05 Aug What are the risks of PRK?
Dr. Gary Foster – Fort Collins & Loveland, CO
PRK eye surgery has been performed in the U.S. since 1985. Since then, millions have had PRK to improve their vision. It has a great and a long safety record. Having said that, PRK is still a surgery so there are risks you should consider as you make your decision.
Accuracy of PRK
PRK has the ability to take even large glasses prescriptions and reduce them to almost perfect. It is important to notice the word almost. Eye laser surgery tends to get you to really close, but not quite perfect. Most laser vision patients would see a bit better if they put on thin glasses, but they see well enough that it isn’t worth wearing them. The results of PRK eye surgery and LASIK surgery are very similar. If you demand perfection, then laser eye surgery may not be right for you.
If your result is not acceptable, then a small amount of additional laser can be applied to bring you closer to your goal if it is medically prudent. Check with your surgeon to find out if there are any costs associated with touchups.
Like any surgery, you are at risk for an infection while you heal from your PRK. This is extremely rare since most having laser eye surgery are healthy. Eye infections tend to be mild and resolve quickly, but if infection goes untreated or is resistant to treatment, corneal scaring and vision loss can occur. Diligent use of your antibiotic eye drops helps prevent this.
We want your immune system to be active to prevent infection, but if it is overactive, you can form some haze on the cornea. To prevent this, your surgeon will have you take anti-inflammatory drops after surgery. Protecting your eyes from the UV rays with sunglasses and a hat will further decrease your chances of haze. There is some evidence that taking vitamin C is also helpful. Mitomycin C can be applied at the time of PRK to decrease haze.
If you have a history of keloid formation, which is a form of over-healing, then please let your surgeon know. This will allow a careful discussion about whether PRK surgery is right for you.
Eyes recovering from surgery can be uncomfortable and light sensitive. A series of different comfort drops and pills are made available to make sure you are comfortable while you heal. Some don’t need anything for comfort, while others make use of both the drops and the pills. If you are not able to take these medicines, you will need to make an alternative plan with your surgeon to make sure your recovery is pleasant. I performed PRK on a close friend to improve his vision. He stayed at my home while he healed. For those first few days, I had to call and remind him several times to take it easy because he kept trying to fix things around my house. He just needed the eye drops to remain comfortable and didn’t use any of the Vicodin I had prescribed. His vision was about 20/40 those first few days and then got better every day after that for about a week. He flew home that same week. You would have your own individual healing path, but my friend’s experience is typical.
Some are born with weaker than normal corneas. If there is significant weakening, the cornea can lose its normal round shape, which causes blurry vision. This weakening process is called ectasia. Eye rubbing can speed the changes. If you have a weak cornea and then have eye laser surgery, ectasia can accelerate. Tests are done ahead of time to determine if you have an above average risk for this. Fortunately, PRK has less chance of causing ectasia then Lasik.
We do know how to strengthen a cornea that shows signs of weakness and it is actually pretty easy to do. It is called crosslinking. The problem is that it is not currently FDA approved, but studies are ongoing and promising.
You will likely experience an increase in dry eye symptoms for the first 3-6 months after PRK. These tend to resolve completely, but on rare occasions, persist and cause problems with eye comfort and visual consistency. PRK tends cause less dryness than Lasik. A number of treatments are available to relieve dry eyes.
Is PRK right for you?
Fortunately, problems with PRK are rare and most have a cure, but I tell my friends that it doesn’t matter if the risk is one in a million if you are the one. I have had eye laser surgery. Prior to my vision correction procedure I considered my strong desire for improved vision against the potential risks and decided eye surgery was the right decision for me. You will need to consider your personal motivation to be more glasses independent and weight that against your individual risks. If I can help you as you make your decision, please contact my office for a no charge evaluation or drop me a line.