An Overview of Photorefractive Keratectomy (PRK Surgery)
Photorefractive Keratectomy (PRK) is a refractive surgical procedure performed to correct refractive errors that affect vision. Refractive errors occur when the shape of the eyes causes light to focus improperly on the retina, resulting in blurry images. By undergoing PRK eye surgery, there is a high likelihood that individuals will achieve clear vision without the need for glasses or contact lenses.
PRK is an outpatient procedure that offers potential independence from corrective eyewear for those with poor vision. It effectively addresses conditions like nearsightedness, farsightedness, and astigmatism.
Studies indicate that approximately 80% of PRK patients experience improved vision within one month after the surgery, with an impressive 95% experiencing significant improvement within three months.
Understanding the Purpose of PRK: Reasons for the Procedure
The field of vision correction has been completely transformed by the extraordinary refractive surgical technique known as photorefractive keratectomy.
For people who struggle with typical refractive defects like nearsightedness (myopia), farsightedness (hyperopia), and astigmatism (irregular eye shape), PRK laser surgery offers a potential treatment.
PRK seeks to enhance visual acuity and lessen reliance on corrective eyewear by reshaping the cornea using state-of-the-art laser technology.
Who Should Undergo a PRK Surgery?
When a person has certain features that preclude them from being an ideal candidate for other types of refractive surgery, such as LASIK (Laser-assisted in situ keratomileusis), the PRK technique is frequently advised.
As opposed to LASIK, PRK does not need the creation of a corneal flap, making it an especially good option for people with dry or thin corneas. This makes PRK a preferred option for individuals with very active jobs or lifestyles, as there is a lower risk of accidentally dislodging the corneal flap.
There are particular prerequisites that must be satisfied to have PRK laser eye surgery. First, you must be at least 18 years old.
Your eye prescription should have been stable, indicating that your refractive error has not been changing significantly for at least 1 year prior to the procedure. The refractive error itself should also fall within the safe treatment parameters for PRK operation.
Additionally, it is important to have overall good health and healthy eyes. Having realistic expectations about the outcomes of PRK laser surgery is also crucial.
However, there are certain conditions that may disqualify individuals from being suitable candidates for PRK. These include advanced glaucoma, an unstable refractive error, skin diseases that can affect healing, uncontrolled diabetes, pregnancy or nursing, a history of specific eye infections, or a cataract that significantly affects vision.
Your ophthalmologist will carefully evaluate your specific situation and discuss whether you meet the criteria for PRK eye surgery.
What to Anticipate During Photorefractive Keratectomy (PRK)?
There are various phases involved in preparing for PRK surgery to ensure a successful and efficient procedure. You will have a thorough consultation with your healthcare professional prior to the procedure to go over the different steps and address any worries or questions you may have.
Your medical history will be examined, and a number of tests will be performed to determine your pupil size, refractive error, corneal thickness, and general eye health.
Rigid gas permeable contact lens use must be stopped at least three weeks prior to the pre-op tests in order to prepare for it. Soft contact lenses should also be avoided for at least a week before the pre-op tests if you wear them. Bring your glasses so that your doctor may assess your prescription and check the stability of your eyes throughout the consultation. This step ensures accurate planning for the procedure.
During this consultation, your doctor will address any concerns or questions you may have, providing clarity and guidance throughout the process. Once everything is discussed and finalised, an appointment for the PRK operation will be scheduled.
It is advised to eat a light breakfast before your appointment and to take any prescribed routine medications. It’s vital to avoid wearing heavy hair accessories or eye makeup that could get in the way of the surgery. It is wise to get in touch with the surgeon’s office and ask if a reschedule is necessary if you are feeling under the weather on the day of the procedure.
What Happens During PRK Surgery?
The PRK (photorefractive keratectomy) method is a precise and effective outpatient surgery centre operation that takes about 10 minutes to complete.(5) What to anticipate during the PRK surgery is listed below:
Numbing the Eye: Before starting the surgery, your doctor will administer numbing eye drops to ensure your comfort throughout the procedure. This helps to prevent any pain or discomfort.
Eyelid Holder: To prevent blinking during the surgery and to keep your eye steady, a small device called an eyelid holder will be placed to gently hold your eyelids open.
Removal of Surface Cells: Next, your ophthalmologist will carefully remove the surface cells of the cornea, known as the epithelium. This is done using a gentle brush technique to ensure a smooth and precise removal.
Focusing on the Target: You will be asked to fixate your gaze on a target light to ensure that your eye remains steady during the procedure. This helps the ophthalmologist to accurately reshape your cornea using the laser.
Reshaping the Cornea: Using a specially programmed excimer laser, your ophthalmologist will reshape your cornea. The laser is controlled by precise measurements and removes the microscopic amounts of tissue to correct the refractive error. During this process, you may hear a clicking noise, which is a normal part of the laser functioning.
