LASIK vs PRK: Which is Better?

This is a fascinating topic to me, and I have thought about it at length. When considering having laser vision correction, you may come across things online discussing LASIK vs PRK asking, “Which is better: PRK or LASIK?” Or asking, “Is PRK safer than LASIK?”  These two questions are fundamentally different but related. “Is PRK safer than LASIK?” is one question, and my answer to that is yes, and I will go into that further in the paragraphs below. The question, “What is better: LASIK or PRK?” is basically that the results are the same long-term. I will go into more detail on that in the paragraphs below also.

 The Preoperative Consultation

First I will discuss the process. When you come into SharpeVision MODERN LASIK for your initial free consult, we will do a series of scans and measurements of your cornea, your refractive error, your corneal thickness, shape, and symmetry. We will also discuss your needs based on your age, anatomy, the bones around your eyes, anxiety level, and the level of dryness of your eyes. After assessing your information and discussing it with you, we will recommend one of several procedures: we offer not only LASIK and PRK, but ICL (implantable contact lens), cataract surgery, and RLE (refractive lens exchange), which is similar to cataract surgery but used for the purpose of getting you out of glasses. Our mission at SharpeVision is to allow you to live your life without the burden and dependence on glasses or contact lenses on your eyes.

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The Procedure

Now I will describe each procedure. For LASIK and PRK, the time of the procedure is about the same, the laser itself is the same, and the results are the same. For the procedure itself, we numb your eyes very well, we will give you Valium to allow you to relax, and I will talk you through the procedure step-by-step, just so you know what to expect. The only difference between LASIK and PRK is in making a flap with the laser in the corneal epithelium (for LASIK), or not making a flap (for PRK). The LASIK flap is made and pulled back so the laser can reshape the cornea. Then the flap is put back so the incision can heal. For the LASIK flap itself, you will experience about 20 seconds of pressure on your eye during which your vision will black out. Remember, your eye is numb, so you will feel no pain. Bam: that is the difference! It’s 20 seconds of a slightly uncomfortable pressure on your eye. Everything else that you experience is virtually the same between the two procedures. S0, how does PRK work if there is no flap? When performing PRK, instead of using the laser to make a flap, we use a mixture of alcohol to help loosen the skin layer (corneal epithelium) which is then gently and carefully removed, so the laser can reshape the cornea, just like LASIK. The excimer laser that is used is the same for LASIK and PRK.

The Recovery

When comparing the recovery experience of PRK vs LASIK, the only difference is in the first few days. With LASIK, you have about four hours of discomfort. We suggest you go home and sleep right through this time after the surgery. With PRK, you have about two days of discomfort, and some patients report day two as the most uncomfortable. We give numbing drops to take home after either procedure, but give more to patients who have had PRK. A “bandage” contact lens is placed on your eye after PRK to protect it while the epithelium grows back and is worn about a week. LASIK patients don’t need this because their epithelial flap was replaced, not removed, and accounts for the faster healing time .

Many of my patients do extensive research when considering having LASIK or PRK. The bottom line is that both are excellent procedures. They are time tested, have 25 years or more of follow up, and are both safe and effective.

LASIK vs PRK: A Comparison

There are many comparison studies to help answer the question of, “which is better, LASIK or PRK?” The one below is a recent study from 2017. There are studies that conclude that PRK is better than LASIK, and there are also well done studies that conclude that LASIK is better than PRK. So, what is the answer to which is better?  I always conclude that it’s a draw, but the differences between PRK and LASIK outlined above will hopefully help you make an informed decision.

https://pubmed.ncbi.nlm.nih.gov/28336402/

We at SharpeVision MODERN LASIK want nothing but the best outcome for you and your family members. I have been doing refractive surgery exclusively for nearly all my career, and have 20 years and 80,000 procedures under my belt. I can provide examples of patients’ stories and discuss reasons for the decisions made in regards to “Is PRK better than LASIK?”  Most of the time, we make the recommendation for you based on your needs, corneal anatomy, orbital anatomy, your hobbies and activities, age, and other factors. Some of my patients come in knowing what they want based on their research. Most of our patients rely on our judgment, and I think that’s a good decision. Sometimes we recommend that you not do any procedure. We also offer the ICL (Implantable Contact Lens) for patients whose anatomy or high refractive error precludes them from LASIK or PRK candidacy.

“Many of my patients do extensive research when considering having LASIK vs PRK. The bottom line is that both are excellent procedures. They are time tested, have 25 years or more of follow up, and are both safe and effective.”

I hope this helps in your decision making process. For my own children, I may recommend either LASIK or PRK. My son is a very active soccer player and wears contact lenses (sometimes irresponsibly). Because of his high activity level and proclivity for getting poked or hit in the eye during games or other contact sports, I would recommend PRK. It’s extremely safe and effective and there is no flap. For my daughters, who are very averse to any sort of discomfort and want quick vision recovery, I would recommend LASIK.

A word about the safety of the LASIK flap. My experience is it’s extremely safe. The flap has been studied extensively, and most surgeons and studies conclude that the flap is very stable and secure. It will not come off from blinking, squeezing your eyes or rubbing them. I don’t recommend vigorous rubbing of your eyes whether you’ve had laser vision correction or not, because it can stretch your eyelids, the eyelid skin, and potentially in extreme cases, stretching of your cornea. I do believe this happens, but it is very rare. The LASIK flap potentially could move under certain circumstances. In my experience, this is only when someone has gotten hit in the eye. In my practice, it’s only happened three times due to a toddler poking mom or dad in the eye shortly after their LASIK procedure. There have been other reported instances of assaults, getting hit with the horn of a mechanical bull, and other one-off things, such as getting hit in the eye with a stick while bike riding or with a tennis ball. Ocular trauma is a very serious occurrence and each is unique. It is obviously very scary and dangerous when one gets hit in the eye for any reason. LASIK and PRK are very similar in that they are effective and safe, but I always recommend wearing eye protection when doing any activities, such as weed whacking, yard work, chipping, shredding or any other activities where there might be high speed objects flying at your head and face. It’s remarkable to me how many times people say they took their eye protection off just for a brief moment and then got something in their eye. The bottom line is just wear eye protection, whether you have had LASIK or PRK or not!