A lucrative business for ophthalmologists, PRK is a harmful, unnecessary eye surgery. PRK preceded LASIK, but then fell out of favor as LASIK was introduced. From the ophthalmologist's perspective, LASIK did not require as much chair time as PRK, and LASIK was more marketable than PRK. After widespread problems from LASIK came to light, PRK was reintroduced under new marketing terms such as "advanced surface ablation". We believe PRK will someday be abandoned once and for all to the junk heap of refractive surgeries.
PRK stands for photorefractive keratectomy. Like LASIK, the goal of PRK is to reduce or eliminate the need for glasses or contact lenses. PRK is similar to LASIK surgery in that a laser is used to burn away corneal tissue, which changes how light rays focus on the retina. The primary difference is that, in LASIK, a corneal flap is made with a blade or a laser to expose the corneal stroma to the laser. In PRK, the surface layer of the cornea, the epithelium, is scraped away or otherwise removed without cutting a flap. Epithelial cells regenerate over a period of several days after PRK; however, Bowman's membrane, which plays a vital role in health of the cornea, is permanently destroyed. Some ophthalmologists speculate that permanent destruction of Bowman's membrane during PRK may lead to late-onset complications, as Bowman's membrane is a protective barrier between the environment and the corneal stroma.
Haze is a common complication of PRK. To reduce risk of haze, many surgeons currently use a toxic substance called mitomycin-C (MMC) during PRK. MMC has been reported to have long-term adverse effects on the eye. Here's a link to a collection of research articles on MMC.
Pain, haze, chronic dry eyes, regression, and night vision problems are the most common complaints after PRK.
Patients who suffer problems after PRK should file a MedWatch report with the FDA.
Because you asked...
From the editor: Frequently I receive email from people who want to know if PRK is safer than LASIK. I am not a doctor, so I can only offer my personal viewpoint as a layperson.
PRK carries many of the same risks as LASIK with the exception of flap complications.
I have interacted with countless patients who had a poor outcome from PRK. Haze, pain, dry eyes, and night vision problems are the most common complaints after PRK. Regression is also common after PRK.
Unnecessary refractive surgery (RK, PRK, LASIK, implantable lenses) is becoming a leading cause of vision loss, and it is completely preventable.
Bottom line, I am opposed to all forms of elective eye surgery. Keep your glasses!
PRK surgery nightmare - Emailed to webmaster of LasikComplications.com 8/16/2011
Excerpt: "No one could tell me for sure that the double vision would go away along with the star bursts and blurring. So I stressed out and eventually became depressed and had to be hospitalized and go on medication... In 2010 I noticed that I had flickers of light in my corrected left eye so I visited my eye doctor who said he saw a tear in my retina... The surgery at the time was probably a couple of thousand dollars for one eye, but the cost of the treatment for acute depression and time lost at work was over $10,000, so this was a costly choice and a life lesson."
Permanent grounding of a USAF pilot following photorefractive keratectomy.
Davis RE, Ivan DJ, Rubin RM, Gooch JM, Tredici TJ, Reilly CD.
Aviat Space Environ Med. 2010 Nov;81(11):1041-4.
INTRODUCTION: Photorefractive keratectomy (PRK) has been extensively studied in the literature and its potential application in aircrew has not gone unnoticed. Complication rates following corneal refractive surgery (CRS), including PRK and laser in-situ keratomileusis (LASIK), remain low, with most patients achieving improved uncorrected visual acuity and reduced spectacle dependence. Overall, predictability, low complication rates, high rate of success, stability, and safety have all been cited as instrumental in the adoption of PRK in aviators. Consequently, the U.S. Air Force (USAF) approved PRK for aviators in August 2000. However, quality of vision outcomes following CRS remain a concern given the unique visual performance requirements in military aircrew, especially in austere operational environments.
CASE REPORT: This paper will present a recent case of steroid-induced ocular hypertension that is believed to have precipitated non-arteritic anterior ischemic optic neuropathy (NA-AION) associated with reduced visual performance following PRK that resulted in the first permanent grounding of a USAF pilot following CRS.
