Questions About Prk Lasik

Charles asks…

Should I choose PRK or Lasik surgery to treat myopia?

I have very bad myopia of about 1000 degrees in each eye.

I haven't reached the minimum age for Lasik yet. But once I have, should I opt for Lasik or PRK for severe myopia? Which is more effective?


Thanks.

admin answers:

This is a question for a surgeon. A few things to discuss:

1) -10.00 is more than I like to send for laser refractive surgeries (either lasik or prk). People think that every Rx can be done in lasik or prk, but the higher ones like this have more problems.

2) it used to be thought that for these higher cases prk was better than lasik b/c the lasik flap had to be so thick & so much stroma was destroyed that it left the corneas too thin & caused a lot of problems, but now that the flaps are being made by laser as well (vs a microkeratome) that might not be the case anymore

3) if you're -10.00 & you're not even 18 yet...you'll probably be more than -10.00 at 18. You need to make sure & wait until your Rx is the same thing over & over again (stable refraction) before you get really serious about lasik

4) you'll need to be out of contacts for a month or so (i always say 6 weeks which is admittedly conservative) before your lasik/prk. People think they can wear their contacts right up until they have lasik, which is not true.

Steven asks…

What is the difference between Lasik and PRK?

I was informed all about Lasik but once it came down to it the doctor said I could only have PRK laser surgery and not Lasik. I don't know much about PRK.. I mean I know it takes longer to heal and I basically know the procedure.. but I wasn't informed of the side affects it may have and I can't seem to find the information I need online. Has anyone had this surgery? WHta were your results and did it hurt? I need as much information as possible please before I make a decision. I will be calling the doctor tomorrow, but I would rather hear about it from people who have actually had it done. Thanks in advance.

admin answers:

The technical difference between Lasik and PRK is where the laser ablates (removes) corneal tissue. The patient difference is speed of vision recovery and discomfort.

When the excimer laser was first developed, all laser assisted surgery to reduce the need for corrective lenses was Photorefractive Keratectomy (PRK). The process of PRK is to remove the outermost layer of soft cells on the cornea (epithelium), reshape the surface of the cornea with the laser, and then wait for the epithelial cells to regenerate and cover the treatment area. Corneal epithelial cells are the fastest reproducing cells in the human body.

Early PRK was quite successful and a significant improvement over previous techniques, but it had some problems. Removal of epithelial cells causes a wound response that includes major discomfort and corneal haze if the laser needed to remove a lot of tissue to correct very bad eyesight.

A very clever eye surgeon realized that if the laser sculpting was done under a flap of corneal tissue and not at the surface, then the wound response would be different. Lasik is actually the combination of two surgical procedures. The first step of Lasik is to create a flap of corneal tissue and move it aside. The second step is to use an excimer laser to reshape the cornea. After ablation, the Lasik flap is repositioned over the treatment area. Lasik “fools” the eye into not knowing it has had surgery, so the wound response is muted. This is why Lasik can have almost instant vision recovery, virtually no pain, and virtually no chance of corneal haze.

There are a few important limitations to Lasik. One is corneal thickness. At least 250 microns of corneal tissue must remain untouched for a healthy eye to remain stable. The Lasik flap is about 100-160 microns thick, so the laser sculpting is starting that much deeper. Some people don’t have corneas thick enough to accommodate the Lasik flap.

The other problem with Lasik is the flap itself. Although Lasik flap related complications are relatively rare, they do occur. No Lasik flap means no possibility of a Lasik flap complication. No possibility is always better than a low probability.

Lasers and surgical techniques have improved over the past decade and the lasers are able to create very nuanced sculpting. Placing 100-160 microns of Lasik flap over a nuanced laser ablation loses some of the nuance. For these reasons, many doctors are returning to PRK as their primary choice for laser eye surgery.

Newer lasers and operative techniques have all but eliminated the chance of corneal haze with PRK.

In the long-term, the results from PRK will likely be equal to or slightly better than Lasik. In the short term you may experience discomfort and vision recovery will slower than Lasik. With PRK you can expect to have very poor vision for 1-3 days, “functional fuzzy” vision for about a week, and then vision quality will improve over the next few weeks and months.

Mandy asks…

why do some air forces allow lasik and PRK while others don't?

why do some countries air force allow pilots to have vision surgery like lasik and prk and others don't?

admin answers:

The biggest problem with this type of eye operation is the possible loss of night vision and peripheral vision. The newer versions seem to be better and cause a lower amount of night vision loss but even so this is a very important part of air force flying as is peripheral vision requirements.

Night vision is essential for landing and take offs for many missions due to time over target for demands. This means the pilot must have decent night vision in order to see other aircraft, possible targets, possible structures and other objects that could be hazardous to low level operations.

Peripheral vision is necessary in many situations as the pilot has to be able to see other aircraft and objects as he handles the aircraft. In formation flying peripheral vision is essential to not hit another aircraft.

Just as many years ago many airforces would not allow any pilots who wore corrective lenses as the possibility of them moving and or coming off and causing vision problems during combat flying and fast direction changes.

So any operation that affects the eyes is deemed a problem by all air forces. It takes for the operation to be perfected and actually not have any bad effects to be considered alright A pilots eyes are one of the major items requird for flying and doing visual ops. While some of these operations are minor and do help with vision, there are some that affect the vision and so while helping for part they also have side effects that are bad for pilots.

Thomas asks…

Why is LASIK surgery so popular if PRK surgery is so much better?

As I understand it, LASIK involves cutting a flap out of your corneal layer (which can fold out again - *scary*!). However, PRK doesn't involve any cutting, but "re-shapes" the eye with lasers.

So are there any advantages to LASIK over PRK which makes the former so much more well-known and popular? Why doesn't everyone get PRK instead of LASIK?

admin answers:

PRK is not "better" than LASIK. They are just different.

LASIK has a significantly faster healing time, which is why it is more popular. Most people can return to work/school seeing well & not in pain 2 days after LASIK. Not so with PRK, which takes weeks to heal & is more uncomfortable. As you pointed out, PRK has no "flap", but it is much more likely to have corneal "haze" that needs to be treated.

Each of them have their merits & disadvantages (there are more than i just listed). You should discuss your options with your doc. But its kind of silly IMO to announce that PRK is "better" than LASIK. I do not consider that to be true at all. Theyre different.

Both PRK & LASIK are significantly better than RK, which you likely not talk any US doc into performing on you in 2010

Sharon asks…

what is better LASIK OR PRK, anyone had them done before?

Im getting my eyes corrected withen the next mouth or two and Im sure my surgeon will recommed whats best for me but ive heard varrying points between each sugery and here they are
1. Lasik takes way less healing time
2.PRK takes more healing time but it is a more stronger/permminent procedure.
Are these points true?
Thanks for youre help.

admin answers:

I do not have any information about the PRK but I had the Lasik procedure done about 3 months ago and it was the best thing I have ever done. After doing my homework and speaking to my doctor, I had the surgery done. The following day I was able to see 25/20 and that month I was able to see 20/20. Last month (2 months after the procedure) I was told the flap was healed already. Since I am new to the Lasik, I am not sure of the long lasting results of it or how permanent it will be, but following the months after Lasik, I am so grateful I had it done. I have had no problems with my eyes since and I would highly recommend Lasik to anyone who is tired of wearing contacts or glasses if they are candidates for the procedure.

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