LASIK vs PRK – Procedure

Laser eye surgery is one the method to correct vision for people who are either shorted-sighted, long-sighted and those with astigmatism.  Laser surgery can be broadly categorized into 2 methods. First method will involve creating a flap on the cornea and second method is without the need to create a flap on the cornea

First method is a procedure widely known as LASIK or Laser-assisted in situ Keratomileusis.

This procedure can be completed in about 10 minutes, and this is how it will be performed.

1)      Anesthetic eye drop will be applied to the eye to completely numb it

2)      An eyelid clip will be placed on the eyes to prevent the eye from blinking or closing

3)      Surgery will start by creating a flap on the cornea using a laser or mechanical blade

4)      Next, the flap will be lifted and fold back on for the laser to reshape the underlying cornea tissue.

5)      When the reshaping is done, the flap will be replaced to the original position over the treated area without the need for stitches.

During the procedure, it will be painless but just slight pressure over the eye from the tool that hold the eye open. After the surgery, it is normal to feel slight discomfort and dryness of the eye. Most patients will experience significant improvement in comfort 24 hours after the surgery.

The second method is performed without creation of corneal flap. Photorefractive Keratectomy or short-form PRK is performed in this manner, which is slightly different in the procedure.

The basic steps for this procedure are as follow

1)      Anesthetic eye drop will be applied to the eye to completely numb it

2)      An eyelid clip will be placed on the eyes to prevent the eye from blinking or closing

3)      Surgery will start by removing the outermost layer of cell (epithelium) from the cornea.

4)      Once the epithelium is removed, laser is used to reshape the underlying cornea tissue

5)      When reshaping is done, antibiotic and anti-inflammatory eye drops are applied to the eye followed by putting on a bandage contact lens to protect the cornea.

The second method will be painless as well but recovery usually takes 3 to 7 days due to the time needed for the epithelium cell of the cornea to grow back. To achieve good vision, it may take from 1 week to several weeks. However, without the need to create a cornea flap eliminate the risk of flap related complication.

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Suitability

A comprehensive eye examination by the eye surgeon will be required to determine if you are suitable for laser eye surgery. 

The following guidelines are the general requirements for Lasik surgery.

1)      The ideal age will be between 21 years old to 40 years old. Most people eyes are fully develop when they reach 21 years and may start to deteriorate again after 40 years old.

2)      Prescription must be stable for at least 1 year.

3)      Ideal prescription to treat will be myopia of up to -10.00D, hyperopia of up to +4.00D and astigmatism of up to -4.00D

4)      No history of eye injury or infection within past 1 year

5)      No history of dry eyes problem as it will worsen the condition after the surgery.

6)      Must not be pregnant or nursing as fluctuation in hormones level will cause slight changes in your vision.

7)      Not suffering from autoimmune diseases such as LUPUS or Sjogren’s syndrome or any other degenerative diseases that will affect healing.

8)      Pupil size in dim lighting must be smaller than 6.5mm to minimize night vision problem after the surgery.

9)      Sport, work or lifestyle that has a higher risk of trauma to the eyes should be avoided to prevent flap complication.

10)   Realistic expectation of vision after surgery as no laser surgery can guarantee 100% perfect or 20/20 vision after the procedure.

Some surgeon will prefer PRK procedure over Lasik for the following conditions

1)      Thin or very flat cornea which is not ideal for creation of flap

2)      Cornea irregularity or scar.

3)      Patient with cornea dystrophy or recurrent corneal erosion

4)      People with active lifestyle or work which has higher risk for eye injury.

5)      Mild to moderate myopia or hyperopia

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Cost

The average cost of lasik vs. prk is very similar. It ranges from $1500 to $2200 per eye. The price of the surgery is affected by the doctor fee, the prescription of patient, and also the type of technology or equipment used. Price may also varies depend on location.

A more complex surgery which require a more skillful and experience surgeon also affect the cost of the eye surgery.

Therefore, it is important not to choose an eye surgeon based on the cost alone.  The following are some questions you should ask your surgeon when discussing on the fee.

1) What type of surgery is recommended ( e.g. Lasik vs. PRK)

2) What are the risk for complication for the type of procedure recommended

3) What happened if complication occurs

4) Are pre-op examination and follow-up visit covered in the fee

5) Is post surgery medication necessary and if so, is it covered in the fee

6) When re-treatment is necessary, is it covered in the fee

7) What other charges are not included in the fee

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Recovery

PRK surgery will need a longer recovery period as compared to Lasik surgery due to the fact that the cornea outer layer of cell (epithelium) is removed during the process as compared to Lasik where the epithelium is preserve. 

For Lasik, your vision will be significantly improved 1 to 2 days after the surgery as compared to PRK which could take up to one week.

For both surgeries, you may experience fluctuating vision especially during the first week of recovery.

People who were initially short-sighted (myopia) might notice that near vision are slightly worse than distance vision during the recovery period. Whereas those who are previously long-sighted (hyperopia) have better near vision than distance vision initially.

For most people, distance vision should improve substantially in the second week and gradually get better in following weeks.

Complete healing of the cornea and stabilization of the vision could take 3 to 6 months.

Pain should be minimal following usual uncomplicated laser eye surgery. Most common symptom will be dry eye after the surgery. This condition is usually temporary (lasting from a few weeks to few months) and will improve as the cornea heals.

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Risks

The creation of corneal flap in Lasik surgery aid in faster healing but it is also the common cause of complication. Flap complication can cause mild to severe damage to the cornea with vision loss.

Without creation of corneal flap in PRK, it eliminates the risk of such complication. The main complication of PRK is corneal haze after the surgery.

Every surgery carries certain risks of complication or side effect. Although the risk involved in a laser eye surgery is minimal, it is still best to discuss with your eye doctor before making a decision. Some of the possible outcomes are

1)      Your vision maybe over-corrected or under-corrected. Which means you might have to wear glasses for certain vision requirement

2)      You might develop severe or chronic dry eyes which makes vision blur and uncomfortable

3)      Your vision might worsen after many years of treatment.

4)      You might experience vision distortion especially in low lighting such as haloes or starburst effect around light.

5)      More seriously, you might lose vision due to complication during or after eye surgery caused by thinner cornea.

You should carefully weigh the risk and benefit based on your needs and expectation before undergoing a laser eye surgery.

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