DISCUSSION: CRS has radically widened the aircrew applicant pool and has decreased spectacle dependence in war-fighters. Despite the low-risk profile of modern CRS, this case demonstrates the potential for poor outcomes from such elective surgery. Understanding these rare, but potentially devastating complications and the unique aeromedical risk factors in aircrew is paramount when considering elective vision-enhancing surgery.
Adverse outcomes of PRK reported to the FDA
I had PRK surgery [redacted] 2011 at the [redacted]. I was told I would be back to work 6 days later with close to corrected vision. I came back for my four day check up, they took the contacts out of my eyes. I was told it would feel a little gritty for a couple of days. I didn't make it fifteen minutes down the road and I felt like I had razor blades underneath my eyelids. Being in the military, I manned up the best I knew how, put way more than prescribed numbing drops and took multiple narcotic pain pills. None of this worked. I got a hold of my surgeon and told him I would try and hold out until the next day. It was the worst pain I have ever experienced in my life. The next day I went down and they said my eyes had "sluthed. " they put the contacts back and for approx two more weeks, waiting for an 8mm abrasion on both of my eyes to heal up - the civilian ophthalmologist noticed these abrasions, right before my surgeon came and looked at my eyes, and overlooked them! the abrasions never healed up, so they patched my eyes for a week and a half a piece and the abrasions finally healed up, leaving behind a lot of scar tissue, which I am still dealing with now. I've been on a long dose of steroids and I am still tapering off of them, and yet the scarring still has not gotten any better. I volunteered for this surgery to make my life better, easier, and more mission ready for my certain career field in the [redacted]. It was placed to my understanding that this was a fairly quick and short term healing procedure. But I am supposedly one of the thousands of select people that this happens to. I was told that after the six month period from my surgery, if this scarring was not healed that I could opt for the surgery again or just deal with it. Source:
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/detail.cfm?mdrfoi__id=2381345
I had prk lasik surgery. I now have a very high reading rx 3. 25 and still need mild rx for distance. I have severe dry eyes. I now need to use eye drops 4+x/day and need to have the tear ducts plugged. I also have to use restasis prescription drops 2x daily. I also am taking theratears nutrition omega-3 capsules daily for dry eye problems. I was told i would need reading glasses after this procedure, but the rx is very high. I only needed 2. 50 distance rx prior to surgery and no reading rx. I must tell you that i also work with the md that did my surgery and feel that i was not informed well. I know that i was over-corrected with this procedure. But i had much discomfort with the recovery. It has been over one year and i still have issues. I am distraught emotionally to accept the high dependency on the close vision needs. I no longer can see in the mirror clearly. I need glasses to see the food i am eating from my plate. It has been quite an emotional rollercoaster. I need my reading rx as well as magnifying mirror just to tweeze my eyebrows! this has been extremely upsetting as i know i will probably continue to need stronger reading rx help as i grow older. I did bring this to the attention of the management at my workplace, and they only responded "i guess you are just in the percentage of people that are not satisfied with the process. " how is that for an employee of this practice! i work for opticare. Source:
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=1040892
The military used prk corrective laser eye surgery on both of my eyes, and my vision in my right eye has become blurry. I have difficulty reading emails on my laptop and cannot read the powerpoint presentations during class. At night, i see starbursts around lights which has made driving dangerous under these conditions. Source:
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=1075441
I was overcorrected in my left eye as a result of wavefront prk with the visx excimer laser. Not only that i have, terrible side effects in both eyes -gash- which greatly affect my night vision and vision in low light situations. Mild dry eye is also problematic. For a procedure that was supposed to make my life easier, it has made it much more difficult and complex on a daily basis. I so very wish that i could go back to my vision with glasses. Not a day goes by that i am not reminded of the adverse events following my prk. Source:
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=1039122
I had prk surgery on my eye to correct vision. I now suffer from severe dry eye problems. I was not properly screened or warned before this elective surgery. Source:
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=1293889
Disclaimer: The information contained on this web site is presented for the purpose of warning people about LASIK and PRK complications prior to surgery. LASIK and PRK patients experiencing problems should seek the advice of a physician.