as well as the longer visual recovery.  While the PRK recovery is longer than that of 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.

How well will I see and what are the risks?

With today’s state-of-the-art laser infrastructure, combined with Dr. Hyver’s experience and deep surgical database, it’s rare that our PRK patients don’t see 20/20 or better.  Like any medical procedure, however, PRK is not without risks or alternatives, something you can learn more about at your consultation with Dr. Hyver.