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Seeing the light: Photorefractive keratectomy (PRK) becoming popular again

Dr. S. Akbar Hasan - here with ophthalmic technician Melissa Efird - says advances in technology have revived PRK and brought it back to treatment rooms.

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When it comes to refractive surgery, everything old is new again.

Once considered the most popular laser vision correction surgery available until LASIK eclipsed it, PRK is on the rebound thanks to improved technique, technology and patient evaluation.

Dr. S. Akbar Hasan, a Mayo Clinic ophthalmologist, says PRK is on the rebound because of patients' wariness over potential complications from LASIK (laser in situ keratomileusis). Hasan performs both and considers PRK safer.

"With the older generation lasers in the mid-90s, people developed some corneal scarring with the PRK technique," Hasan says. "A lot of them were very, very nearsighted and required a large treatment, which resulted in some scarring. Because of the newer generation lasers, we don't see any scarring in low to moderately nearsighted people."

PRK works by polishing off the skin (epithelium) of the cornea and uses an excimer laser — a "cool" laser that doesn't produce heat — to remove tissue from the surface of the cornea. The patient goes home with a contact lens, which acts as a bandage, on the treated eye.

In contrast, the surgeon performing LASIK reshapes the inner layers of the cornea with an excimer laser after creating a flap of corneal tissue that is folded back during treatment. After the procedure, the flap is repositioned on the treated area. The incision to make the flap is made across the cornea with a precision cutting instrument. Healing progresses rapidly and with less discomfort than with PRK. However, compared to PRK, also called surface ablation, LASIK carries a small, but greater risk of problems associated with the corneal flap.

"You have short-term benefits with LASIK," Hasan says, "and in my opinion, long-term benefits with PRK. It's not a high risk, but it is some additional risk. With PRK there is more corneal stability. There are no flap complications because there is no incision on the eye."

The only downside, Hasan says, is that PRK takes longer to heal. Patients will most likely have good vision in five to seven days and great vision in three to four weeks. With LASIK they'll have good vision within a couple of days and great vision within the week.

Hasan sees further refinements in refractive surgery. A hybrid procedure called laser epithelial keratomileusis (LASEK) combines the quicker healing and minimal discomfort of LASIK with the surface ablation of PRK.

"Eventually there will be a jet of water or plastic blade that will shave off the skin to keep it viable," Hasan says. "That will be the ideal situation."

Info:
Department of Ophthalmology
(904) 953-2020

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