One of the aspects that I love about being an optometrist is co-managing LASIK and other refractive procedures we can offer our patients. Refractive surgery is the ever-advancing technology that I get to utilize on a daily basis. The clinical life in this sub-specialty of optometry and ophthalmology began over 30 years ago with incisional procedures such as radial keratotomy (RK). This progressed into ealy PRK procedures and then into today’s advanced custom LASIK with laser flap creation. The advancements in one of the world’s most commonly performed surgical procedures are mind-boggling. With all of these advancements, we still utilize and advanced form of LASIK’s predecessor, Photo-Refractive Keratectomy or PRK.
Photo-Refractive Keratectomy (PRK) and Laser-Assisted Sub-Epithelial Keratectomy or Laser Epithelial Keratomileusis (LASEK) are both surface ablation procedures. The terms are often used interchangeably. They have some distinct advantages over the more commonly performed LASIK procedure. This occurs in a variety of cases that provide the patient a safer surgical and post-operative experience.
PRK is a good choice over LASIK in patients who:
• Are at increased risk of post excimer kerato-ectasia due to thinner corneas
• Are at slightly increased risk of kerato-ectasia because of mild surface curvature irregularities
• Have epithelial disease, which can lead to healing issues with LASIK
• Have occupations or hobbies in which they are at high risk of ocular injury (boxing, mixed martial arts, commercial scuba diving, etc.)
• May have a higher risk of epithelial ingrowth with a conventional flap (History of corneal dystrophies or dry eye)
Current PRK Advantages:
• Lesser amount of tissue removed from the deep corneal structure
• Concurrent use of Mitomycin-C to potentially reduce haze formation and refractive regression
• New options for pain management, including the use of advanced NSAIDS like Prolensa
PRK also offers the following advantages as compared to LASIK:
• No risk of flap complications
• May offer less postoperative dryness with no severing of the corneal nerve plexus
• More residual corneal tissue for possible excimer enhancement
Today’s PRK is very similar to the original procedure in that there is an epithelial removal, a laser application and a bandage contact lens is place for epithelial recovery. The advancements in custom wavefront guided and wavefront optimized excimer ablation combined with a lower risk de-epithelialization have made PRK highly desired. There is no procedure that is absolutely free of risk but the risks of complication are quite low. Medicinal advancements in pain control have virtually eliminated the significant ocular pain of PRK yesteryear. Actually, in many situations, custom PRK is commonly the preferred technique of both the Canadian and US militaries.
This is the case even when a patient qualifies for both LASIK and PRK. Because there is no flap with PRK, there is zero risk of flap displacement in environments where explosive or high velocity impact to the face and eyes are more probable. Both procedures have been proven safe and effective under the proper circumstances. Actually, in various studies the long-term visual outcomes were virtually identical and equally safe. There are those who scrutinize the PRK procedure because the healing does take a little longer, but remember that just because PRK takes a little longer to heal and has been around longer does not mean it has not progressed to become a very favorable procedure for the right patient.
Please contact us so our optometrist can determine if you are a good candidate for LASIK or PRK.