Bandage Contact Lens: After the cornea has been reshaped, a soft bandage contact lens will be placed on your eye. This contact lens helps with healing and provides comfort in the initial days following the surgery. It protects the treated area and promotes the regeneration of the epithelial cells.
Following the PRK laser surgery, your ophthalmologist will provide you with post-operative guidelines for proper care and healing. It is essential to follow these instructions to ensure a smooth recovery and optimal visual outcomes.
Post-PRK Recovery Phase
The post-PRK recovery phase is a crucial period for ensuring proper healing and optimal visual outcomes. Here are some key points to help you understand what to expect after photorefractive keratectomy surgery.
Follow Aftercare Instructions: Your doctor will provide you with detailed aftercare instructions that you should closely follow. These instructions may include guidelines for eye drops, medications, and specific activities or restrictions to promote healing.
Use Eye Drops as Prescribed: Eye drops are critical in preventing infection and facilitating the healing process. It is crucial to use the prescribed eye drops exactly as instructed by your doctor. This will help in maintaining proper eye moisture and reducing the risk of complications.
Wear Sunglasses: Light sensitivity is a common side effect following photorefractive keratectomy surgery. Protect your eyes from bright sunlight or harsh indoor lighting by wearing sunglasses when you are outside. This can help minimise discomfort and provide relief during the initial stages of recovery.
Manage Pain as Necessary: In the first 24 to 36 hours following a PRK operation, mild pain or discomfort is possible. You will receive medication from your doctor to assist you in managing any discomfort you may experience. Follow the dosage instructions and let your doctor know if you have any severe or lingering pain.
Arrange Transportation: It is important to have someone accompany you to the surgery and drive you back home afterwards. The effects of the anaesthesia and the procedure may temporarily affect your vision, making it unsafe to travel alone.
Schedule Follow-up Visits: In order to track your recovery, your doctor will set up follow-up visits. To make sure that your eyes are healing properly and that your eyesight is developing as planned, it is crucial to keep these checkups as scheduled.
You can promote a quick and effective recovery from PRK surgery by following the aftercare instructions, taking the prescribed medications, protecting your eyes, and attending follow-up visits. Throughout the healing process, don’t hesitate to ask your doctor any questions or express any concerns.
Recovery Period from the PRK Surgery
Recovery from photorefractive keratectomy surgery typically takes 3 to 6 months for clear vision. Initial vision recovery and mild discomfort last up to 4 days as the cornea regenerates. Sensitivity to light and a foreign body sensation may occur during this time. After 4 to 6 weeks, vision becomes clear for finer activities. After 6 months, vision stabilises and becomes fully clear.
Potential Risks of PRK Surgery
PRK has a high success rate, with approximately 90% of patients achieving 20/20 vision without glasses or contacts after one year. About 95% of patients achieve 20/40 vision or better.(3) It is a safe and proven procedure with a reliable track record.
While PRK eye surgery is generally considered safe and effective, like any surgical procedure, it carries some potential complications. Here are some of the possible complications associated with PRK:
Corneal Haze: Corneal haze is a common complication that can occur after PRK surgery. It refers to a cloudy or hazy appearance of the cornea, which can temporarily affect vision. Corneal haze usually resolves on its own as the eye heals, but it may take several months to a year. In some cases, doctors may prescribe medication or perform additional laser treatments to treat corneal haze.
Corneal Ectasia: Corneal ectasia is a relatively rare but more severe complication that can occur after PRK laser eye surgery. A range of eye illnesses with aberrant corneal thinning or irregular corneal thickening are referred to by this term. The keratoconus condition is the most prevalent one in this group.
Corneal ectasia, which causes distorted vision, can occur if the cornea gets too weak and bulges outward. Remember that corneal ectasia is a serious condition that can call for additional treatment or even a corneal transplant.
Corneal Crosslinking: Using a procedure called corneal crosslinking, problems like keratoconus, which can result in corneal ectasia, can be prevented from progressing further and strengthening the cornea. This treatment includes saturating the cornea with specially formulated riboflavin drops before exposing it to ultraviolet radiation.
Riboflavin and UV radiation together strengthen the cornea by increasing collagen crosslinking. The FDA has not yet given corneal crosslinking approval, despite the fact that it is a promising treatment.
Flap-Related Complications: Unlike LASIK surgery, which involves creating a corneal flap, PRK does not involve the creation of a flap. Therefore, flap-related complications like flap dislocation or flap-related infections are not a concern in photorefractive keratectomy surgery.
The risks following PRK laser eye surgery are generally low, and most patients report positive results. To determine if Photorefractive Keratectomy is right for you, you must speak with a skilled ophthalmologist who can assess your unique situation, discuss the potential risks and advantages, and provide recommendations.
